title: Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance.
abstract: BACKGROUND
  Seroma formation in breast cancer patients who have undergone axillary lymph node dissection (ALND) is a source of significant discomfort and morbidity. We aimed to ascertain seroma incidence after ALND, when Harmonic Focus (HF) scalpel is used for dissection instead of conventional diathermy (CD).
  This retrospective study was carried out in a single hospital over 6 years. Patients were allocated into HF group (HFG) or CD group (CDG). Seroma volume, hospital stay, and complications were evaluated.
  
  
  RESULTS
  Of 94 patients, 42 were in the HFG and 52 in the CDG. Two day median seroma volume was 205 ml (IQR 95-265) for HF, and 227.5 ml (IQR 149-385) for CD. The total median seroma output was 270 ml (IQR 160-478) for HF, and 385 ml (IQR 220-558) for CD. No statistically significant differences between HFG and CDG were identified in these data, as well as patient demographics, operative time, and complication rates. Duration of surgery >2.5 h increased seroma formation (p < 0.001). Mastectomy and ALND increased seroma formation compared to wide local excision (WLE) and ALND (p < 0.05). Nodal involvement, number of lymph nodes resected, and extra nodal spread did not influence seroma formation.
  In our hands, HF use was not superior to CD in limiting seroma formation in ALND for breast cancer. Increased seroma formation in surgeries >2.5 h in duration is commensurate with surgeries involving mastectomy and ALND (>2.5 h in our study), which entails greater and sustained tissue and lymphovascular trauma.
authors.affiliation: Department of Surgery, Westmead Hospital, Westmead, NSW, Australia. Electronic address: tselvendran@hotmail.com.
authors.forename: Selwyn
authors.initials: S
authors.lastname: Selvendran
authors.affiliation: Department of Medicine, St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Cheluvappa
authors.affiliation: Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia.
authors.forename: Vinh Khiêm
authors.initials: VK
authors.lastname: Tr Ng
authors.affiliation: Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Yarrow
authors.affiliation: Department of Surgery, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Tony C
authors.initials: TC
authors.lastname: Pang
authors.affiliation: Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia.
authors.forename: Davendra
authors.initials: D
authors.lastname: Segara
authors.affiliation: Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Breast Cancer, Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: Patsy
authors.initials: P
authors.lastname: Soon
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation; D004322:Drainage; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000295:instrumentation; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*
keywords: Breast cancer; Conventional diathermy; Electrocautery; Harmonic focus; Seroma