Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and safety of surgical energy devices for axillary node dissection: a systematic review and network meta-analysis

  • Review Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Various surgical energy devices are used for axillary lymph-node dissection. However, those that reduce seroma during axillary lymph-node dissection are unknown. We aimed to determine the best surgical energy device for reducing seroma by performing a network meta-analysis to synthesize the current evidence on the effectiveness of surgical energy devices for axillary node dissection for breast cancer patients. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform Search Portal. Two reviewers independently selected randomized controlled trials (RCTs) comparing electrosurgical bipolar vessel sealing (EBVS), ultrasonic coagulation shears (UCS), and conventional techniques for axillary node dissection. Primary outcomes were seroma, drained fluid volume (mL), and drainage duration (days). We analyzed random-effects and Bayesian network meta-analyses. We evaluated the confidence of each outcome using the CINeMA tool. We registered with PROSPERO (CRD42022335434). We included 34 RCTs with 2916 participants. Compared to the conventional techniques, UCS likely reduces seroma (risk ratio [RR], 0.61; 95% credible interval [CrI], 0.49–0.73), the drained fluid volume (mean difference [MD], − 313 mL; 95% CrI − 496 to − 130), and drainage duration (MD − 1.79 days; 95% CrI − 2.91 to − 0.66). EBVS might have little effect on seroma, the drained fluid volume, and drainage duration compared to conventional techniques. UCS likely reduce seroma (RR 0.44; 95% CrI 0.28–0.69) compared to EBVS. Confidence levels were low to moderate. In conclusion, UCS are likely the best surgical energy device for seroma reduction during axillary node dissection for breast cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets analyzed in this study are available from the corresponding author (J. Watanabe, m06105jw@jichi.ac.jp) upon reasonable request.

References

  1. American Cancer Society. Breast cancer facts and figures. [cited 2022 November 18]. Available from: https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html

  2. Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020;18:452–78.

  3. Cardoso F, Paluch-Shimon S, Senkus E, Curigliano G, Aapro MS, André F, et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol. 2020;31:1623–49.

    Article  CAS  PubMed  Google Scholar 

  4. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52:277–300.

    Article  PubMed  Google Scholar 

  5. Shima H, Kutomi G, Sato K, Kuga Y, Wada A, Satomi F, et al. An optimal timing for removing a drain after breast surgery: a systematic review and meta-analysis. J Surg Res. 2021;267:267–73.

    Article  PubMed  Google Scholar 

  6. Cheng H, Clymer JW, Sadeghirad B, Ferko NC, Cameron CG, Amaral JF. Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence. World J Surg Oncol. 2018;16:2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pergialiotis V, Kontzoglou K, Dimitroulis D, Vlachos D-EG, Routsolias P, Vlachos GD. Electrosurgical bipolar vessel sealing during axillary lymphadenectomy: a systematic review and meta-analysis. Breast Dis. 2015;35:5–11 (content.iospress.com).

  8. Zhang Z, Li L, Pang Y, Li Q, Guo C, Wang Y, et al. Comparison of harmonic scalpel and conventional technique in the surgery for breast cancer: a systematic review and meta-analysis. Indian J Cancer. 2018;55:348–58.

    Article  PubMed  Google Scholar 

  9. Manouras A, Markogiannakis H, Genetzakis M, Filippakis GM, Lagoudianakis EE, Kafiri G, et al. Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system. Arch Surg. 2008;143:575–80. (discussion 581).

  10. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84.

    Article  PubMed  Google Scholar 

  11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Citationchaser. [cited 2022 November 18]. Available from: https://estech.shinyapps.io/citationchaser/?fbclid=IwAR0m29-j74QVVZ7iedxcd7xAARlTYFjvwkkXdMTNPeYP7d_wPvIYNYdVCAk

  13. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019:l4898.

