Harmonic Scalpel Versus Electrocautery Dissection in Modified Radical Mastectomy: A Randomized Controlled Trial
- 594 Downloads
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.
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).
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).
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).
We thank Dr. Naveed Haroon for his assistance in data collection.
The authors declare no conflict of interest.
- 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
- 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.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
- 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.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