Scalpel Dissection Research Articles

Frequency of seroma formation after modified radical mastectomy. A comparison between electrocautery and scalpel dissection techniques.

Objective: To compare the use of electrocautery and scalpel dissection while performing modified radical mastectomy in terms of frequency of seroma formation. Study Design: Randomized Clinical Trial. Setting: Department of Surgery, Fauji Foundation Hospital, Rawalpindi. Period: 19-06-2019 to 22-06-2022. Material & Methods: A total of one hundred (n=100) female patients between age 22-60 years, who underwent modified radical mastectomy for breast carcinoma were enrolled in the study and randomized into two groups. Electrocautery dissection was performed in group A while patient in group B will undergo Scalpel dissection. Outcome was measured in terms of seroma formation at 7th day postoperatively. Results: Mean age of patients in our study was 42.39 years and standard deviation 8.26. At day 7 after the surgery, mean drain volume was 39.77 ml in our patients. Seroma formation was observed in a total of 14(28%) patients in group A (electrocautery) and 8(16%) patients in group B (Scalpel). Conclusion: Frequency of seroma formation was significantly lower with scalpel dissection as compared to those with electrocautery dissection after MRM.

Comparative study of complications using electrocautery versus conventional scissors for raising flap in modified radical mastectomy

Background: In the current scenario of rapid advancement in the field of surgery, the intraoperative and post-operative complications have reduced drastically by the use of effective surgical techniques in the modified radical mastectomy. Previously scissors were used for raising flap, today electrocautery is used by most of the surgeons for raising flap in modified radical mastectomy. Now electrocautery and conventional scissors are the two most widely used technique for raising flaps in modified radical mastectomy. Methods: The study was conducted on 60 patients admitted in surgical wards of Sri Guru Ram Das institute of medical sciences and research with carcinoma breast. The study will be conducted to identify the complications using electrocautery versus conventional scissors for raising flap in modified radical mastectomy. The study participants were divided into two groups. Results: Seroma and flap necrosis consequences were comparable in both research groups; however, electrocautery surgery took less time than scalpel dissection. Seroma development after four weeks of surgery and flap infection complications were comparable. Conclusions: Dissection in MRM by scissors took longer operative period and drain output was more and the patient had longer hospital stay.

Evaluation of the safety of using harmonic scalpel during laparoscopic cholecystectomy in children: A preliminary report.

Background and objectiveIn spite of being one of the most common surgical procedures performed in adults, laparoscopic cholecystectomy (LC) is relatively uncommon in the pediatric age group. Most surgeons prefer to dissect the cystic duct using a monopolar electrosurgical hook and occlude it with simple metal clips. Although the safety of using the ultrasonically-activated shears, e.g., harmonic scalpel for dissection of the gallbladder is confirmed in many studies, its efficacy in the closure of the cystic artery and duct in adults is still debatable. Furthermore, very few reports studied its safety in children during LC. The aim of our work is to study the safety and efficacy of ultrasonic shears in controlling the cystic duct and artery during LC in children.Materials and methodsA prospective study was conducted from May 2017 to April 2020, where all children having symptomatic gallbladder stone disease were included in the study. HS was used as a sole instrument in gallbladder dissection as well as in controlling cystic duct and artery. No metal clips or sutures were used throughout the procedure.ResultsA total of forty-two children having symptomatic gallstone disease were included in the study. The main indication for LC was hemolytic anemia. Their age ranged from 3 to 13 years with a mean of 8.4 ± 3.25 years. All operations were completed laparoscopically, i.e., no conversion to open surgery was needed. The mean operative time was 40 ± 10.42 min. There were no intraoperative complications apart from gall bladder perforation in two cases during dissection from the liver bed while the postoperative recovery was smooth in all patients. Patients started oral feeding after 11.30 ± 3.01 h. The mean time for discharge was 25.47 ± 7.49 h, ranging from 14 to 48 h. Postoperative ultrasound for all cases showed no evidence of minor or major bile leaks or CBD injuries.ConclusionThis is the first report to evaluate the use of HS as a sole instrument during LC in the pediatric age group. HS is a safe and efficient instrument that can be used alone in gallbladder dissection as well as in controlling cystic duct and artery during LC in children.