  14. Higgins JPT TJ. Cochrane handbook for systematic reviews of interventions Version 6.3.2022. [cited 2022 November 18]. Available from: https://training.cochrane.org/handbook/current

  15. Salanti G, Ades AE, Ioannidis JPA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64:163–71.

    Article  PubMed  Google Scholar 

  16. Owen RK, Bradbury N, Xin Y, Cooper N, Sutton A. MetaInsight: an interactive web-based tool for analyzing, interrogating, and visualizing network meta-analyses using R-shiny and netmeta. Res Synth Methods. 2019;10:569–81.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JPT. Evaluating the quality of evidence from a network meta-analysis. PLoS ONE. 2014;9: e99682.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Böhm D, Kubitza A, Lebrecht A, Schmidt M, Gerhold-Ay A, Battista M, et al. Prospective randomized comparison of conventional instruments and the Harmonic Focus(®) device in breast-conserving therapy for primary breast cancer. Eur J Surg Oncol. 2012;38:118–24.

    Article  PubMed  Google Scholar 

  19. CINeMA: Confidence in network meta-analysis. Bern: Institute of Social and Preventive Medicine; 2017 [Internet]. [cited 2022 May 20]. Available from: https://cinema.ispm.unibe.ch/

  20. Nikolakopoulou A, Higgins JPT, Papakonstantinou T, Chaimani A, Del Giovane C, Egger M, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020;17: e1003082.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lumachi F, Basso SMM, Santeufemia DA, Bonamini M, Chiara GB. Ultrasonic dissection system technology in breast cancer: a case-control study in a large cohort of patients requiring axillary dissection. Breast Cancer Res Treat. 2013;142:399–404.

    Article  CAS  PubMed  Google Scholar 

  22. Khaled I, Saad I, Soliman H, Faisal M. Intraoperative and postoperative outcomes of Harmonic Focus versus monopolar electrocautery after neoadjuvant chemotherapy in breast conservative surgery: a comparative study. World J Surg Oncol. 2021;19:325.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hahl J. Contact Nd-YAG laser in mastectomy and axillary evacuation: a prospective randomized study. Lasers Med Sci. 1991;6:205–8 (Springer Science and Business Media LLC).

  24. Kriwanek S, Armbruster C, Blauensteiner W, Dinstl K, Schemper M. Results of a controlled study of CO2 laser vs conventional technique in breast cancer. Lasers Med Sci. 1993;8:133–9 (Springer Science and Business Media LLC).

  25. Wyman A, Rogers K. Randomized trial of laser scalpel for modified radical mastectomy. Br J Surg. 1993;80:871–3.

    Article  CAS  PubMed  Google Scholar 

  26. Zafar S, Khan MA, Rafiq U, Mahmood N. ComparisonoOf axillary drain output in conventional and advanced compressive energy source like ultrasonic scalpel and Ligasure dissection of axilla in breast cancer surgery. J Ayub Med Coll Abbottabad. 2021;33:431–6.

    PubMed  Google Scholar 

  27. Lumachi F, Burelli P, Basso SMM, Iacobone M, Ermani M. Usefulness of ultrasound scissors in reducing serous drainage after axillary dissection for breast cancer: a prospective randomized clinical study. Am Surg. 2004;70:80–4.

    Article  PubMed  Google Scholar 

  28. Abul Nagah, Tarek, Lotfy. Comparative study between using harmonic scalpel and electrocautery in modified radical mastectomy. Bioceram Dev Appl. researchgate.net; 2007; Available from: https://www.researchgate.net/profile/Galal-Abulnagah/publication/268005631_COMPARATIVE_STUDY_BETWEEN_USING_HARMONIC_SCALPEL_AND_ELECTROCAUTERY_IN_MODIFIED_RADICAL_MASTECTOMY/links/55bc878a08ae092e9660c070/COMPARATIVE-STUDY-BETWEEN-USING-HARMONIC-SCALPEL-AND-ELECTROCAUTERY-IN-MODIFIED-RADICAL-MASTECTOMY.pdf

  29. Antonio M, Pietra T, Domenico LG, Massimo D, Ignazio R, Antonio N, et al. Does LigaSureTM reduce fluid drainage in axillary dissection? A randomized prospective clinical trial. Ecancermedicalscience [Internet]. ecancer Global Foundation; 2007 [cited 2022 November 18];1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223974/

  30. 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;13:223–30.

