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      A Comparative Study of the Use of Harmonic Scalpel versus Unipolar Cautery in Modified Radical Mastectomy

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          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 10 th or 11 th 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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          Most cited references26

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          Impact of aging on the biology of breast cancer.

          Christopher C. Benz (2008)
          Breast cancer is a heterogeneous malignancy; its age-specific incidence profile rises exponentially until menopause and increases more slowly thereafter, reflecting the superimposition of early-onset and late-onset breast cancer rates. While early-onset breast cancers largely represent inherited or early life transforming effects on immature mammary epithelium, late-onset breast cancers likely follow extended exposures to promoting stimuli of susceptible epithelium that has failed to age normally. Among stimuli thought to promote late-onset breast tumorigenesis are the altered extracellular matrix and secreted products of senescent fibroblasts; however, the extent to which these senescent influences exist within the aging breast remains unknown. Clinical observations and biomarker studies indicate that late-onset breast cancers grow more slowly and are biologically less aggressive than early-onset breast cancers, even when controlled for hormone receptor (e.g. estrogen receptor, ER) and growth factor receptor (e.g. HER2) expression, supporting the conclusion that the biology of breast cancer is age-dependent.
          Article 0 comments Cited 68 times – based on 0 reviews     Review now
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            Systemic cytokine response after major surgery.

            P Lamont, J. D. Morris, D Kwiatkowski … (1992)
            The systemic cytokine response to major surgical trauma was studied in 20 patients undergoing elective aortic surgery and five patients after inguinal hernia repair. Tumour necrosis factor alpha and interferon gamma were not detected in these patients. An early and short-lived interleukin 1 beta (IL-1 beta) response to major surgery was detected only by intensive sampling in the perioperative period. The IL-1 beta peak preceded a more marked interleukin 6 (IL-6) response that peaked 4-48 h after surgery. IL-6 levels had fallen sharply by 48-72 h in all patients who had an uneventful postoperative course. The IL-6 peaks were significantly lower after hernia surgery than after major aortic operations (P < 0.001); IL-1 beta was not detected in any samples. Three patients undergoing aortic surgery developed unexpected major postoperative complications. IL-6 levels in this group were significantly higher than those of the other patients undergoing aortic surgery within 6-8 h of skin incision, and remained elevated for longer. These rises in plasma IL-6 levels preceded the clinical onset of major complications by 12-48 h. The systemic IL-1 beta and IL-6 response to surgical trauma increased with the severity of the surgical insult. An early, exaggerated IL-6 response was associated with the subsequent clinical development of major complications.
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              Electrocautery as a factor in seroma formation following mastectomy.

              E Rimm, Richard Porter, Roddy O'Connor … (1998)
              Electrocautery has been postulated as a factor in the risk of seroma formation after mastectomy. Eighty consecutive mastectomies in 74 patients were randomly assigned to dissection of the mastectomy flaps with either scalpel (n = 38) or electrocautery (n = 42). Total volume of fluid output through drains and aspirated from seromas was recorded. Other factors investigated included the type of drain utilized, estimated blood loss, and complications. Seromas developed in 16 wounds in the electrocautery group compared with 5 in the scalpel group (38% and 13%, respectively; P = 0.01). Other factors with an independent risk for seroma included use of Jackson-Pratt drains compared with Blake drains (P = 0.006), and lower estimated blood loss (P = 0.006). No differences in characteristics of patients or in other complications were noted. Use of electrocautery to create skin flaps in mastectomy reduced blood loss but increased the rate of seroma formation.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Niger J Surg
                Journal ID (iso-abbrev): Niger J Surg
                Journal ID (publisher-id): NJS
                Title: Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1117-6806
                ISSN (Electronic): 2278-7100
                Publication date (Print): Jan-Jun 2017
                Volume: 23
                Issue: 1
                Pages: 20-25
                Affiliations
                [1]Department of Surgery, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
                [1 ]Medical Student, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Address for correspondence: Dr. Pallavi Mittal, Department of Surgery, Ward No. 4, Government Medical College and Rajindra Hospital, Patiala - 147 001, Punjab, India. E-mail: pallavi_mittal1988@ 123456yahoo.com
                Article
                Publisher ID: NJS-23-20
                DOI: 10.4103/1117-6806.199962
                PMC ID: 5441211
                PubMed ID: 28584507
                SO-VID: 0fc041d5-cf18-4e17-82e0-532c3bce9950
                Copyright © Copyright: © 2017 Nigerian Journal of Surgery
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Original Article

                Keywords: harmonic scalpel,modified radical mastectomy,unipolar cautery
                Data availability:
                Keywords: harmonic scalpel, modified radical mastectomy, unipolar cautery

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