Effect of harmonic scalpel on seroma formation following surgery for breast cancer: a prospective randomized study.
OBJECTIVE
With the escalating cost of healthcare provision, surgical techniques that could lead to shorter postoperative stay and reducing cost of health provision are welcomed. We report the results of a prospective randomized trial to investigate the role of harmonic scalpel (HS) in reducing postsurgical seroma formation, complications, pain and consequent cost in breast surgery.


METHODS
Thirty-three procedures were carried out on 32 women. Patients were prospectively randomized to either HS or electrocautery (EC). The two cohorts were accordingly matched and postsurgical seroma volumes, complications and pain scores were documented.


RESULTS
There were 16 procedures in the HS and 17 in the EC group. First 48 h drainage, total drained volume, aspirated volume, operative time, pain score, number of patients that developed seromas, number of clinic visits for aspiration, complications and required analgesia were comparable in the two groups. Multivariate analysis showed no significant correlation between the total amount of seroma drainage and the known risk factors (body mass index/BMI, size of the invasive tumor and number of positive nodes).


CONCLUSIONS
No significant reduction in seroma formation or wound complications and pain could be found with the use of HS. We were unable to demonstrate any significant clinical advantages with the use of HS or cost benefit.
Hedley Atkins Breast Unit, Guy's Hospital, London, UK. Michalis_Kontos@yahoo.com
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Kontos
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Kothari
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Hamed
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D049291:Seroma / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D013525:Surgical Instruments; D016896:Treatment Outcome