Iron Bioavailability of Maize Is Improved by Degermination for Some but Not All Genotypes: Enhancing Maize Nutrition With Biofortification and Processing

ObjectivesTo evaluate bioavailable Fe, total Fe concentration and phytate concentration of whole and degerminated maize in a diverse panel of 52 genotypes. This work sought to expand upon previous work which identified the germ fraction of the maize kernel as an inhibitory component for Fe bioavailability.MethodsSamples were degerminated manually by scalpel dissection of the germ fraction. Samples were then cooked, lyophilized, and milled to a flour. Iron bioavailability was evaluated with the Caco-2 Cell Bioassay. Iron concentration was measured by ICP-ES. Phytate concentration was determined via a colorimetric assay for total phytate phosphorous (Megazyme Phytate Kit, Megazyme International).ResultsIn 30 of the maize genotypes, bioavailable Fe increased when degerminated, thus indicating a higher fractional Fe uptake as the amount of Fe decreased by more than 70%. The remaining 22 genotypes showed no change or a decrease in Fe bioavailability with degermination. These results confirm previous research showing that the germ fraction is a strong inhibitory component for many maize varieties. Degermination greatly reduced phytate content and phytate:Fe molar ratio; Fe concentrations were positively correlated with phytate, and negatively correlated with phytate:Fe molar ratios for most maize groups. While the high phytate content of the germ fraction likely plays a role, only degerminated yellow maize indicated a significant correlation between Fe bioavailability and phytate concentration, and only pigmented maize indicated a correlation between Fe bioavailability and phytate:Fe molar ratio. Other factors in the maize germ and endosperm fractions are likely relevant to changes in Fe bioavailability.ConclusionsThis study suggests that Fe nutrition from maize can be enhanced by processing (degermination) and or by selecting varieties where the inhibitory effect of the germ fraction is relatively low.Funding SourcesFunded by the United States Department of Agriculture, Agricultural Research Service.

A study of the potential adverse effects of electrosurgical smoke on medical staff during malignant tumor surgery*

Abstract Objective The aim of this study was to investigate the potential adverse effects of electrosurgical smoke on medical staff performing malignant tumor surgery. Methods This study was divided into two parts: in vitro and in vivo experiments. The human thyroid cancer cell line, ARO, was cultured and passaged. The tumor cells were burned with an ultrasonic scalpel, and the surgical smoke was absorbed by a transwell membrane. The captured particles were diluted in 3 mL of culture medium, and cell survival was assessed under a microscope. DNA was extracted from the cells for genotyping. BALB/c mice were used to construct thyroid cancer xenograft models. The tumor tissues were dissected on day 14 using an ultrasonic scalpel. The smoke from the electrosurgical procedure was collected on a transwell membrane. The membrane was washed in 2 mL of rinsing solution, and the solution was then injected into the right armpit of 10 mice. After sacrifice, the tumor tissues were removed and stained with hematoxylin and eosin (HE). Results Viable ARO cells could be seen on the first day after culturing cell fragments from surgical smoke, and vigorous cell proliferation could be seen on the 17th day of incubation. The genotype of the cells cultured in the presence of smoke particles was identical to the genotype of the original cells. Tumor growth was observed in four out of 10 mice injected with the smoke particle rinse. HE staining showed a significantly increased number of nuclei in the tumor tissue, which was consistent with the general morphological characteristics of malignant tumors. Conclusion Viable tumor cells were detected in surgical smoke generated by ultrasonic scalpel dissection, and these cells had growth activity. Thus, it is necessary to protect patients and medical staff from electrosurgical smoke.

