Coût efficacité du Ligasure Precise® versus clips chirurgicaux lors du curage axillaire pour cancer du sein

Keith, Magri; Bertrand, V.; Sautière, J.-L.; Pivot, Xavier; Riethmuller, Didier; Maillet, R.; Marinkovic, Z

doi:10.1016/s0368-2315(06)76406-7

Cited by 18 publications

(3 citation statements)

References 13 publications

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“…This study concluded that the duration of drainage was significantly shorter with LigaSure ™ but its benefits in term of fluid loss remains to be shown. Furthermore, its employment did not reduce the cost of hospitalization [33]. …”

Section: Discussionmentioning

confidence: 99%

Does LigaSure(TM) Reduce Fluid Drainage in Axillary Dissection? A Randomised Prospective Clinical Trial

Antonio

Pietra

Domenico

et al. 2007

ecms

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Background:Axillary lymph node dissection (ALND) is an integral part of breast cancer treatment. It is required in about 40–50% of patients. The placement of a drain in the axilla after an operation is current surgical practice. Short surgical stay programmes increase operating efficiency and reduce medical care costs, without compromising quality of care. LigaSure™ is a new haemostatic device that uses bipolar energy to seal vessels. The aim of this study is to determine whether axillary dissection with LigaSure™ reduces the time of wound drainage, the duration of surgical intervention and the volume of drainage after treatment.Patients and methods:This study is a prospective randomized controlled trial. A total of 100 women with breast cancer who needed axillary dissection were randomized into the LigaSure™ or conventional axillary dissection group. Levels I to III lymph node dissection was performed. A closed suction drain was always placed in the axilla and removed after 6–8 days or when fluid amount was <60 cc in the previous 24 hours.Results:There were no significant differences between the two groups when considering the duration of surgical procedure: average duration was 70.7 ± 24.66 minutes for LigaSure™ patients, while in the conventional dissection group the mean was 70.6 ± 22.47 minutes (p=0.98). Total amount of drained fluid was 624.49 cc in the LigaSure™ axillary dissection group and 792.96 in the conventional ALND group; this difference did not achieve statistical significance (p=0.09); the duration of draining was also similar, with no statistical difference (p=0.15).Conclusions:The present study did not show clear advantages in LigaSure™ use for ALND, although it represents a good haemostatic device, especially in abdominal surgery.

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Section: Discussionmentioning

confidence: 99%

Does LigaSure(TM) Reduce Fluid Drainage in Axillary Dissection? A Randomised Prospective Clinical Trial

Antonio

Pietra

Domenico

et al. 2007

ecms

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“…Another retrospective study concluded that the drainage duration is significantly shorter with the use of a vessel sealing system but not the cost of treatment. The benefit in terms of fluid loss also remains to be demonstrated [28]. The differences in outcomes probably reflect differences in study methods; thus, further randomized trials with larger sample sizes are required.…”

Section: Factors Related To Surgerymentioning

confidence: 99%

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

2012

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Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Seroma has been defined as serous fluid collection under the skin flaps or in the axillary dead space following mastectomy and/or axillary dissection. Because the true etiology of a seroma is unknown, a multifactorial-causation hypothesis has been accepted. Surgical factors include technique, extent of dissection and the surgical devices used for dissection. Obliteration of dead space with various flap fixation techniques, use of sclerosants, fibrin glue and sealants, octreotide, and pressure garments have been attempted with conflicting results and none have been consistent. Early movement of the shoulder during the postoperative period may increase the formation of seroma, although delayed physiotherapy decreases the formation of seroma. A detailed analysis of the use of drains showed that use of single or multiple drains, early or late removal, and drains with or without suction are not significantly different for the incidence of seroma. Although there is evidence for reduced seroma formation after early drain removal, very early removal within 24 hours seems to increase formation of seroma. No patient or tumor factors seem to affect seroma formation except body mass index and body weight. Consensus is lacking among studies/trials with different groups producing conflicting evidence. Besides a few established factors such as body mass index, the use of electrocautery for dissection, early drain removal, low vacuum drains, obliteration of dead space, and delayed shoulder physiotherapy, most of the hypothesized causes have not been demonstrated consistently. Thus, seroma remains a threat to both the patient and surgeon. Recurrent transcutaneous aspiration remains the only successful management.

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“…10 Concerning the surgical technique, a transverse rather than a longitudinal approach to the femoral arteries reduces the risk of infections and lymphatic complications. 11 New technology such as electrofusion was tested, in particular in senology, where electrofusion showed its superiority in terms of reduction in the durations of drainage, 12,13 hospitalization, 13 and seromas 14 in axillary lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study

Gouaillier-Vulcain

Marchand

Martinez

et al. 2015

Annals of Vascular Surgery

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Coût efficacité du Ligasure Precise® versus clips chirurgicaux lors du curage axillaire pour cancer du sein

Cited by 18 publications

References 13 publications

Does LigaSure(TM) Reduce Fluid Drainage in Axillary Dissection? A Randomised Prospective Clinical Trial

Does LigaSure(TM) Reduce Fluid Drainage in Axillary Dissection? A Randomised Prospective Clinical Trial

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study

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