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Takaya K, Baba M, Kuranami M, Shido H, Asou T, Kishi K. Usefulness of Harmonic ACE+7 Scalpel in Breast Reconstruction with Extended Latissimus Dorsi Flap: An Open-label Single Institution Pilot Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5163. [PMID: 37547349 PMCID: PMC10400065 DOI: 10.1097/gox.0000000000005163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
The extended latissimus dorsi (ELD) flap is a safe and aesthetically acceptable method to reconstruct small to medium-sized breasts. However, the long time required for flap elevation and intraoperative bleeding contributes to various postoperative complications. We investigated the use of alternative devices, such as the Harmonic ACE+7, which has a long arm that can help simultaneously detach and seal tissues to prevent such complications. Methods We compared 27 patients who underwent breast reconstruction with the ELD flap using the Harmonic ACE +7 scalpel, and 28 patients who underwent breast reconstruction using an electrocautery scalpel, between May 2019 and March 2022. Data on patient demographics, surgery, and postoperative complications were collected. Surgical outcomes were compared between electrocautery (EC) and Harmonic ACE+7 (HA) groups. Results The median age of the patients was 50.2 years. The patient demographics between the groups did not show significant differences. Flap necrosis and hematomas did not occur, and seroma was the major postoperative complication (65.7% in the EC group and 70% in the HA group). The time required for flap elevation was significantly shorter in the HA group than in the EC group (286.0 minutes and 179.0 minutes, respectively). Blood loss reduced significantly in the HA and EC groups (138.5 mL and 78.2 mL, respectively). Moreover, decreased drainage was observed for the breast area. There were no significant differences in other end points. Conclusion In breast reconstruction with ELD flaps, using the Harmonic ACE+7 can help reduce the rate of seroma, operative time, and intraoperative bleeding without further disadvantages.
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Affiliation(s)
- Kento Takaya
- From the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
- Yamato Municipal Hospital, Kanagawa, Japan
| | - Miho Baba
- From the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Toru Asou
- From the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Kishi
- From the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
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Watanabe J, Kataoka Y, Koike A, Miki A, Shiozawa M, Sakuragi M, Harao M, Kitayama J, Sata N. Efficacy and safety of surgical energy devices for axillary node dissection: a systematic review and network meta-analysis. Breast Cancer 2023:10.1007/s12282-023-01460-7. [PMID: 37058224 DOI: 10.1007/s12282-023-01460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
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.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-Cho 89, Sakyo-Ku, Kyoto, 606-8226, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Akira Koike
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Mikio Shiozawa
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masako Sakuragi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Michiko Harao
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Kitayama
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Vettoretto N, Foglia E, Gerardi C, Lettieri E, Nocco U, Botteri E, Bracale U, Caracino V, Carrano FM, Cassinotti E, Giovenzana M, Giuliani B, Iossa A, Milone M, Montori G, Peltrini R, Piatto G, Podda M, Sartori A, Allocati E, Ferrario L, Asperti F, Songia L, Garattini S, Agresta F. High-energy devices in different surgical settings: lessons learnt from a full health technology assessment report developed by SICE (Società Italiana di Chirurgia Endoscopica). Surg Endosc 2023; 37:2548-2565. [PMID: 36333498 PMCID: PMC9638482 DOI: 10.1007/s00464-022-09734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. METHODS A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from - 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. RESULTS The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to - 5.25/-9.02% of operating room time and to - 5.03/-30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. CONCLUSIONS The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement.