Dissection Methods in Abdominoplasty: A Systematic Review and Meta-Analysis

Abdominoplasty is one of the most common cosmetic procedures performed worldwide. Despite recent advances in surgical technique, the risk of complications remains high. The advantages of using various dissection devices as a method of flap elevation in abdominoplasty remains unclear. A systematic search was undertaken to identify studies comparing electrocautery dissection with scalpel dissection and plasma-kinetic energy-based dissection methods in abdominoplasty. A meta-analysis was performed using the selected studies. Seven studies were analyzed. These studies included a total of 1143 patients who underwent abdominoplasty using electrocautery (n = 617), steel scalpel (n = 457), or plasma dissection (n = 69). A meta-analysis was conducted, which showed an overall reduction in incidences of seroma, operative time, and length of hospital stay in the scalpel dissection group compared with the electrocautery group. The plasma dissection group showed a reduction in rate of postoperative wound infection and hematoma, as well as a reduction in drain output and length of hospital stay, compared with the electrocautery group. There are few studies comparing outcomes using different dissection techniques in abdominoplasty. These studies are small and heterogeneous in design. However, using plasma-kinetic energy-based devices or scalpel dissection appears to be associated with reduced complication rates, shorter operative time, lower drain volumes, and a reduction in the length of hospital stay.

Outcomes of Harmonic Scalpel and Electrocautery in Patients Who Underwent Modified Radical Mastectomy.

ObjectiveThis study aimed to compare the mean operative time, total analgesic required, and the mean number of drainage days in harmonic scalpel versus electrocautery in breast cancer patients undergoing modified radical mastectomy (MRM).MethodologyThis retrospective cross-sectional study was conducted in the Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC). The duration of the study was six months, from January 2018 until July 2018. A total of 194 females with biopsy-proven breast cancer undergoing MRM were included in the study. They were divided into two groups. In group ‘A', a harmonic scalpel was used, and in group 'B', electrocautery was used for hemostasis.ResultsThe mean age of the participants was 48.68 ±10.04 years. The mean operative time was 102.13 ±2.04 minutes. The mean number of days of drainage was 1.27 ±2.63. The mean analgesia amount was 30.72 ±3.25 mg. In the harmonic scalpel group, the mean operative time was 100.43 ±0.89 minutes, whereas, in the electrocautery group, it was 103.86 ±1.12 minutes with a significant difference (p=0.001). In the harmonic scalpel group, the mean number of drainage days was 8.90 ±0.42, whereas, in the electrocautery group, it was 13.58 ±1.26 with a statistically significant difference (p=0.001). In the harmonic scalpel group, the mean analgesia amount was 1,800.5 ±353.55 mg, whereas, in the electrocautery group, it was noted to be 2,006.25 ±289.43 with a statistically significant difference (p=0.001).ConclusionThis study concludes that compared with standard electrocautery, harmonic scalpel dissection is associated with significant benefits in decreasing postoperative drainage and blood loss during operations after MRM for breast cancer.

A NOVEL TECHNIQUE OF HARMONIC TISSUE DISSECTION REDUCES POSTOPERATIVE HEMATOMA, FLAP NECROSIS, WOUND SEPSIS AFTER MODIFIED RADICAL MASTECTOMY COMPARED TO CONVENTIONAL ELECTROCAUTERY

Background: Breast cancer is a serious public health problem with high incidence and prevalence coefficients. This study was undertaken with the intention to evaluate the benefits of harmonic scalpel dissection over electrocautery in MRM.
 Methods: This comparative study was conducted in Department of Surgery, IGMC Shimla over a period of one year from 1 July 2015 to 30 June 2016. Histologically proven cases of carcinoma breast presenting in the surgery OPD or admitted in the surgery wards were included in the present study.
 Results: Postoperative hematoma occured in 1 patient of Electrocautery Group, which was drained. There were no cases of postoperative hematoma in Harmonic Group. This difference was not found to be statistically significant with P value=.313. Postoperative flap necrosis occurs in 1 (3%) patient of harmonic MRM Group and 4(11.8%) patients of electrocautery MRM Group. This difference was not found to be statistically significant with P value 0 .1633. Postoperative wound sepsis occurs in 2 (5%) patient of Harmonic MRM Group and 5(14%) patients of Electrocautery MRM Group. This difference was not found to be statistically significant with P value 0.2312.
 Conclusion- Harmonic scalpel signi?cantly reduces postoperative overall complications (?ap necrosis, and SSI) in the patient undergoing MRM
 Keywords: Flap necrosis, SSI, MRM

