title: Evaluation of the harmonic scalpel in breast conserving and axillary staging surgery.
abstract: BACKGROUND
  The ultrasonically activated scalpel has been introduced as an alternative to conventional methods of hemostasis in surgical procedures. The present study investigated the benefits of using the Harmonic FOCUS (HF) scalpel in breast-conserving surgery (BCS) and in axillary staging surgery.
  
  
  METHODS
  All early-stage breast cancer patients who underwent BCS and axillary staging surgery between January 2009 and December 2010 were retrospectively identified. Those patients treated with the HF scalpel were defined as the HF group, while patients whose surgery involved the electrocautery and the clamp-and-tie technique were designated as the conventional method (CM) group. Both groups were subsequently divided into the axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) subgroups, respectively.
  
  
  RESULTS
  A total of 89 patients were included in the study, with 41 patients in the HF group and 48 in the CM group. There were 13 patients in the SLNB subgroup and 28 were in the ALND subgroup of the HF group, and 21 patients were in the SLNB subgroup and 27 in the ALND subgroup of the CM group. Multiple linear regression analysis revealed that the length of surgery was significantly reduced in the ALND subgroup of the HF group (β = -16.70, p < 0.001). The incidence of axillary numbness was significantly decreased in the ALND subgroup of the HF group, with the results measured by multiple logistic regression analysis (OR = 0.27, p = 0.044). No statistically significant differences were identified concerning intraoperative blood loss, postoperative drainage, and seroma between the HF and CM groups.
  
  
  CONCLUSIONS
  Using the Harmonic FOCUS scalpel in breast conserving surgery and axillary lymph mode dissection significantly reduced the length of surgery and decreased the axillary numbness rate as compared to conventional methods.
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Shuo-Hui
authors.initials: SH
authors.lastname: Hung
authors.forename: Dachen
authors.initials: D
authors.lastname: Chu
authors.forename: For-Moon
authors.initials: FM
authors.lastname: Chen
authors.forename: Tom
authors.initials: T
authors.lastname: Chen
authors.forename: Ran-Chou
authors.initials: RC
authors.lastname: Chen
mesh_terms: D001365:Axilla / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation*; D015412:Mastectomy, Segmental / Q000295:instrumentation*; D009367:Neoplasm Staging / Q000295:instrumentation*; D061646:Operative Time; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*