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Affiliation(s)
- Nereo Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Chiara Gerardi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale, Politecnico di Milano, Milan, Italy
| | - Umberto Nocco
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
| | - Emanuele Botteri
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy
| | - Umberto Bracale
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Valerio Caracino
- U.O.C. Chirurgia Generale e d'Urgenza, AUSL Pescara, Pescara, Italy
| | | | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Beatrice Giuliani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome Sapienza Polo Pontino, Rome, Italy
| | - Marco Milone
- U.O.C. Chirurgia Generale, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
| | - Giulia Montori
- U.O.C. Chirurgia Generale, Ospedale di Vittorio Veneto, Treviso, Italy
| | - Roberto Peltrini
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Mauro Podda
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Alberto Sartori
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Federica Asperti
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Letizia Songia
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
- SC Ingengeria Clinica, ASST di Lecco, Lecco, Italy
| | - Silvio Garattini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
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Zhang Z, Li L, Pang Y, Li Q, Guo C, Wang Y, Zhu C, Meng X. Comparison of harmonic scalpel and conventional technique in the surgery for breast cancer: A systematic review and meta-analysis. Indian J Cancer 2019; 55:348-358. [PMID: 30829269 DOI: 10.4103/ijc.ijc_306_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Harmonic scalpel is considered as a promising surgical tool for breast cancer, while its advantage over conventional approach is still controversial. Therefore, we performed this meta-analysis to compare the outcomes of harmonic scalpel and conventional tools in the surgery for breast cancer. MATERIALS AND METHODS Studies reporting the outcomes of harmonic scalpel and conventional technologies were systematically searched from online databases, PubMed and EMBASE up to April 30, 2018. Data were presented as odds ratio, risk ratio (RR), and mean difference (MD) with 95% confidence interval (CI). RESULTS Intraoperative blood loss (I2 = 96%, P < 0.05, MD = -68.78, 95% CI -93.31 to -44.24), seroma (I2 = 3%, P = 0.41, RR = 0.63, 95% CI 0.46-0.86) and hematoma formation (I2 = 0%, P = 0.64, RR = 0.41, 95% CI 0.23-0.73), drainage volume (I2 = 89%, P < 0.05, MD = -105.33, 95% CI -161.33 to -49.33) and time (I2 = 93%, P < 0.05, MD = -2.18, 95% CI -3.75 to -0.61), necrosis (I2 = 35%, P = 0.20, RR = 0.37, 95% CI 0.16-0.86), surgical duration (I2 = 79%, P < 0.05, MD = -8.49, 95% CI -16.56 to -0.43), and hospital stay (I2 = 97%, P < 0.05, MD = -0.94, 95% CI -1.74 to -0.14) are significantly different between the two groups. CONCLUSIONS Harmonic scalpel is superior to conventional tools in terms of decreasing intraoperative blood loss, seroma and hematoma formation, drainage volume and time, necrosis prevalence, surgical duration, and hospital stay, which should be strongly recommended in the surgery for breast cancer.
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Affiliation(s)
- Zili Zhang
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Lin Li
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yi Pang
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Qi Li
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Chunli Guo
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yongchao Wang
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Chengpei Zhu
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Xiangchao Meng
- Department of General Surgery, Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Late Shoulder-Arm Morbidity Using Ultrasound Scalpel in Axillary Dissection for Breast Cancer: A Retrospective Analysis. J Surg Res 2018; 233:88-95. [PMID: 30502293 DOI: 10.1016/j.jss.2018.07.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND We aimed to assess whether the use of the harmonic scalpel (HS) in axillary dissection would reduce long-term shoulder-arm morbidity compared to traditional instruments (TIs). MATERIALS AND METHODS A retrospective analysis on 180 patients who underwent standard axillary dissection for breast cancer between 2007 and 2015 was carried out. All patients were evaluated for postoperative pain, impairment of shoulder-arm mobility, seroma formation in axilla, frozen shoulder, and lymphedema. RESULTS HS procedure on average was 50% shorter compared to the TI technique. HS reduced by 4.5 times the risk of axillary seroma. TIs were associated with 4 times higher risk of developing a painful frozen shoulder. CONCLUSIONS Use of the HS was associated with reduced costs and a positive long-term effect on shoulder-arm morbidity. Axillary seromas are not the only reason of later postoperative shoulder-arm morbidity: other mechanisms are hypothesized in the onset of this very disabling disorder.
