scholarly journals A study showing efficacy of harmonic scalpel over electrocautery in modified radical mastectomy

2017 ◽  
Vol 4 (4) ◽  
pp. 1422 ◽  
Author(s):  
Anandaravi B. N. ◽  
Praveen P. Nair ◽  
Mohammed Anwar Aslam
Keyword(s):  
Blood Loss ◽  
Axillary Dissection ◽  
Breast Tissue ◽  
Harmonic Scalpel ◽  
Operating Time ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Drainage Volume ◽  
Group A ◽  
Group B

Background: The dissection in breast surgeries can be done using sharp scalpel and scissor dissection and high frequency electrocautery. Rarely, radiofrequency ablation and laser had been used in some limited trails. This study aims to prove the efficacy of harmonic scalpel over electrocautery in modified radical mastectomy operation.Methods: In this study, we included 40 patients with operable breast cancer. The patients were randomized into two equal groups by closed envelope technique to do modified radical mastectomy either using harmonic scalpel (group A) or using electrocautery (group B). The efficacy of two procedures were compared intraoperatively and postoperatively. The intraoperative parameters used were total time taken for surgery, time taken for axillary dissection, time for raising the flaps and time taken dissection of the breast tissue and the amount of blood loss. The post-operative parameters used were total drainage volume, days of drainage and seroma formation.Results: Our study showed use of harmonic sclalpel in modified radical mastectomy, resulted in reduction in total operating time (t= 4.037, p=0.00) as well as reduction in time taken for axillary dissection (t=3.66, p=0.001) and the amount of blood loss (t=3.02, p=0.00). The total drain volume (t=3.031, p=0.004) and the days of drainage (t=5.97, p=0.00) were also less with the harmonic scalpel dissection as compared to electrocautery.Conclusions: The use of harmonic scalpel in modified radical mastectomy shortens the operating time, axillary dissection time, amount of blood loss and drainage volume and drainage day and hence the hospital stay.

scholarly journals COMPARATIVE STUDY OF SEROMA FORMATION IN HARMONIC SCALPEL VERSUS ELECTROCAUTERY IN POST MODIFIED RADICAL MASTECTOMY

2021 ◽  
Vol 71 (2) ◽  
pp. 451-53
Author(s):  
Muhammad Farooq Shahid ◽  
Taseer Ibrahim ◽  
Muhammad Ali Muazzam ◽  
Hummaira Chaudhry ◽  
Usman Shah Bukhari ◽  
...  
Keyword(s):  
Harmonic Scalpel ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
Military Hospital ◽  
Modified Radical Mastectomy ◽  
Quasi Experimental ◽  
Group A ◽  
Group B ◽  
Surgery Department ◽  
Mean Time

Objective: To compare the frequency of seroma formation in harmonic scalpel vsunipolar electrocautery in post modified radical mastectomy (MRM). Study Design: Quasi experimental study. Place and Duration of Study: General Surgery Department, Pak Emirates Military Hospital Rawalpindi, from Jul to Dec 2017. Methodology: Eighty women with breast carcinoma planned for modified radical mastectomy were included in the study with inclusion and exclusion criteria and divided in equal group A (Harmonic) and group B (Unipolar cautery). Randomization was performed by lottery method for both groups. A standard level III clearance was performed. All patients were followed up on weekly basis and seroma formation was evaluated in both groups. Results: Mean age in group A and B was 51.36 ± 11.04 years vs 52 ± 11.19 years (p>0.05). Mean duration of complain in group A and B was 1.675 ± 0.47 months vs 1.775 ± 0.42 (p>0.05). Mean time of procedure in group A and B was 110.00 ± 4.71 mins vs 100.875 ± 5.14 (p>0.05). Mean body mass index in group A and B was 30.217 ± 4.99 kg/m2 vs 30.210 ± 5.31 kg/m2 (p>0.05). Seroma formation in group A and group B patients were found to be 5 (12.5%) vs 10 (25%) with (p>0.05). Conclusion: Frequency of seroma formation in harmonic scalpel is lower than electrocautery in post modified radical mastectomy, so it can be safely performed along with harmonic scalpel with reduced duration of drainage and seroma formation.

