Comparative Study between the Effect of the Ultrasound Dissector (the Harmonic) versus Monopolar and Bipolar Electrocautry in Reducing Seroma Formation Post-Conservative Breast Surgery

Abstract

Abstract Background Breast cancer, according to national cancer institute, is the commonest cancer in women in Egypt, It represents 37% of all female cancers among Egyptian females cancers, seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery (monoplar and bipolar) in reducing seroma formation post conservative breast surgery. Patients and Methods This prospective randomized study was conducted on female patients with breast tumours at the General Surgery Department at Ain Shams University Hospitals starting from November 2020 to May 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained. Results Our study included 60 patients, in whom a conservative breast surgery and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 20) or monopolar electrocautery (n = 20) or bipolar electrocautery (n = 20). Our mean age was 45.47±9.14 years (19-60 years). 10/60 patients (16.6%) had positive family history of mammary cancer, 18/60 patients were diabetic (30%), 23/60 patients were hypertensive (38%), 10/60 patients received neoadjuvant chemotherapy (10%). The mean lesional size was 2.9 ±1.03 cm (1.5-6.2 cm).the mean safety margin was 2.23±0.37 (1.5-3 cm). Operation timing was longer in bipolar electrocautry being (91.90 ± 3.14 minute) than monopolar elctrocautery being (83.35± 3.41 minute), while in harmonic group operation timing being (51.65 ± 5.02 minute).in addition intraoprative blood loss was significant large amount in monopolar electrocautery 75.15 ± 3.12 ml, while in harmonic dissection compared with bipolar electrocautery mean intraoprative blood loss was no significant (52.00 ± 4.18 ml vs 55.80 ± 9.89 ml pvalue =0.055). moreover there was asignificant reduction in the mean time of drain removal (2.90 ± 0.64 day in harmonic dissector), while in bipolar electrocautery 4.95 ± 0.69 day and longest mean time in drain removed in monopolar electrocautery 6.85 ± 0.37 day). And the incidence of seroma formation after drain removal is significant in monopola relectrocautery 58.3%. p-value =0.040, while in harmonic dissection compared bipolar electrocautery incidence of seroma formation after drain removal (16.7% vs 25.0%), this mean that harmonic dissector is low incidence of seroma formation. Conclusion Harmonic dissection technique leads to significant decreases in intraoperative blood loss, operative time, mean time of drain removal and postoperative seroma in terms of shorter drain duration and better quality of life. Here, we recommend the use of the harmonic dissection technique in conservative breast surgery.