A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20171154Keywords:
Harmonic scalpel, Modified radical mastectomy, SeromaAbstract
Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.
Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.
Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.
Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.
References
Kurtz SB, Frost DB. A comparison of two surgical techniques for performing mastectomy. Eur J surg Oncol. 1995;21:143-5.
Oldel RC, Laparoscopic electrosurgery. In Hunter JG, Sackier Jm, Minimally invasive surgry. New York:McGraw Mill.1993;33-41.
Voyles CR, Tucker RD. Education and engineering solutions for potential problems with laparoscopic monopolar electrocautery. Am J Surg. 1992;164:57-62.
Dessole S, Rubattu G, Capobianco G. Utility of bipolar electrocautery scissors for abdominal hysterectomy. Am J Obest Gynecol. 2000;183:57-62.
Barret C, Capelluto E, Champault G. Intraperitoneal thermal variations during laparoscopic surgery. Surg Endosc. 1994;4:92-9.
Amaral JF. The experimentaldevelopment of ultrasonically activated scalpel for laparoscopic use. Surg laparosco Endose. 1996;10:71-3.
Votilainen PE, Hapiainem PK, Haglund CH. Ultrasonically activated shears in thyroid surgery. Am J Surgen. 1998;175:491-3.
Mc Carus SD. Physiological mechanism of the ultrasonically activated scalpel. J Am. 1996;3:601-8.
Kanehira E, Omura K, Kinoshita T, Kawakami K, Watanbe Y. How secure are the arteries occlude by a newly developed ultrasonically activated device? Surg Endose. 1999;13:340.
Hambley R, Heba PA, Abell E, Cohen BA, Jegasothy BV. Wound healing of skin inscisions produced by ultrasonically vibrating knife, scalpel, electrosurgery and carbondioxide laser.J Dermatol Syrg oncol. 1988;14:1213-7.
Amstrong DN, Armbroze WL,Schertzer ME, Orangio GR. Harmonic scalpel vs electrocautery haemorrhoidectomy : a prospective evaluation. Dis Colon Rectum. 200;44(4):558-64.
Friend GM. Haemostatic tools for gastrointestinal surgeon: Ultrasonic coagulator vs bipolar ligation. J gastrointest Surg. 2001;5:1-3
Bland M. An introduction to Medical Statistics. 3rd edn. Oxford Medical Publications. 1987;160-260.
Tejler G, Aspergren K. complications and hospital stay after surgery for breast cancer: a prospective study B J Surg. 1985;72:542-4.
Deo SVS, Shulka NK, Ashana S, Niranjan, Sonivas G. Modified Radical mastectomy using harmonic scalpel. Singapore Med J. 2002;43:226-8.
Swanstorm LL, Pennings JL. Laparoscopic control of short gastric vessels. J Am Coll Surg. 1995;181:347-51.
Hoefer Ra Jr, Dubois JJ, Ostrow LB. Wound complications following modified radical mastectomy: an analysis of perioperative factors. JAMA. 1990;90:47-53.
Tarterr PI, Burrows L, Papatestas AE. Perioperative transfusion has prognostic significance for breast cancer surgery. 1985;97:225-9.
Porter A, O’conner S, Rimm E, Lopez M, electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176:8-11.