Comparison between Scissors and Electrocautery in Seroma Formation Following Modified Radical Mastectomy (MRM)

2020 ◽  
Vol 23 (2) ◽  
pp. 87-89
Author(s):  
Hasnat Zaman Zim ◽  
SM Amjad Hossain ◽  
Abul Bashar Mohammad Khurshid Alam ◽  
Samia Shihab Uddin
Keyword(s):  
Axillary Dissection ◽  
Skin Flap ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
Modified Radical Mastectomy ◽  
Chi Square ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background and Objective: Seroma is encountered as the commonest complication after mastectomy. Though various factors are suspected in causation of seroma, in this prospective study we tried to evaluate role of two different surgical technique of MRM in causation of seroma formation. Materials and Methods: In this observational comparative study, a total 90 patient of early breast carcinoma who had undergone Modified Radical Mastectomy (MRM) in 3 tertiary care hospitals of Dhaka were divided into 2 groups. In Group A, we used electrocautery for raising the skin flap and axillary dissection while in Group B we used curved Metzenbaum scissors to raise the skin flap along with aid of suture ligation for axillary dissection. Incidence of seroma formation was compared in both the groups. Results: Incidence of seroma was significantly higher with use of electrocautery. Results in both the groups were compared by Chi-square method, and statistically significant difference in incidence of seroma formation was found between two groups. Conclusion: Breast surgery, as MRM does not support injudicious use of electrocautery. Journal of Surgical Sciences (2019) Vol. 23(2): 87-89

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

2021 ◽  
Vol 17 (1) ◽  
pp. 52-55
Author(s):  
Shiraz Shaikh ◽  
Ambreen Munir ◽  
Shahnawaz Abro ◽  
Shahida Khatoon ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
General Surgery ◽  
Stable Condition ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
University Hospital ◽  
P Value ◽  
Modified Radical Mastectomy ◽  
Group A ◽  
Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

Comparison of Efficacy of I/V Tramadol and Bupivacaine Irrigation through Drains after Modified Radical Mastectomy

2021 ◽  
Vol 15 (11) ◽  
pp. 3007-3011
Author(s):  
Zarqa Rani ◽  
Iqra Mushtaq ◽  
Mehreen Akram ◽  
Zahra Ishrat
Keyword(s):  
Breast Cancer ◽  
Urinary Retention ◽  
Controlled Trial ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Modified Radical Mastectomy ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at 0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at 0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects. Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension

scholarly journals Laparoscopically assisted Adenomyomectomy Using the Double/Multiple-Flap Method with Temporary Occlusion of the Bilateral Uterine Artery and Utero-Ovarian Vessels in Comparison with the Double/Multiple-Flap Only Method

2021 ◽  
Vol 81 (03) ◽  
pp. 321-330
Author(s):  
Limei Ji ◽  
Lanying Jin ◽  
Shunjie Zheng ◽  
Mingjun Shao ◽  
Dawei Cui ◽  
...  
Keyword(s):  
Blood Loss ◽  
Uterine Artery ◽  
Operating Time ◽  
Significant Difference ◽  
Group A ◽  
Vas Scores ◽  
Temporary Occlusion ◽  
Group B ◽  
Uterine Volume

