European Surgery

, Volume 45, Issue 6, pp 286–290 | Cite as

The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy

  • B. Anlar
  • N. Karaman
  • L. Dogan
  • C. Ozaslan
  • C. Atalay
  • M. Altinok
original article

Summary

Background

Mastectomy when performed with scalpel and electrocautery is associated with some blood loss and morbidity in the form of prolonged drainage, seroma, wound infection, flap necrosis, and hematoma.

Methods

A total of 120 patients operated with mastectomy enrolled for the study. The groups were defined by the instruments used for flap preparation: 41 patients operated with electrocautery, 40 patients operated with scalpel, and 39 patients operated with harmonic scalpel formed three groups. The need for closed suction drains, the amount and duration of seroma, surgical site infection, hematoma, and flap ischemia and necrosis were evaluated.

Results

The amounts of intraoperative blood loss in electrocautery and harmonic scalpel groups were 560 and 500 mL, respectively, and it was increased to 750 mL in scalpel group (p = 0.001). Total drainage amounts of scalpel and harmonic scalpel groups were 894 and 908 mL, respectively, and it was increased to 1,113 mL in electrocautery group (= 0.0033). Seroma incidence rates in scalpel, electrocautery, and harmonic scalpel groups were 45, 65 and 28 %, respectively (p = 0.003). The differences between groups in relation to the duration of surgery, breast volume and weight, the areas of flap dissection, the duration of closed suction drainage, and the amount of early drainage were not statistically significant. There was also no difference between groups with regard to hematoma, flap necrosis, and ecchymosis and infection rates.

Conclusions

Although the use of harmonic scalpel reduces the risk of seroma formation and intraoperative blood loss, further studies are needed to verify the real impact of such technique.

Keywords

Breast cancer Mastectomy Harmonic scalpel Electrocautery Complications 

Notes

Conflict of interest

We indicate that we do not have any financial interest.

References

  1. 1.
    Osteen RT, Cady B, Chmiel JS, et al. National survey of carcinoma of the breast by the Commission of Cancer. J Am Coll Surg. 1991;178:213–9.Google Scholar
  2. 2.
    Kurtz SB, Frost DB. A comparison of two surgical techniques for performing mastectomy. Eur J Surg Oncol. 1995;21:143–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Tejler G, Aspegren K. Complications and hospital stay after surgery for breast cancer: a prospective study of 385 patients. Br J Surg. 1985;72:542–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Porter KA, Connor SO, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176:8–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Hoefer RA Jr, Dubois JJ, Ostrow LB, Silver LF. Wound complications following modified radical mastectomy: an analysis of perioperative factors. JAOA. 1990;90:47–53.PubMedGoogle Scholar
  6. 6.
    Watt-Boolsen S, Nielsen VB, Jensen J, Bak S. Postmastectomy seroma. Dan Med Bull. 1989;360:487–9.Google Scholar
  7. 7.
    Woodworth PA, Mcboyle MF, Helmer SD, Beamer RL. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg. 2000;66:444–51.PubMedGoogle Scholar
  8. 8.
    Hoenig DM, Chrostek CA, Amaral JF. Laparoscopic coagulation shears: alternative method of haemostatic control of unsupported tissue. J Endo Urol. 1996;10:431–3.Google Scholar
  9. 9.
    Gravenstein JS, Paulus DA. “Clinical monitoring practice,” 2nd ed. Lippincott; 1987. pp. 340–4.Google Scholar
  10. 10.
    Deo SV, Shukla NK. Modified radical mastectomy using harmonic scalpel. J Surg Oncol. 2000;74(3):204–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Deo SV, Shukla NK, Asthana S, Niranjan B, Srinivas G. A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery. Singapore Med J. 2002 May;43(5):226–8.PubMedGoogle Scholar
  12. 12.
    Galatius H, Okholm M, Hoffmann J. Mastectomy using ultrasonic dissection: effect on seroma formation. Breast. 2003;12(5):338–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Adwani A, Ebbs SR. Ultracision reduces acute blood loss but not seroma formation after mastectomy and axillary dissection: a pilot study. Int J Clin Pract. 2006;60(5):562–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Kontos M, Kothari A, Hamed H. Effect of harmonic scalpel on seroma formation following surgery for breast cancer: a prospective randomized study. J BUON. 2008;13(2):223–30.PubMedGoogle Scholar
  15. 15.
    Iovino F, Auriemma PP, Ferraraccio F, Antoniol G, Barbarisi A. Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial. Am J Surg. 2012;203(6):708–14.PubMedCrossRefGoogle Scholar
  16. 16.
    Manouras A, Markogiannakis H, Genetzakis M, Filippakis GM, Lagoudianakis EE, Kafiri G, Filis K, Zografos GC. Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system. Arch Surg. 2008;143(6):575–80 (discussion 581).PubMedCrossRefGoogle Scholar
  17. 17.
    He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, Lv Z, Chai J, Cao L. Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer: a randomized clinical study. Clin Breast Cancer. 2012;12:454–8 (pii: S1526-8209(12)00179-6).PubMedCrossRefGoogle Scholar
  18. 18.
    Hung SH, Chu D, Chen FM, Chen T, Chen RC. Evaluation of the harmonic scalpel in breast conserving and axillary staging surgery. J Chin Med Assoc. 2012;75(10):519–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Böhm D, Kubitza A, Lebrecht A, Schmidt M, Gerhold-Ay A, Battista M, Stewen K, Solbach C, Kölbl H. Prospective randomized comparison of conventional instruments and the harmonic focus(®) device in breast-conserving therapy for primary breast cancer. Eur J Surg Oncol. 2012;38(2):118–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Burdette TE, Kerrigan CL, Homa K. Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial. Plast Reconstr Surg. 2011;128(4):243e–9e.PubMedCrossRefGoogle Scholar
  21. 21.
    Ruggeri M, Dibidino R, Marchetti M, Lombardi CP, Raffaelli M, Cicchetti A. The harmonic study: cost-effectiveness evaluation of the use of the ultrasonic scalpel in total thyroidectomy. Int J Technol Assess Health Care. 2012;28(3):259–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • B. Anlar
    • 1
  • N. Karaman
    • 1
  • L. Dogan
    • 1
  • C. Ozaslan
    • 1
  • C. Atalay
    • 1
  • M. Altinok
    • 1
  1. 1.Department of General SurgeryAnkara Oncology Education and Training HospitalAnkaraTurkey

Personalised recommendations