Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis

Abstract

BackgroundDespite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.MethodsA comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.ResultsA total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01), seroma development[OR: 0.49 (0.34, 0.70); P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85).ConclusionCompared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.

Superior Dissecting Capability of A New Ultrasonic Device Improves Efficiency and Reduces Adhesion Formation

“…Ultrasonic devices have long been valued for the little lateral thermal damage they produce and recognized for significant clinical benefits that potentially accrue from this de minimis tissue damage. For example, a recent metaanalysis on the use of Harmonic devices for dissection in mastectomy for breast cancer in comparison to electrosurgery showed Harmonic provided less postoperative drainage, seroma development, blood loss and wound complications [3]. Harmonic was regarded as superior to electrosurgery for axillary dissections, demonstrating shorter duration of drainage, lower rates of seroma formation and reduced numbness [4,5].…”

Era of Bloodless Surgery: Spotlights on Hemostasic Materials and Techniques

“…Compared to standard electrocautery devices, harmonic scalpel dissection presents significant advantages in decreasing intraoperative blood loss, postoperative drainage and wound complications in modified radical mastectomy without increasing operative time [62]. The meta-analysis comparing conventional surgery to Harmonic scalpel for gastrectomy and lymphadenectomy also demonstrates the advantages of Harmonic scalpel compared to conventional surgical techniques [63].…”

The utility of pectoral drain in patients undergoing modified radical mastectomy-an observational study

“…1 Therefore workers have suggested ways to decrease the duration of drainage by promoting early closure of open lymphatic channels by various means such as fibrin glue, ligation of lymphatic trunks, decreasing the suction pressure deployed and ultrasonic dissection. [2][3][4][5][6] The traditional convention employs two drain tubes, one put over the chest wall and the other in the axilla and both these drain tubes are connected to a single self-expanding plastic reservoir bottle. The self-expanding property of the compressed plastic bag provides the suction effect at the area being drained.…”