Intraoperative and postoperative outcomes of Harmonic Focus versus monopolar electrocautery after neoadjuvant chemotherapy in breast conservative surgery: a comparative study

Islam Khaled,Ihab Saad,Hany Soliman,Mohammed Faisal

doi:10.1186/s12957-021-02435-8

Islam Khaled, Ihab Saad + Show 2 more

Open Access

https://doi.org/10.1186/s12957-021-02435-8

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Abstract

BackgroundSurgical devices are commonly used during breast conservative surgery (BCS) to provide better hemostasis. The Harmonic scalpel has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of BCS after neoadjuvant chemotherapy (CTH) compared to the conventional method using monopolar diathermy.ResultsA prospective, nonrandomized, comparative study was conducted on patients scheduled to undergo BCS with axillary dissection after neoadjuvant CTH. Patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.32 ± 27.3 vs. 139.3 ± 31.9 min, respectively; p < 0.001). Besides, blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 vs. 187 ± 49.8 mL, respectively; p < 0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p < 0.001) and shorter time until drain removal (p < 0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). The incidence of postoperative complications was comparable between both groups (p = 0.128).ConclusionsThis study confirmed the superiority of Harmonic Focus compared to monopolar electrocautery among patients receiving neoadjuvant CTH before BCS.

Highlights

Breast conservative surgery (BCS) has emerged as a promising technique for patients wishing to preserve their breast, with comparable survival rates to conventional mastectomy [1]
Conventional electrocautery is a widely available, easy-to-use, and cheap method for blood vessel sealing during surgery; the tool is limited by the induction of postoperative inflammatory reactions and wide burn area, which can increase the risk of postoperative seroma; besides, excessive smoking from electrocautery may compromise the surgical field [7]
This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of breast conservative surgery (BCS) after neoadjuvant CTH compared to the conventional method using monopolar diathermy

Summary

Results

A total of 100 patients were divided into a 1:1 ratio to undergo Harmonic Focus or monopolar electrocautery. In terms of intraoperative characteristics, patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.3 ± 27.3 vs 139.3 ± 31.9 min, respectively; p < 0.001). Patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (86.8 ± 20.7 vs 147.5 ± 35.4 in monopolar electrocautery; p < 0.001) and shorter time until drain removal (2.6 ± 0.7 vs 4.1 ± 0.9 in monopolar electrocautery; p < 0.001). Patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). Duration of operation (min), mean ± SD Blood loss (mL), mean ± SD No total lymph nodes, mean ± SD No positive lymph nodes, mean ± SD pTNM, n (%) I I III

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