<p>Primary Dermis Fat Grafting for Socket Reconstruction: Retrospective Comparison of Electrocoagulation versus Scalpel Dissection for Epidermis Removal</p>

PurposeTo evaluate outcomes of the use of electrocoagulation for epidermis removal in dermis fat grafting (DFG) compared to the conventional scalpel dissection in patients who underwent primary anophthalmic socket reconstruction.DesignRetrospective, observational, and comparative study.MethodsA retrospective review was performed on patients who underwent primary DFG for socket reconstruction between 2017 and 2019 at tertiary teaching hospitals. Patients with previous orbital surgery, previous radiotherapy to the periocular region, any medical condition that affects healing, cicatrizing ocular surface disease or heavy smokers were excluded. Patients with complete documentation of preoperative and postoperative data only were included. Patients were divided into two groups; group A: epidermis removal by the traditional scalpel dissection and group B: epidermis removal using low power setting electrocoagulation. The main outcome was the timing of complete epithelialization of the dermis layer. Other outcomes included implant motility, prosthesis fitting, patient’s satisfaction, and any complications.ResultsA total of 27 patients met the study criteria, and the mean follow-up period was 24.81 months. There were no differences between both groups regarding preoperative characteristics. The mean duration of complete epithelialization of the DFG implant was 9.15 ± 2.94 weeks in group A compared to 22.29 ± 4.43 weeks in group B (p value <0.001). Dermal ulceration was noticed in 9 patients (64.3%) in group B compared to none in group A (p value =0.001). Dermal ulceration was significantly associated with long conjunctival healing period (p value <0.001). Volume loss was more common in group B while graft hirsutism and granuloma were more evident in group A. Final prosthesis fitting was possible in all included patients.ConclusionEpidermis removal using the electrocoagulation is related to much more delayed epithelialization of the dermis with a higher rate of dermal ulceration compared to the scalpel dissection technique. However, there was no significant difference between both groups regarding the final prosthesis fitting or the overall patient satisfaction.

Cold Knife Dissection and Bipolar Diathermy Vs Harmonic Scalpel in Parotid Gland Surgery for Benign Tumours

IntroductionSurgical techniques for extirpation of tumours of the parotid gland have evolved significantly in recent years. Previous data suggest the use of harmonic scalpel reduced operative time, intraoperative blood loss, postoperative drain production, and incidence of facial nerve injury, in comparison to cold scalpel dissection. Material and methodsRetrospective analysis of 2 group of patients operated using harmonic scalpel versus cold knife dissection and bipolar diathermy and compare operative time and post-surgical complication rate, facial nerve injury, sialocele or salivary fistula formation, after parotidectomy for benign parotid tumours. Results108 patients were included. Regarding surgical time, the mean time to using harmonic scalpel was 114±39 (min.: 60/max.: 240), and the mean time using bipolar diathermy was 135±38 (min.: 90/max.: 285) and this was the only significant difference between the 2 techniques (P=.049). ConclusionsHarmonic scalpel is a safe and effective tool to perform parotid surgery in benign tumours. However, a shorter surgical time was the only advantage found over the traditional cold dissection and bipolar dissection method.

Disección fría y coagulación bipolar versus disección con bisturí armónico en la cirugía de los tumores benignos de la glándula parótida

IntroductionSurgical techniques for extirpation of tumours of the parotid gland have evolved significantly in recent years. Previous data suggest the use of Harmonic Scalpel reduced operative time, intraoperative blood loss, postoperative drain production, and incidence of facial nerve injury, in comparison to cold scalpel dissection Material and methodsretrospective analysis of 2group of patients operated using harmonic scalpel versus cold knife dissection and bipolar diathermy and compare operative time and post-surgical complication rate:, facial nerve injury, sialocele or salivary fístula formation, after parotidectomy for benign parotid tumours. Results108 patients were included. Regarding surgical time, the mean time to using Harmonic Scalpel was 114±39 (Min: 60/Max: 240), and the mean time using bipolar diathermy was 135±38 (Min: 90/Max: 285) and this was the only significant difference between the 2techniques (p=.049). ConclusionsHarmonic scalpel is a safe and effective tool to perform parotid surgery in benign tumours. However, a shorter surgical time was the only advantage found over the traditional cold dissection and bipolar dissection method.

