title: Axillary lymph node dissection for breast cancer utilizing Harmonic Focus®.
abstract: BACKGROUND
  For patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach. Due to the rich lymphatic network in the axilla, it is necessary to carefully dissect and identify all lymphatic channels. Traditionally, these lymphatics are sealed with titanium clips or individually sutured. Recently, the Harmonic Focus®, a hand-held ultrasonic dissector, allows lymphatics to be sealed without the utilization of clips or ties. We hypothesize that ALND performed with the Harmonic Focus® will decrease operative time and reduce post-operative complications.
  
  
  METHODS
  Retrospective review identified all patients who underwent ALND at a teaching hospital between January of 2005 and December of 2009. Patient demographics, presenting pathology, treatment course, operative time, days to drain removal, and surgical complications were recorded. Comparisons were made to a selected control group of patients who underwent similar surgical procedures along with an ALND performed utilizing hemostatic clips and electrocautery. A total of 41 patients were included in this study.
  
  
  RESULTS
  Operative time was not improved with the use of ultrasonic dissection, however, there was a decrease in the total number of days that closed suction drainage was required, although this was not statistically significant. Complication rates were similar between the two groups.
  
  
  CONCLUSIONS
  In this case-matched retrospective review, there were fewer required days of closed suction drainage when ALND was performed with ultrasonic dissection versus clips and electrocautery.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9155, USA. katherine.ostapoff@phhs.org
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Ostapoff
authors.forename: David
authors.initials: D
authors.lastname: Euhus
authors.forename: Xian-Jin
authors.initials: XJ
authors.lastname: Xie
authors.forename: Madhu
authors.initials: M
authors.lastname: Rao
authors.forename: Amy
authors.initials: A
authors.lastname: Moldrem
authors.forename: Roshni
authors.initials: R
authors.lastname: Rao
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000556:secondary* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation / Q000706:statistics & numerical data*; D014465:Ultrasonics / Q000295:instrumentation*