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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; 23:20-25. [PMID: 28584507 PMCID: PMC5441211 DOI: 10.4103/1117-6806.199962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Oncosurgery is an emerging branch with the set goals of prolonging the life and ensuring the best possible quality of life to the surviving patient. The use of harmonic scalpel has proved to be beneficial in a variety of surgeries but its role in breast surgery is still controversial. Aims: We conducted this study to compare the intraoperative and postoperative outcomes in modified radical mastectomy using harmonic scalpel versus electrocautery. Subjects and Methods: Fifty female patients with confirmed diagnosis of breast carcinoma and planned for modified radical mastectomy were taken up for surgery. Twenty-five patients were operated using harmonic scalpel (Group A) and another 25 were operated using unipolar cautery (Group B). Results: The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.40 ± 29.96 vs. 99.80 ± 24.00 min, P < 0.001). The smaller amount of drainage content (431.60 ± 145.94 vs. 594.20 ± 278.63, P = 0.013) and intraoperative blood loss (426.00 ± 76.54 vs. 502.00 ± 104.56, P = 0.005) in the group operated with the ultrasound harmonic scalpel was statistically significant. There was no significant difference between the groups with regard to drain duration (5.24 ± 0.97, P = 0.127), seroma (12% vs. 16%, P = 0.684), hematoma (4% vs. 4%, P = 1.000), wound infection (24% vs. 32%, P = 0.529), flap necrosis (8% vs. 28%, P = 0.066), pain intensity (measured on visual analog scale) (5.08 ± 1.29 vs. 5.20 ± 1.68, P = 0.778), and lymphedema (4% vs. 8%, P = 0.552). The length of hospital stay could not be compared effectively because all the patients were discharged on the 10th or 11th postoperative day. The cost of the equipment used in the electrocautery group was almost negligible as compared to the harmonic group. Conclusions: The use of harmonic scalpel versus electrocautery is somewhat advantageous but not cost-effective.
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Affiliation(s)
- Pallavi Mittal
- Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Ashwani Kumar
- Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Sunmeet Kaur
- Medical Student, All India Institute of Medical Sciences, New Delhi, India
| | - Paras Kumar Pandove
- Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Rachan Lal Singla
- Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Jagpal Singh
- Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
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Cheng H, Clymer JW, Ferko NC, Patel L, Soleas IM, Cameron CG, Hinoul P. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer. BREAST CANCER-TARGETS AND THERAPY 2016; 8:125-40. [PMID: 27486342 PMCID: PMC4958357 DOI: 10.2147/bctt.s110461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection. METHODS A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables. RESULTS Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002), seroma by 46% (P<0.0001), necrosis by 49% (P=0.04), postoperative chest wall drainage by 46% (P=0.0005), blood loss by 38% (P=0.0005), and length of stay by 22% (P=0.007). Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup. CONCLUSION In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.
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Affiliation(s)
| | | | | | - Leena Patel
- Cornerstone Research Group, Burlington, ON, Canada
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Gunn J, Gibson T, Li Z, Diehl N, Bagaria S, McLaughlin S. Symptomatic Axillary Seroma after Sentinel Lymph Node Biopsy: Incidence and Treatment. Ann Surg Oncol 2016; 23:3347-53. [DOI: 10.1245/s10434-016-5398-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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9
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Sowa Y, Numajiri T, Kawarazaki A, Sakaguchi K, Taguchi T, Nishino K. Preventive effects on seroma formation with use of the harmonic focus shears after breast reconstruction with the latissimus dorsi flap. J Plast Surg Hand Surg 2016; 50:349-353. [DOI: 10.1080/2000656x.2016.1178129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lamblin G, Chauvy L, Rannou C, Mathevet P, Chabert P, Mellier G, Chene G. Does ultrasonic advanced energy reduce lymphocele incidence in laparoscopic para-aortic lymphadenectomy? Eur J Obstet Gynecol Reprod Biol 2014; 185:53-8. [PMID: 25528730 DOI: 10.1016/j.ejogrb.2014.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the use of ultrasonic advanced energy in reducing the occurrence of symptomatic lymphocele and its related complications in laparoscopic extra-peritoneal para-aortic lymphadenectomy in patients with gynecological cancer. STUDY DESIGN A retrospective cohort study of consecutive patients in a tertiary referral center identified 2 groups of patients, undergoing laparoscopic extra-peritoneal para-aortic lymphadenectomy with or without the use of ultrasonic advanced energy. Surgery time, hospital stay, number of retrieved nodes and lymphocele requiring treatment were studied. Results were also compared between trained and trainee surgeons. RESULTS 163 patients were scheduled for laparoscopic extra-peritoneal para-aortic lymphadenectomy: 81 treated using bipolar energy (control group: group 1) between August 1999 and January 2005, and 82 treated using ultrasonic advanced energy (study group: group 2) between July 2010 and March 2014. The main indication (90% in group 1, 61% in group 2) was advanced cervical carcinoma (stage IB2 and above). Ultrasonic advanced energy significantly decreased operative time (p=0.001) and intra-operative bleeding (p=0.01) and increased the number of para-aortic nodes retrieved (p=0.02). There was no significant difference in hospital stay or lymphocele requiring treatment (8.6% in group 1, 8.5% in group 2: p=0.98). For senior than for junior surgeons, surgery time was shorter but not significantly (p=0.80) and postoperative lymphocele rates were identical. CONCLUSION Ultrasonic advanced energy may provide benefit in laparoscopic para-aortic lymphadenectomy, facilitating surgical ergonomics, but did not decrease post-surgery lymphocele.