Teaching Palmar Anatomy: A Comparative Case Study of Conventional Scalpel Dissection With an Innovative Hydro‐dissection Method

We present a comparative case study of two dissection methods for teaching palmar anatomy: 1) an innovative hydro‐dissection method using water and brushes, and 2) conventional scalpel dissection. The objective was to compare the visibility of palmar structures for students using the two methods. Conventional dissection methods used to study the palmar aspect of the hand are difficult for students, due to the thickness of the skin firmly bound to the palmar aponeurosis and the drying of tissue layers in the course of dissection. This difficulty complicates students' observation of key structures in the hand, such as nerve innervations and deep fascia. A method of hydro‐dissection we have developed based on descriptions found in an ancient Indian surgical Āyurvedic treatise, the Susruta Saṃhitā, is tested here as an alternative method. The hand dissected using the hydro‐dissection method was soaked for seven days in a six‐liter tank filled with distilled water moving at a constant velocity. Subsequently, the students used special blunt metal brushes designed for this technique, for peeling and scraping the tissue while the hand was submerged. The second hand was dissected using conventional scalpel cutting dissection methods. These two processes are presented with documentation and photographs showing the structures visible over time during the course of both dissection processes. The results were that superficial fascia, the venous network, the lymphatic vessel distribution, the superficial branching of the radial nerve and ulnar nerve were more clearly visible in the hand that had undergone hydro‐dissection. The fascial compartments, short muscles of thumb and little finger, deep and superficial branches of ulnar nerve, deep and superficial palmar arch, and retinaculum were identified by the students more easily in the course of hydro‐dissection, due to the ease of tracing in comparison with the conventional method. The fibrous sheath expansions of both the flexor and extensor expansions could be identified using this method without a high‐level of skill and experience in dissection. Students were also able to make clearer identification of ligaments because they are not cut in the process. Movements of the digits was easier because the tissues were well‐moistened throughout the study. Articular study of the palm with the major and minor joints was also simplified since hydration in hydro‐dissection preserved the capsules and tiny ligaments from the usual damages occurring during blade dissection. In conclusion, hydro‐dissection is an effective blunt dissection method for students studying palmar anatomy and, we suggest, also for plantar anatomy. This method is particularly effective for entry‐level students without a high level of skill in dissection. We are currently working to develop a hydro‐dissection machine to standardize water quality, temperature, pressure, and flow, so that we can test this method on other structures and eventually develop an atlas and manual of hydro‐dissection. This study demonstrates the efficacy of hydro‐dissection for teaching structures in the palmar aspect of the hand.Support or Funding InformationGovernment Ayurveda Medical College ThiruvananthapuramThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy

Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.

Does Type of Dissection for Skin And Subcutaneous Tissue Affect Wound Outcome???

Introduction: Choice of dissection scalpel versus electrosurgery for skin and subcutaneous tissue has been always a topic of debate. We in this study have aimed to compare the wound outcomes following both. Aims :Compare the wound outcome following scalpel versus electrosurgery incision for skin and subcutaneous tissues in all major abdominal surgeries, hernia repairs and thyroid surgeries. Methods and Materials: Prospective comparative study conducted in a tertiary teaching hospital from October 2013 to October 2015. Patients undergoing scalpel and electrosurgical dissection were compared in postoperative period for wound outcomes and data recorded. Statistical analysis was conducted using Chi Square Test and p-value calculated. Results: Sample size of 110 patients were studied in each group and followed up for wound outcome on Day 3,5 and 10 for erythema formation, serous discharge, purulent exudate and separation of deeper tissues. There was significant occurrence of erythema formation and serous discharge among the study groups but there was no statistically difference between the two groups. There was no significant occurrence of purulent exudate and separation of deeper tissues among the study groups. Conclusions: Results of the study showed there is no significant difference in postoperative wound infection rate or scar cosmesis in scalpel and electrosurgery group. Hence it is the surgeon choice to choose scalpel or electrosurgical dissection for skin and subcutaneous tissue.

