Annals of Surgical Oncology

, Volume 21, Issue 3, pp 808–814 | Cite as

Harmonic Scalpel Versus Electrocautery Dissection in Modified Radical Mastectomy: A Randomized Controlled Trial

  • Salma Khan
  • Shaista Khan
  • Tabish Chawla
  • Ghulam Murtaza
Breast Oncology

Abstract

Purpose

To test the hypothesis that the use of a harmonic scalpel increases operative time but results in less estimated blood loss, postoperative pain, drainage volume, and duration of surgery, as well as fewer complications, such as flap necrosis, seroma, and surgical site infection (SSI), than electrocautery.

Methods

This parallel-group, single-institution blinded randomized controlled trial was conducted at the department of surgery of our institute between April 2010 and July 2011. Women undergoing modified radical mastectomy were randomly allocated to either harmonic dissection (n = 76) or electrocautery (n = 76).

Results

Both the groups were comparable for baseline variables with age of 50.5 ± 12.2 and 48.5 ± 14.5 years in the harmonic and electrocautery groups, respectively. Harmonic dissection yielded better outcomes compared to electrocautery with lower estimated blood loss (100 ± 62 vs. 182 ± 92, p < 0.001), less drain volume (631 ± 275 ml vs. 1035 ± 413 ml, p < 0.001), fewer drain days (12 ± 3 vs. 17 ± 4, p < 0.001), less seroma formation (21.3 vs. 33.3 %, p = 0.071), and less postoperative pain [median (interquartile range) 2 (2–2) vs. 3 (3–4), p < 0.001], whereas mean operative time (191 ± 44 vs. 187 ± 36 min, p = 0.49) and SSI (0 vs. 4 %, p = 0.122) did not differ. On multivariable Cox regression analysis, harmonic dissection was associated with lower risk of significant postoperative pain [adjusted relative risk 0.028 (95 % confidence interval (CI) 0.004–0.2)] and overall complications [adjusted relative risk 0.47, (95 % CI 0.26–0.86)]. On multiple linear regression, duration of drains in the harmonic dissection group was 4.5 days less than electrocautery (r2 = 0.28, β = 11.8, p < 0.001).

Conclusions

The harmonic scalpel significantly reduces postoperative discomfort and morbidity to the patient without increasing operating time. We thus recommend preferential use of harmonic dissection in modified radical mastectomy. (ClinicalTrials.gov NCT01587248).

Notes

Acknowledgment

We thank Dr. Naveed Haroon for his assistance in data collection.

DISCLOSURE

The authors declare no conflict of interest.

REFERENCES

  1. 1.
    Deo SV, Shukla NK, Asthana S, et al. A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery. Singap Med J. 2002;43:226–8.Google Scholar
  2. 2.
    Rodd CD, Velchuru VR, Holly-Archer F, et al. Randomized clinical trial comparing two mastectomy techniques. World J Surg. 2007;31:1164–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Deo SV, Shukla NK. Modified radical mastectomy using harmonic scalpel. J Surg Oncol. 2000;74:204–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Riegler M, Cosentini E, Bischof G. Update and economic aspects of the harmonic scalpel in general surgery. Eur Surg. 2004;36:172–9.CrossRefGoogle Scholar
  5. 5.
    Galatius H, Okholm M, Hoffmann J. Mastectomy using ultrasonic dissection: effect on seroma formation. Breast. 2003;12:338–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Dahri FJ, Awan MS, Qazi AR, et al. Early wound complications following modified radical mastectomy with axillary clearance. J Surg Pak (Int). 2011;16:4.Google Scholar
  7. 7.
    Jan WA, Haq MIU, Khan AS. Early complications of modified radical mastectomy with axillary clearance. J Postgrad Med Inst (Peshawar-Pakistan). 2011;20.Google Scholar
  8. 8.
    Keogh GW, Doughty JC, McArdle CSM, Cooke TG. Seroma formation related to electrocautery in breast surgery: a prospective randomized trial. Breast. 1998;7:39–41.CrossRefGoogle Scholar
  9. 9.
    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;60:562–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Shamim M. Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial. World J Surg. 2009;33:1594–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Hoenig DM, Chrostek CA, Amaral JF. Laparosonic coagulating shears: alternative method of hemostatic control of unsupported tissue. J Endourol. 1996;10:431–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Burdette TE, Kerrigan CL, Homa KA. Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial. Plastic Reconstr Surg. 2011;128:243e.CrossRefGoogle Scholar
  13. 13.
    Iovino F, Auriemma PP, Ferraraccio F, et al. Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial. Am J Surg. 2012;203:708–714.PubMedCrossRefGoogle Scholar
  14. 14.
    Khater A. Harmonic scalpel as a single instrument in modified radical mastectomy. Is it more cost effective than electrocautery and ligature? Egypt J Surg. 2010;29.Google Scholar
  15. 15.
    Hosmer DW, Lemeshow S, May S. Model development. In: Applied survival analysis: regression modeling of time to event data. New York: Wiley; 2008. p. 133–136.Google Scholar
  16. 16.
    Foschi D, Cellerino P, Corsi F, et al. The mechanisms of blood vessel closure in humans by the application of ultrasonic energy. Surg Endosc. 2002;16:814–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Emam TA, Cuschieri A. How safe is high-power ultrasonic dissection? Ann Surg. 2003;237:186–91.PubMedGoogle Scholar
  18. 18.
    Lumachi F, Brandes AA, Burelli P, et al. Seroma prevention following axillary dissection in patients with breast cancer by using ultrasound scissors: a prospective clinical study. Eur J Surg Oncol. 2004;30:526–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Ribeiro GH, Kerr LM, Haikel RL, et al. Modified radical mastectomy: a pilot clinical trial comparing the use of conventional electric scalpel and harmonic scalpel. Int J Surg. 2013;11:496–500.PubMedCrossRefGoogle Scholar
  20. 20.
    Kurtz SB, Frost DB. A comparison of two surgical techniques for performing mastectomy. Eur J Surg Oncol. 1995;21:143–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Sheen-Chen SM, Chou FF. A comparison between scalpel and electrocautery in modified radical mastectomy. Eur J Surg. 1993;159:457.PubMedGoogle Scholar
  22. 22.
    Chan KC, Watson D, Lennard TWJ. Outcome of a prospective randomized controlled study comparing perioperative blood loss and postoperative pain in total mastectomies performed by scalpel and electrocautery. Breast. 1997;6:379–80.CrossRefGoogle Scholar
  23. 23.
    Porter KA, O’Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176:8–11.PubMedCrossRefGoogle Scholar
  24. 24.
    Iovino F, Auriemma PP, Ferraraccio F, et al. Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial. Am J Surg. 2012;203:708–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Kozomara D, Galic G, Brekalo Z, et al. A randomised two-way comparison of mastectomy performed using harmonic scalpel or monopolar diathermy. Coll Antropol. 2010;34(Suppl 1):105–12.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Salma Khan
    • 1
  • Shaista Khan
    • 1
  • Tabish Chawla
    • 1
  • Ghulam Murtaza
    • 1
  1. 1.Department of SurgeryAga Khan University HospitalKarachiPakistan

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