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Affiliation(s)
- Gery Lamblin
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
| | - Lauriane Chauvy
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Corinne Rannou
- Department of Radiology, Femme Mère Enfant University Hospital, Lyon, France
| | - Patrice Mathevet
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Philippe Chabert
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Georges Mellier
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Gautier Chene
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
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Salvia R, Malleo G, Marchegiani G, Butturini G, Esposito A, Bassi C. Pancreaticoduodenectomy with harmonic focust curved shears for cancer. Dig Surg 2014; 31:249-54. [PMID: 25323993 DOI: 10.1159/000363071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/19/2014] [Indexed: 12/12/2022]
Abstract
Ultrasonically activated shears enable the effective cutting and hemostasis of tissue, and have been shown to offer significant benefits in surgical procedures requiring fine dissection. Harmonic Focus®, one of the latest ultrasonic devices, is a clip-like, light-weight, hand-held instrument with curved thin shears. Experience with Harmonic Focus in pancreatic surgery is limited. We have performed more than 1,000 pancreatic resections with this device. It may well represent a valuable tool for the extensive tissue and vascular dissection that is required in pancreaticoduodenectomy. In particular, Harmonic Focus performs very well in lymph node dissection, which is central in cancer surgery. In this report, we describe pancreaticoduodenectomy for pancreatic-head and periampullary cancer with the Harmonic Focus device.
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Affiliation(s)
- Roberto Salvia
- Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
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Ebner F, deGregorio N, Vorwerk E, Janni W, Wöckel A, Varga D. Should a drain be placed in early breast cancer surgery? Breast Care (Basel) 2014; 9:116-22. [PMID: 24944555 DOI: 10.1159/000360928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. This reduction in surgical procedures calls the need for a drain into question. METHOD Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score. RESULTS The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. The data regarding wound infection and drain insertion is inconclusive. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in outpatient seroma aspirations. CONCLUSION The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments.
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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. [PMID: 24186056 DOI: 10.1007/s10549-013-2746-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
In the sentinel node era, axillary dissection (ALND) for breast cancer (BC) is required much less frequently than in the past. However, complications, such as prolonged drainage output and seroma formation, are still observed. Harmonic dissection devices (HDDs) are widely used in laparoscopic and minimally invasive surgery to reduce collateral damage during tissue dissection, but its usefulness in breast surgery is unclear. The aim of this study was to evaluate the efficacy of HDDs compared to that of conventional dissection in performing ALND. One hundred thirty-nine women (median age 61 years, range 34-71 years) with confirmed pT1-2 primary infiltrating ductal BC undergoing curative surgery were enrolled in the study. The population was prospectively randomized between two age- and stage-matched arms: group A (cases)-68 (48.9 %) patients (HDD technique), versus group B (controls)-71 (51.1 %) patients (conventional technique). In group B, skin flaps were obtained using a scalpel, scissors, and electrocautery which was never used for ALND. In group A, for each operation time, the HDDs were used exclusively. The mean operative time, intraoperative blood loss, and drainage output were (A vs. B) 95 ± 22 versus 109 ± 25 min, 56 ± 12 versus 86 ± 15 mL, and 412 ± 83 versus 456 ± 69 mL, respectively (p < 0.01). Twenty-nine (20.9 %) patients developed an axillary seroma: 9 (13.2 %) and 20 (28.2 %) for groups A and B, respectively (p = 0.030). Our study confirms that in patients with BC requiring ALND the use of HDDs is more time efficient than conventional surgery, and reduces intraoperative bleeding, the amount of drainage, and the risk of seroma formation. These results may lead to several short- and long-term advantages. Thus, a careful evaluation of the cost-benefits of nontraditional tools, such as HDDs, should be performed in all patients undergoing modified radical or partial mastectomy and ALND for BC.
