A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast

Ananya Deori,C K Durga,Raghav Yelamanchi,Himanshu Agrawal,Arun Kumar Gupta,Nikhil Gupta

doi:10.21315/mjms2021.28.1.12

Ananya Deori, C K Durga + Show 4 more

Open Access

https://doi.org/10.21315/mjms2021.28.1.12

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Abstract

BackgroundAxillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM.MethodsA parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared.ResultsGroup A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups.ConclusionUltrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.

Highlights

Breast cancer is the most common malignancy among women in India and across the globe [1]
Surgery remains the main stay of treatment for non-metastatic breast cancer and has evolved from Halsted radical mastectomy to modified radical mastectomy (MRM) and further to breast conservative surgery [3]
Studies comparing the inflammatory markers profile obtained from the drain fluid of MRM patients revealed that MRM performed using electrocautery has the highest inflammatory mediators when compared to cold knife and ultrasonic dissector [12]

Summary

Introduction

Breast cancer is the most common malignancy among women in India and across the globe [1]. Axillary dissection is one of the important components of breast cancer surgery and can be performed by a variety of techniques using scalpel, scissors, electrocautery or ultrasonic dissector. Seroma formation is a common complication following MRM and a variety of hypotheses have been proposed for its etiology. These include the presence of dead space postresection, surgical disruption of lymphatic pathways, thermal damage to the lymphatics and inflammatory exudates [4–6]. Axillary dissection is one of the important components of modified radical mastectomy (MRM).

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Discussion

Conclusion