    CAS  PubMed  Google Scholar 

  31. Khater. Harmonic scalpel as a single instrument in modified radical mastectomy. Is it more cost effective than electrocautery and ligature. Egypt J Surg. researchgate.net; 2010; Available from: https://www.researchgate.net/profile/Ashraf-Khater/publication/228765542_HARMONIC_SCALPEL_AS_A_SINGLE_INSTRUMENT_IN_MODIFIED_RADICAL_MASTECTOMY_IS_IT_MORE_COST_EFFECTIVE_THAN_ELECTROCAUTERY_AND/links/5479f4d20cf2a961e487adf4/HARMONIC-SCALPEL-AS-A-SINGLE-INSTRUMENT-IN-MODIFIED-RADICAL-MASTECTOMY-IS-IT-MORE-COST-EFFECTIVE-THAN-ELECTROCAUTERY-AND.pdf

  32. Kozomara D, Galić G, Brekalo Z, Sutalo N, Kvesić A, Soljić M. A randomised two-way comparison of mastectomy performed using harmonic scalpel or monopolar diathermy. Coll Antropol. 2010;34(Suppl 1):105–12.

    PubMed  Google Scholar 

  33. Russo AL. Axillary dissection using a new ultrasonic device. EJC Suppl. infona.pl; 2010; Available from: https://www.infona.pl/resource/bwmeta1.element.elsevier-4bd5b6e4-0cdd-336e-918f-7247de25a706

  34. Cortadellas T, Córdoba O, Espinosa-Bravo M, Mendoza-Santin C, Rodríguez-Fernández J, Esgueva A, et al. Electrothermal bipolar vessel sealing system in axillary dissection: a prospective randomized clinical study. Int J Surg Elsevier. 2011;9:636–40.

    Article  Google Scholar 

  35. Ramesh RS, Manjunath S, Shivakumar K, Philip R, Selvan S. Use of ultrasonic shears in patients with breast cancer undergoing axillary dissection-a pilot study. Indian J Surg Oncol. 2011;2:156–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yilmaz KB, Dogan L, Nalbant H, Akinci M, Karaman N, Ozaslan C, et al. Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer. 2011;14:58–63.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 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;203:708–14.

    Article  PubMed  Google Scholar 

  38. He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, et al. Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer: a randomized clinical study. Clin Breast Cancer. 2012;12:454–8.

    Article  PubMed  Google Scholar 

  39. Nespoli L, Antolini L, Stucchi C, Nespoli A, Valsecchi MG, Gianotti L. Axillary lymphadenectomy for breast cancer. A randomized controlled trial comparing a bipolar vessel sealing system to the conventional technique. Breast. 2012;21:739–45 (Elsevier).

  40. Anlar B, Karaman N, Dogan L, Ozaslan C, Atalay C, Altinok M. The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy. Eur Surg. 2013;45:286–90 (Springer Science and Business Media LLC).

  41. Rohaizak M, Khan FJ, Jasmin JS, Mohd Latar NH, Abdullah SSN. Ultracision versus electrocautery in performing modified radical mastectomy and axillary lymph node dissection for breast cancer: a prospective randomized control trial. Med J Malaysia. 2013;68:204–7.

    CAS  PubMed  Google Scholar 

  42. Mori T, Abe H, Kawai Y, Murakami K, Akabori H, Yamaguchi T, et al. Prospective, randomized trial comparing harmonic scalpel and electrocautery in breast surgery. J Clin Orthod Wolters Kluwer. 2013;31:e12014–e12014.

