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



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. ( NCT01587248).



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


The authors declare no conflict of interest.


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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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