title: A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer.
abstract: BACKGROUND
  Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.
  
  
  METHODS
  A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.
  
  
  RESULTS
  Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002), seroma by 46% (P<0.0001), necrosis by 49% (P=0.04), postoperative chest wall drainage by 46% (P=0.0005), blood loss by 38% (P=0.0005), and length of stay by 22% (P=0.007). Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup.
  
  
  CONCLUSIONS
  In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.
authors.affiliation: Ethicon Inc., Cincinnati, OH, USA.
authors.forename: Hang
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Ethicon Inc., Cincinnati, OH, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Clymer
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Ferko
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Leena
authors.initials: L
authors.lastname: Patel
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Ireena M
authors.initials: IM
authors.lastname: Soleas
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Chris G
authors.initials: CG
authors.lastname: Cameron
authors.affiliation: Ethicon Inc., Cincinnati, OH, USA.
authors.forename: Piet
authors.initials: P
authors.lastname: Hinoul
keywords: complications; dissection; ultrasonic