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Harmonic Scalpel Versus Monopolar Electrotome in Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty: A Retrospective Study in 122 Patients

  • Original Article
  • Breast Surgery
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Abstract

Background

The transaxillary approach of breast augmentation is the most popular method in Asia, but longer period of recovery was observed in spite of the assistance of endoscope.

Objectives

Introducing the ultrasonic dissection devices might be a solution to minimizing tisue damage thus relieving pain and shortening the period of recovery.

Method

Between March 2020 and September 2022, we retrospectively reviewed the cases of 122 patients underwent endoscopic augmentation mammoplasty via the transaxillary approach using either the monopolar electrotome (ME) alone or assisted with Harmonic Scalpel (HS) in defining the retropectoral pocket and severing the pectoralis major muscle.

Result

The total drainage volume was significantly lower in the HS group than ME group (74.33 ± 48.81 vs. 180.30 ± 125.10 mL; p < 0.0001). VAS score of the first 24 hour after surgery of the ME group was significantly higher than that of the HS group (6.10 ± 1.27 vs. 2.88 ± 1.29, p < 0.0001). Operation time in HS group was reduced compared to ME group (113.1 ± 14.46 mins vs. 131.3 ± 35.51 mins, p < 0.001). The duration of drainage placement (1.08 ± 0.27 vs. 2.72 ± 1.18 days) and hospital stay after surgery (3.08 ± 0.42 vs. 5.64 ± 2.78 days; p < 0.0001) were largely reduced in HS group.

Conclusion

The assistance of Harmonic Scalpel significantly reduced total postoperative drainage, relieved pain and shortened operation time, length of drainage placement and hospital stay compared to using monopolar electrotome alone in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty.

Level of Evidence IV

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Reference

  1. Zelken J, Cheng MH (2015) Asian breast augmentation: a systematic review. Plast Reconstr Surg Glob Open 3(11):e555

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nguyen HH, To LT (2021) Comparison of endoscopic transaxillary and peri-areolar approaches in breast augmentation with smooth implants. Aesthet Plast Surg 45(6):2665–2675

    Article  Google Scholar 

  3. Lee DW, Kim SJ, Kim H (2019) Endoscopic transaxillary versus inframammary approaches for breast augmentation using shaped implants: a matched case-control study. Aesthet Plast Surg 43(3):563–568

    Article  Google Scholar 

  4. Li Z, Mu D, Xu B, Wang C, Cheng H, Li S, Qi J (2020) Drainage collection after endoscopic-assisted transaxillary dual-plane augmentation mammaplasty using cold or electrosurgical separation of interpectoral space. Plast Surg (Oakville) 28(1):19–28

    Article  Google Scholar 

  5. Fraga TS, Köhler HF, Chulam TC, Kowalski LP (2021) Impact of scalpel type on operative time and acute complications in thyroidectomies. Braz J of Otorhinolaryngol 87(2):205–920

    Article  Google Scholar 

  6. Michalik T, Matkowski R, Biecek P, Szynglarewicz B (2019) The use of ultrasonic scalpel lowers the risk of post-mastectomy seroma formation in obese women. J Cancer 10(15):3481–3485

    Article  PubMed  PubMed Central  Google Scholar 

  7. Arvind NK, Ali Q, Singh O, Gupta S, Sahay S (2018) Contemporary use of ultrasonic versus standard electrosurgical dissection in laparoscopic nephrectomy: safety, efficacy and cost. Arab J Urol 16(3):335–341

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lim DR, Cho DH, Lee JH, Moon JH (2016) Comparison of a hemorrhoidectomy with ultrasonic scalpel versus a conventional hemorrhoidectomy. Ann Coloproctol 32(3):111–116

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wiatrak BJ, Willging JP (2022) Harmonic scalpel for tonsillectomy. Laryngoscope 112:14–16

    Article  Google Scholar 

  10. Bozkurt G, Turri-Zanoni M, Russo F, Elhassan HA, Castelnuovo P, Battaglia P (2019) Ultrasonic scalpel-assisted endoscopic endonasal surgery of infratemporal fossa: our first impressions. World Neurosurg 123:23–28

    Article  PubMed  Google Scholar 

  11. Huang Y, Mu GC, Qin XG, Lin JL, Liu C, Chen ZB, Zeng YJ (2013) The application of ultrasonic harmonic scalpel in the radical surgery of gastric cancer. Clin Trans Oncol 15(11):932–937

    Article  CAS  Google Scholar 

  12. Inoue K, Nakane Y, Michiura T, Yamada M, Mukaide H, Fukui J, Miki H, Ueyama Y, Nakatake R, Tokuhara K, Iwamoto S, Yanagimoto H, Toyokawa H, Satoi S, Kwon AH (2012) Ultrasonic scalpel for gastric cancer surgery: a prospective randomized study. J Gastrointest Surg 16(10):1840–1846

    Article  PubMed  Google Scholar 

  13. Sasi W (2010) Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy. JSLS 14(1):23–34

    Article  PubMed  PubMed Central  Google Scholar 

  14. Devassy R, Gopalakrishnan S, De Wilde R (2015) Surgical efficacy among laparoscopic ultrasonic dissectors: are we advancing safely? A review of literature. J Obstet Gynaecol India 65(5):293–300