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Affiliation(s)
- F Lumachi
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), School of Medicine, University of Padua, Padova, Italy,
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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. [DOI: 10.1007/s10353-013-0231-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thomson DR, Sadideen H, Furniss D. Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev 2013; 2013:CD006823. [PMID: 24158902 PMCID: PMC8606254 DOI: 10.1002/14651858.cd006823.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Axillary dissection is commonly performed for breast carcinoma. It is uncertain whether insertion of a drain reduces complication rates. OBJECTIVES To assess the effects of wound drainage after axillary dissection for breast carcinoma on the incidence of postoperative seroma formation. Secondary outcome measures include the incidence of infection and length of hospital stay. SEARCH METHODS We searched the Cochrane Wound and Breast Cancer Group's Specialised Registers (22 February 2013), MEDLINE (1950 to 22 February 2013), EMBASE (1966 to 22 February 2013), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (22 February 2013) for all prospectively registered and ongoing trials (22 February 2013). Reference lists of included studies were handsearched by two independent review authors to look for additional eligible trials. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing wound drainage versus no wound drainage in individuals after axillary dissection for the treatment of breast carcinoma were included. All disease stages were considered. Breast-conserving surgery and mastectomy were considered. Patients undergoing sentinel node biopsy without axillary dissection were not included. No limits were applied to language or study location. Two review authors independently determined the eligibility of each study. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data for each included study using a predesigned data extraction proforma and assessed risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. Discrepancies were resolved by consensus discussion with a third review author. Dichotomous variables were analysed using a Mantel-Haenszel model to produce odds ratios (ORs). Continuous variables were analysed using an inverse variance model to produce a mean difference (MD). MAIN RESULTS Seven RCTs including 960 participants were identified. The quality of trials was generally low, with several studies at risk of selection bias, and no studies used blinding during treatment or outcome assessment. There was a high level of statistical variation between the studies, which therefore reduces the reliability of the evidence. The OR for seroma formation was 0.46 (95% confidence interval (CI) 0.23 to 0.91, P = 0.03) in favour of a reduced incidence of seroma in participants with drains inserted. There was no significant difference in infection rates between drainage and no drainage groups (OR = 0.70; 95% CI 0.44 to 1.12, P = 0.14). The mean difference in length of hospital stay, reported in four trials consisting of 600 participants, was 1.47 days greater in the drained population (95% CI 0.67 to 2.28, P = 0.0003). A mean difference of 0.79 fewer postoperative seroma aspirations was found in the drained population (95% CI 1.23 to 0.35 fewer, P = 0.0004) in two trials including 212 participants. No significant difference in volume of seroma aspirations was reported (MD -19.44, 95% CI -59.45 to 20.57, P = 0.34) in three trials including 519 participants. No significant difference in the incidence of lymphoedema was noted (OR 2.31 favouring no drainage, 95% CI 0.47 to 11.37, P = 0.30), with only six instances reported in three trials of 360 participants, nor was any significant difference in the incidence of haematoma observed (OR 1.68, 95% CI 0.33 to 8.51, P = 0.53), with only five instances reported in two trials of 314 participants. AUTHORS' CONCLUSIONS There is limited quality evidence that insertion of a drain following axillary lymphadenectomy reduced the odds of developing a seroma and reduced the number of post-operative seroma aspirations. These benefits should be balanced against an increased length of hospital stay in the drained population.
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Affiliation(s)
- David R Thomson
- Oxford University Clinical Academic Graduate School, University of Oxford, John Radcliffe Hospital, Medical Sciences Division, Level 3, John Radcliffe Hospital., Oxford, Oxfordshire, UK, OX3 9DU
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He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, Lv Z, Chai J, Cao L. Harmonic Focus Versus Electrocautery in Axillary Lymph Node Dissection for Breast Cancer: A Randomized Clinical Study. Clin Breast Cancer 2012; 12:454-8. [PMID: 23040644 DOI: 10.1016/j.clbc.2012.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/17/2012] [Accepted: 07/09/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, Jinan, People's Republic of China.
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Abstract
Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques.
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Affiliation(s)
- Marc Thill
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck Campus, Frankfurt, Germany
- Department of Gynecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Kristin Baumann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck Campus, Frankfurt, Germany
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