    Google Scholar 

  43. Khan S, Khan S, Chawla T, Murtaza G. Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial. Ann Surg Oncol. 2014;21:808–14.

    Article  PubMed  Google Scholar 

  44. Manjunath S, Ramesh RS, Shivakumar K, Goel V. Ultrasonic shears versus electrocautery in axillary dissection for breast cancer-a randomized controlled trial. Indian J Surg Oncol. 2014;5:95–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Tukenmez M, Agcaoglu O, Aksakal N, Destek S, Cabioglu N, Barbaros U, et al. The use of Ligasure vessel sealing system in axillary dissection; effect on seroma formation. Chirurgia. 2014;109:620–5.

    CAS  PubMed  Google Scholar 

  46. Malik ZI. Axillary dissection in mastectomy: ultracision vs monopolar electrocautry. Age. pjmhsonline.com; 2015; Available from: https://pjmhsonline.com/2015/oct_dec/pdf/1328%20%20%20Axillary%20Dissection%20in%20Mastectomy%20Ultracision%20vs%20Monopolar%20Electrocautry.pdf

  47. Nawaz A, Waqar S, Khan A, Mansoor R, Butt UI, Ayyaz M. Harmonic scalpel versus electrocautery in axillary dissection in carcinoma breast. J Coll Physicians Surg Pak. 2015;25:870–3.

    PubMed  Google Scholar 

  48. Seki T, Hayashida T, Takahashi M, Jinno H, Kitagawa Y. A randomized controlled study comparing a vessel sealing system with the conventional technique in axillary lymph node dissection for primary breast cancer. Springerplus. Springer; 2016;5:1004.

  49. Militello G, De Marco P, Falco N, Kabhuli K, Mascolino A, Licari L, et al. Is it really useful the harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series G. Chir. 2016;37:262–5.

    Article  CAS  Google Scholar 

  50. Mittal P, Kumar A, Kaur S, Pandove PK, Singla RL, Singh J. A comparative study of the use of harmonic scalpel versus unipolar cautery in modified radical mastectomy. Niger J Surg. 2017;23:20–5.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Okamura N. Utility of LigaSure (TM) vessel-sealing device in axillary dissection for breast cancer surgery: a randomized single center study. Res. Assoc Cancer Res. 2017.

  52. Shanmugam S, Govindasamy G, Hussain SA, Rao PSH. Axillary dissection for breast cancer using electrocautery versus ultrasonic dissectors: a prospective randomized study. Indian J Cancer. 2017;54:543–6.

    Article  PubMed  Google Scholar 

  53. Archana A, Sureshkumar S, Vijayakumar C, Palanivel C. Comparing the harmonic scalpel with electrocautery inreducing postoperative flap necrosis and seroma formation after modified radical mastectomy in carcinoma breast patients: a double-blind prospective randomized control trail. Cureus. 2018;10: e2476.

    PubMed  PubMed Central  Google Scholar 

  54. Faisal M, Fathy H, Shaban H, Abuelela ST, Marie A, Khaled I. A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial. Patient Saf Surg. 2018;12:8.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Salama AMF, Nawar AM, Zayed ME, Essa MS. Evaluation of ultrasonic axillary dissection in preservation of intercostobrachial nerve and lymphatic sealing in breast cancer patients: randomized controlled trial. Ann Med Surg (Lond). 2020;60:255–60.

    Article  PubMed  Google Scholar 

  56. Shaukat A, Anjum MA. Comparison of axillary lymph node dissection by using ligasure vessel sealing system vs conventional thread ligation in patients undergoing modified radical mastectomy for carcinoma of breast. Ann Punjab Med Coll (APMC). 2020;14:254–8 (apmcfmu.com).

  57. Deori A, Gupta N, Gupta AK, Yelamanchi R, Agrawal H, Durga CK. A prospective randomised controlled study comparing ultrasonic dissector with electrocautery for axillary dissection in patients of carcinoma breast. Malays J Med Sci. 2021;28:97–104.

