A Randomised Controlled Trial Comparing Ultrasonic Dissection with Electrocautery for Axillary Dissection in Breast Cancer

Abstract

Background: Morbidity of axillary dissection includes prolonged lymphatic drainage, surgical site infections, haematoma, flap necrosis and seroma. These complications are likely to delay wound healing and thereby delay administration of adjuvant treatments. Ultrasonic dissection device, the Harmonic Scalpel@, is a recent addition into the breast. Ultrasonic dissection reduces blood loss and reduces post-operative drain and seroma formation, without the use of surgical clips and ties. We hypothesised that axillary lymph node dissection (ALND) performed with ultrasonic dissection will decrease post-operative drain volume and number of days the patient is put on drain. Here, we present our randomised controlled trial study to compare the outcomes of ALND using ultrasonic dissection (harmonic scalpel) with standard electrocautery. Methods: A total of 113 patients were randomised to two arms - the control arm underwent ALND by standard electrocautery dissection and the experimental arm underwent axillary dissection with ultrasonic scalpel. The primary objectives were (1) to measure the total post-operative drainage volume and (2) the total number of days with drain. Results: The total drainage was significantly less in the intervention arm with a P = 0.015. However, the total number of days on drain was not significantly different in both the arms. The drainage on the 1st post-operative day, which indirectly measures haemostatic capacity, was also not different between the two groups. Conclusion: Although ultrasonic dissection of the axilla significantly reduces the total drain output, the total days the patients spent with drain in situ was not significantly different. The operating time was significantly increased with ultrasonic dissection. Hence, with this study, the routine use of ultrasonic dissection could not be recommended.