Is it really useful the Harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series.

The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain. Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb. The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery.

PTU-002 The use of plasmajet as a novel technique for tissue dissection in complex abdominal surgery: Abstract PTU-002 Table 1

<h3>Introduction</h3> The PlasmaJet system is a unique novel technology that utilises argon gas that is electrically excited into a plasma state. This argon plasma energy is highly focused in a beam that disperses rapidly with distance therefore causing minimal deep thermal tissue injury, unlike all other electrical devices such as diathermy, argon plasma coagulator or harmonic scalpel. <h3>Method</h3> The plasma stream that leaves the tip of the device releases kinetic, light and thermal energy that changes with distance and angulation to the tissue. These last two variables influence the dissection properties of the PlasmaJet. The closer the tip of device is to the tissue and the more acute the angulation, the greater is the kinetic and thermal energy stream, which produces to greater tissue separation and dissection. <h3>Results</h3> Plasmajet subjectively allows for easier and more efficient division of routine but also fibrotic “hostile” adhesions which would otherwise have been extremely difficult even with scalpel dissection. PlasmaJet appears to cause less bleeding compared to conventional dissection techniques, but needs formal evaluation. Plasmajet can be used across the spectrum of coloproctology (see Table 1). Inadvertent tissue injury can occur, and was noted in 1/97 major complex colorectal procedures. The complication was an enterotomy identified intra-operatively and repaired with no post-operative sequelae. No post-operative mortality was seen. A small number of collections (≥3 cm fluid diameter) were noted but were not significantly higher than unit data. <h3>Conclusion</h3> PlasmaJet represents a new surgical modality for efficient precise tissue dissection. It should be considered for any re-operative abdominal case where dense adhesions maybe encountered. It has minimal thermal penetration and is therefore very safe. It provides the surgeon with another valuable tool to aid difficult dissection of tenacious adhesions under very challenging conditions thereby improving patient outcomes. <h3>Disclosure of interest</h3> None Declared.

English

Post-operative breast surgery for malignancy has a common side effect of seromas, whose formation and drainage requires a special attention to prevent as much as possible and as early as possible to avoid morbidity. How best we can prevent the dead space is the problem. In this study a review of various methods adopted all over the world is reviewed including early discharge of the patient with drain. It is always preferable to remove the drain when the collection of serum is less than 25ml in 24 hours the chance of re accumulation of fluid is less likely. INTRODUCTION: Carcinoma breast has remained the second leading cause of cancer death among women worldwide over the past three decades[1] and contributes significantly to cancer surgical load. Surgical treatment for breast cancer includes breast conservation therapy and mastectomy with or without axillary dissection depending on disease stage. Seroma formation is the most frequent postoperative Side effect seen after mastectomy and axillary surgery with an incidence of 3% to 85%. OBSERVATIONS: TYPE OF SURGERY: Surgical treatment for breast cancer has undergone a paradigm shift from Halstead's radical mastectomy to breast conservation. It has been demonstrated that radical mastectomy increases seroma formation compared with that of simple mastectomy, but the association is inconclusive when radical mastectomy is compared with modified radical mastectomy (MRM). SURGICAL DEVICES: Various electro-mechanical devices are used during surgery to reduce blood loss and operating time. These include electrocautery, laser scalpel, argon diathermy, ultrasonic scalpel, ultrasonic scissors, and vessel sealing systems. All of these devices have been investigated in an effort to reduce seroma formation. Randomized trials have shown that the use of electrocautery for dissecting flaps is significantly associated with increased seroma formation when compared to that of scalpel dissection. However, no individual study has shown a significant effect on seroma formation with or without the use of a laser scalpel, argon diathermy, or an ultrasonic scalpel. Ultrasonic scissors resulted in reduced seroma formation in a randomized controlled trial comparing level I and II axillary dissection using either ultrasound scissors or surgical scissors with ligation. MANAGEMENT OF DEAD SPACE: MECHANICAL DEVICES: Different techniques have been employed to obliterate the dead space (under flaps and the axilla) to reduce seroma formation. CHEMICAL: Fibrin glue.light activated fibrin sealant, and transdermal photo-polymerized adhesive reduce seroma formation after mastectomy in animal models. Use of a fibrinolysis inhibitor was based on the hypothesis that fibrinolytic activity in serum and lymph might contribute to fluid accumulation. SHOULDER MOVEMENT: Shoulder dysfunction is a common complication of mastectomy,and it is necessary to mobilize the shoulder early to prevent this complication. It was thought that early shoulder mobilization led to increased seroma formation and this hypothesis was supported by a systematic review of 12 randomized controlled trials (RCTs) of which six were included in a metaanalysis. CONCLUSIONS: Seroma formation is a side effect of M.R.M rather than a complication Physical closure of the dead space appears to reduce seroma rate, but studies have failed to address the issues of cosmesis, and shoulder movement restrictions and these add to the operating time. and mechanical pressure do not reduce seroma drainage. Drains should be used, but the number of drain DOI: 10.14260/jemds/2015/237

