Harmonic dissection versus electrocautery in breast surgery in regional Victoria.
BACKGROUND
Harmonic instruments are an alternative tool for surgical dissection. The aim of this study is to evaluate differences in clinical outcomes relating to harmonic dissection when compared with electrocautery in patients undergoing major breast surgery in a regional centre over a 3-year period.


METHODS
Retrospective chart analysis was conducted of 52 patients undergoing major breast surgery for carcinoma or ductal carcinoma in situ by a single surgeon in a regional centre from May 2008 to January 2011. Analysis involved the extraction of qualitative data relating to patient demographics, surgery type and specimen histopathology. Quantitative data were extracted relating to duration of surgery, duration of patient-controlled analgesia (PCA) use, length of hospital admission, drainage output and presence of infection, haematoma or seroma.


RESULTS
Fifty-two patients underwent major breast surgery; harmonic dissection n = 32 and electrocautery n = 20. The two groups were comparable. There was no significant difference identified relating the outcome measures. The median operative duration was shorter in the harmonic dissection group, however, was not of statistical significance. No significant difference was identified between groups relating to length of inpatient stay, duration of PCA use and total volume wound drainage and total days of drainage. Incidence of seroma and infection in the groups was not significantly different.


CONCLUSIONS
The harmonic dissection is safe and effective in major breast surgery. The study did not demonstrate any clinical advantage from the use of harmonic dissection in major breast surgery compared with electrocautery, nor was there any difference in the complication rates measured.
Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Andrew K
AK
Kiyingi
Leigh J
LJ
Macdonald
Sarah A
SA
Shugg
Ruth C
RC
Bollard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation / Q000379:methods*; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014739:Victoria
breast-conserving surgery; diathermy; electrosurgery; mastectomy; ultrasonic therapy