    PubMed  PubMed Central  Google Scholar 

  58. Park HS, Lee J, Kim JY, Park JM, Kwon Y. A prospective randomized study to compare postoperative drainage after mastectomy using electrosurgical bipolar systems and conventional electro-cautery. J Breast Cancer. 2022;25:307–17.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Zahid A, Javed T, Kaleem M, Andrabi WI, Jamil T, Qureshi SS, et al. Comparison of seroma formation with harmonic scalpel versus monopolar electrocautery in axillary dissection following modified radical mastectomy. Pak J Med Health Sci. 2022;16:198–198 (pjmhsonline.com).

  60. Adrien C, Katia M, Marie-Lucile B, Alice R, Claire B, Roman R. Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis. Sci Rep. 2022;12:10016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Konishi T, Fujiogi M, Niwa T, Morita K, Matsui H, Fushimi K, et al. Comparison of outcomes after differentiated thyroid cancer surgery performed with and without energy devices: a population-based cohort study using a nationwide database in Japan. Int J Surg. 2020;77:198–204.

    Article  PubMed  Google Scholar 

  62. Piemontese A, Galvain T, Swindells L, Parago V, Tommaselli G, Jamous N. Budget impact analysis of HARMONIC FOCUS™+ Shears for mastectomy and breast-conserving surgery with axillary lymph node dissection compared with monopolar electrocautery from an Italian hospital perspective. PLoS ONE. 2022;17: e0268708.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Xue DQ, Qian C, Yang L, Wang XF. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 2012;38:375–81.

    Article  CAS  PubMed  Google Scholar 

  64. Douay N, Akerman G, Clément D, Malartic C, Morel O, Barranger E. Seroma after axillary lymph node dissection in breast cancer. Gynecol Obstet Fertil. 2008;36:130–5.

    Article  CAS  PubMed  Google Scholar 

  65. Robertson SA, Rusby JE, Cutress RI. Determinants of optimal mastectomy skin flap thickness. Br J Surg. 2014;101:899–911.

    Article  CAS  PubMed  Google Scholar 

  66. Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Pathophysiology of seroma in breast cancer. Breast Cancer. 2005;12:288–93.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Ahmed M. F. Salama, Dr. Mohammed Faisal, Dr. Subbiah Shanmugam, and Dr. Okamura for providing us with details of their study.

Funding

This study received no external funding.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Jun Watanabe, Akira Koike, Atsushi Miki, Mikio Shiozawa, Masako Sakuragi, Michiko Harao, Joji Kitayama & Naohiro Sata

  2. Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan

    Jun Watanabe

  3. Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-Cho 89, Sakyo-Ku, Kyoto, 606-8226, Japan

    Yuki Kataoka

  4. Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan

    Yuki Kataoka

  5. Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan

    Yuki Kataoka

  6. Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan

    Yuki Kataoka

Authors
  1. Jun Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuki Kataoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akira Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mikio Shiozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masako Sakuragi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michiko Harao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joji Kitayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naohiro Sata
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, JW and YK; methodology, JW, YK, AK, AM, MS, MS, MH, JK, and NS; software, JW and YK; validation, JW, YK, AK, AM, and SM; formal analysis, JW and YK; investigation, JW, YK, AK, AM, MS, MS, MH, JK, and NS; resources, JW, data curation, JW, YK, AK, and AM; writing—original draft preparation, JW; writing—review and editing, YK, AK, AM, MS, MS, MH, JK, and NS; visualization, JW and YK; supervision, MS, MS, MH, JK, and NS; project administration, JW, YK, JK, and NS; funding acquisition, JW All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Jun Watanabe.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watanabe, J., Kataoka, Y., Koike, A. et al. Efficacy and safety of surgical energy devices for axillary node dissection: a systematic review and network meta-analysis. Breast Cancer 30, 531–540 (2023). https://doi.org/10.1007/s12282-023-01460-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-023-01460-7

Keywords

Search

Navigation