    Article  PubMed  PubMed Central  Google Scholar 

  15. Newcomb WL, Hope WW, Schmelzer TM, Heath JJ, Norton HJ, Lincourt AE, Heniford BT, Iannitti DA (2009) Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. Surg Endosc 23(1):90–96

    Article  PubMed  Google Scholar 

  16. Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169(2):697–700

    Article  PubMed  Google Scholar 

  17. Theodore D, Michael K, Antınios A (2006) Comparison of monopolar electrocoagulation, bipolar electrocoagulation, ultracision, ligasure. Surg Today 36(10):908–913

    Article  Google Scholar 

  18. Lamberton GR, Hsi RS, Jin DH, Lindler TU, Jellison FC, Baldwin DD (2008) Prospective comparison of four laparoscopic vessel ligation devices. J Endourol 22(10):2307–2310

    Article  PubMed  Google Scholar 

  19. Mannelli G, Meccariello G, Deganello A, Maio V, Massi D, Gallo O (2014) Impact of low-thermal-injury devices on margin status in laryngeal cancer. An experimental ex vivo study. Oral Oncol 50(1):32–39

    Article  PubMed  Google Scholar 

  20. Türkan A, Akkurt G, Yalaza M, Değirmencioğlu G, Kafadar MT, Yenidünya S, İnan A, Dener C (2019) Effect of ligasure™, monopolar cautery, and bipolar cautery on surgical margins in breast-conserving surgery. Breast Care (Basel) 14(4):194–199

    Article  PubMed  Google Scholar 

  21. Družijanić N, Pogorelić Z, Perko Z, Mrklić I, Tomić S (2012) Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, harmonic scalpel and ligasure. Can J Surg 55(5):317–321

    Article  PubMed  PubMed Central  Google Scholar 

  22. Carlander J, Johansson K, Lindström S, Velin AK, Jiang CH, Nordborg C (2005) Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery. Br J Surg 92(6):772–777

    Article  CAS  PubMed  Google Scholar 

  23. Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 15(4):373–380

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zielin´ski J, Jaworski R, Irga N, Kruszewski JW, Jaskiewicz J (2013) Analysis of selected factors influencing seroma formation in breast cancer patients undergoing mastectomy. Arch Med Sci 9(1):86–92

    Article  PubMed  Google Scholar 

  25. Sampathraju S, Rodrigues G (2010) Seroma formation after mastectomy: pathogenesis and prevention. Indian J Surg Oncol 1(4):328–333

    Article  PubMed  Google Scholar 

  26. Szecsi PB, Larsen J, Horby J, Axelsson CK (2012) Seroma production after breast cancer surgery has a pro-inflammatory component. Open Breast Cancer J 4(1):11–17

    Article  CAS  Google Scholar 

  27. Rzymski P, Kubasik M, Gaca M, Opala T (2011) Is the shear wave sonographic elastography correlated with pain after breast augmentation with silicone implants an indication of inflammatory activity? A preliminary report. Wideochir Inne Tech Maloinwazyjne 6(4):217–225

    PubMed  PubMed Central  Google Scholar 

  28. Xiong JC, Hou Q, Hu ZY, Gao YK, Lu L, Sun MQ, Hu H, Qian YX, Wang H, Jiang H (2022) The application of anatomy combined with ultrasound knife in transaxillary endoscopic biplane breast augmentation. Front Surg 9:865379

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sutton PA, Awad S, Perkins AC, Lobo DN (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the harmonic scalpel and the ligasure. Br J Surg 97(3):428–433

    Article  CAS  PubMed  Google Scholar 

  30. Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, Saito S (2016) Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol 36(4):197–206

    Article  Google Scholar 

  31. Xie Z, Yan K, Qu Y, Gao S, Lu T, Hu C, Wang S, Shangguan W, Wu GA (2023) Retrospective study of transaxillary endoscopic breast augmentation using ultrasonic scalpel or conventional electrocautery for implant pocket dissection. Aesthet Plast Surg. https://doi.org/10.1007/s00266-023-03569-8.Advanceonlinepublication

    Article  Google Scholar 

  32. Lin Y, Liu S, Zhang X, Li H, Mu D (2023) Comparison of the effect of the harmonic scalpel and monopolar cautery in transaxillary endoscopic dual-plane breast augmentation. JPRAS 83:148–154

    ADS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Di Zhu and Dr. Hongyu Zhu for the acquisition of the data.

Funding

The present study was supported by the Featured Clinical Discipline Project of Shanghai Pudong (Grant Number PWYts2021-07).

Author information

Author notes

  1. Lu Lu, Qiang Hou and Zheyuan Hu have contributed equally.

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China

    Lu Lu, Qiang Hou, Zuochao Yao, Jiachao Xiong, Jianghui Ying, Meiqing Sun, Hui Wang & Hua Jiang

  2. Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China

    Zheyuan Hu, Meiqing Sun & Hua Jiang

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  1. Lu Lu
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Correspondence to Hui Wang or Hua Jiang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lu, L., Hou, Q., Hu, Z. et al. Harmonic Scalpel Versus Monopolar Electrotome in Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty: A Retrospective Study in 122 Patients. Aesth Plast Surg 48, 273–281 (2024). https://doi.org/10.1007/s00266-023-03747-8

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