Education Embraced: Substantiating the Educational Foundations of Landmark Education’s Transformative Learning Model

In 2011, Renee Lockwood offered a “dissection of the religio-spiritual dimensions of Landmark Education.” Dissecting her argument suggested a narrow categorization of basic human experiences as religio-spiritual; literature cited was from religious studies absent teaching and learning research. Key distinctions of NRMs (New Religious Movements) and the brief mention of shifting boundaries of secular and sacred generally speaking in western culture were overlooked. Most critiques were of the est training (est) – last offered in 1984, while The Landmark Forum (the Forum) was first offered in 1991. This critique employed instead research of both classic and contemporary scholars who study teaching and learning. Lockwood’s dissection scalpel was ultimately a means to verify the educational substance of Landmark Education’s (Landmark) self-described “breakthrough technology” (2015). Rather, Landmark’s holistic, transformational approach to education is not only appropriate for a culture shaped by the aforementioned shifting boundaries, but also valuable for those concerned about 21st century problems facing humanity.

Video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel.

Segmental resection is a useful procedure to preserve respiratory function. A 56-year-old woman presented with a finding of a left upper lobe lesion on CT scanning. She was performed video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel. Video-assisted thoracoscopy surgery (VATS) segmentectomy is associated with safe and feasible procedure. With the Harmonic scalpel dissection, blood loss is minimal and this speeds patient recovery.

Dissection Technique for Abdominoplasty

INTRODUCTION: Due to its popularity and high complication rate, abdominoplasty techniques have undergone a continuous process of evolution to provide better and safer results.1-2 The technique used to raise the abdominal flap has been implicated, but there are few studies, none is prospective and the results are contradictory.3-4 The aim of this study was to evaluate its effect on outcomes and complications after a full abdominoplasty, comparing two different techniques, the scalpel and the diathermocoagulation device (coagulation mode). METHODS: Prospective study that included women submitted to abdominoplasty with umbilical transposition, between January 2009 and December 2011, at a single centre. Two groups identified: group A, abdominoplasty performed with steel scalpel; and group B, abdominoplasty performed with diathermocoagulation. Several variables were determined including general characteristics, time until drain removal, daily and total volume of drain output, operative time, local and systemic complications; statistical analysis using SPSS v21.0; uni and multivariate analysis performed. RESULTS: A total of 119 full abdominoplasties were performed (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for BMI, comorbidities and weight of surgical specimen; no differences for operative time, systemic complications, hematoma and necrosis incidence. The scalpel group had a significant reduction of 54,56 percent on total drain output, 2,65 days on time to drain removal; no cases of seroma or healing problems. There was a statistical difference on daily drain output (day 2, 3), with lower levels on scalpel group (Figure 1).Figure 1: Average daily drain output from group A (scalpel dissection, n=39) and group B (diathermocoagulation on coagulation mode, n=80). *Drain outputs were significantly lower in group A on postoperative day 2 and 3 (p<0.05, t test).CONCLUSIONS: Performing abdominal dissection with scalpel showed benefits on patient recovery, reducing time requested for drain removal, drain output, seroma and healing problems incidence.