title: Electrosurgical bipolar vessel sealing during axillary lymphadenectomy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Various methods are currently used during axillary lymphadenectomy. Our systematic review aims to investigate the potential benefits of bipolar vessel sealing systems (EBVS) over conventional suture ligation during the axillary dissection of breast cancer patients.
  
  
  METHODS
  We searched Medline (1966-2014), Scopus (2004-2014), Popline (1973-2014) Cochrane CENTRAL (1999-2014) and ClinicalTrials.gov (2000-2014) together with reference lists from included studies Statistical meta-analysis was performed using the RevMan 5.1 software.
  
  
  RESULTS
  Four studies were finally included, involving 352 patients. Usage of EBVS significantly increased the number of retrieved axillary lymph nodes (MD 1.67 nodes, 95% CI 0.21, 3.13). Intraoperative times were not affected by these new technique, when compared to traditional suture ligation (MD -10.82 minutes, 95% CI -23.27, 2.70). Neither the volume of postoperative axillary drainage (MD -38.47 ml, 95% CI -110.26, 32.59) nor the duration of drainage (MD -0.49 days, 95% CI -1.23, 0.25) were significantly affected by EBVS application. We observed, however, that bipolar systems may be associated with an increased risk of postoperative seroma formation (OR 2.04, 95% CI 1.13, 3.70).
  
  
  CONCLUSIONS
  Electrosurgical bipolar vessel sealing systems seem to increase the accuracy of axillary dissection and are equally safe compared to conventional suture ligation regarding intraoperative and postoperative blood loss. They are associated, however, with and increased incidence of seroma formation. Further randomized trials are needed in the field in order to obtain firm conclusions.
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Athens, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Pergialiotis
authors.affiliation: 2nd Department of Surgery, Medical School, Athens University, Laiko Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kontzoglou
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical School, Athens University, Alexandra Hospital, Athens, Greece.
authors.forename: Dimitirios
authors.initials: D
authors.lastname: Dimitroulis
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical School, Athens University, Alexandra Hospital, Athens, Greece.
authors.forename: Dimitrios-Efthymios G
authors.initials: DE
authors.lastname: Vlachos
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Routsolias
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical School, Athens University, Alexandra Hospital, Athens, Greece.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Vlachos
mesh_terms: D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000098:blood supply; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods
keywords: EBVS; axilla; lymph nodes; mastectomy