Abstract Introduction Adenomyomectomy is the most conservative surgical treatment for adenomyosis. However, the surgical efficacy of this treatment and the best approach to use are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using the double/multiple-flap method combined with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels to treat symptomatic adenomyosis. Patients We recruited 155 patients with symptomatic adenomyosis and divided them into group A (n = 76) and group B (n = 79), with each group treated using a different surgical approach. All eligible women were informed of the potential complications, benefits, and alternatives of each approach before they were assigned into one of the two groups. In group A, we performed laparoscopic adenomyomectomy with the double/multiple-flap method while in group B, we performed a double/multiple-flap adenomyomectomy combined with temporary occlusion of the bilateral uterine artery and utero-ovarian vessels. Over a 24-month follow-up period, we evaluated operating time, intraoperative blood loss, visual analog scale (VAS) scores, anti-Mullerian hormone levels, uterine volume, and relief of menorrhagia. Results There were no significant differences between groups A and B with respect to VAS scores, relief of menorrhagia and uterine volume at 3 months, 6 months, 12 months and 24 months after surgery (p > 0.05). Both groups showed significant improvement of these parameters after surgery compared with preoperative values (p < 0.05). Blood loss in group B was significantly lower than in group A (p < 0.001) while there was no significant difference in operating times (p > 0.05). Levels of AMH did not differ significantly between the groups throughout the follow-up period (p > 0.05). Conclusion Laparoscopic adenomyomectomy with temporary occlusion of the bilateral uterine artery and the utero-ovarian vessels offers a feasible surgical option to treat symptomatic adenomyoma.

scholarly journals Minilaparotomy hysterectomy Versus laparoscopic hysterectomy for benign uterine lesions A Comparative study

2020 ◽  
Vol 3 (4) ◽  
pp. 01-06
Author(s):  
Ayman El-Dorf
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Vessel Sealing ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Bipolar Vessel Sealing ◽  
Bipolar Vessel

Background: Hysterectomy is world wide's second most commonly done gynecological surgery, second only to the caesarean section. There is no general consensus, however, about the optimal hysterectomy process. Hysterectomy may be achieved through different techniques such as stomach, vaginal and laparoscopic. The goal of the study is to explore whether the hysterectomy of minilaparotomy for benign uterine lesions may be a viable option to laparoscopic hysterectomy in terms of short-term operational and postoperative performance. Methods: 105 patients who were due to undergo complete hysterectomy for a benign uterine lesion were split into 3 categories according to their preference of therapeutic therapy method: group A (35 patients) minilaparotomy hysterectomy utilizing traditional sutures. Group B (35 patients) minilaparotomy hysterectomy utilizing bipolar vessel sealing procedure (Ligasure). Group C (35patients) laparoscopic hysterectomy using Ligasure. Result (s): The operating time in Group A (84.71 ± 9.91 minutes), group B (55.31 ± 7.81 minutes), while group C (94.81 ± 16.1 minutes).The duration until resumption of intestinal sounds in group C (12.31 ± 2.51 hours) in comparison to group A (17.41 ± 1.91 hours) and group B (16.51 ± 1.761 hours). Blood loss in group B (99.11 ± 30.81 ml), group A (130.31 ± 54.41 ml) and group C (136.61 ± 6.61 ml). The longest hospital stay occurred in group A (31.8 1± 5.71 hours) versus groups B (20.71 ± 2.51 hours) and C (19.31 ± 6.1 hours). The highest pain score was observed in group A (5.21 ± 1.11) versus groups B (3.81 ± 1.61) and C (3.71 ± 1.21). There was no significant difference in the incidence of intraoperative or postoperative complications. Conclusion (s): Less operational time and intraoperative blood loss were correlated with the usage of ligasure bipolar vessel sealing device in minilaparotomy hysterectomy, whereas it was comparable to laparoscopic hysterectomy in hospital stay and low morbidity postoperative pain scoring and a limited hospital stay. It can be an acceptable alternative to laparoscopic hysterectomy, suitable in areas without laparoscopic experience or facilities.

scholarly journals Comparison of Axillary Exclusion Versus no Exclusion on Seroma Formation after Modified Radical Mastectomy

2021 ◽  
Vol 15 (1) ◽  
pp. 32-35
Author(s):  
Soofia Irfan ◽  
◽  
Muhammad Yaqoob ◽  
Sajid Rehman Randhawa ◽  
Muhammad Faisal Bilal Lodhi ◽  
...  
Keyword(s):  
Radical Mastectomy ◽  
Ethical Review ◽  
Common Side Effect ◽  
Axillary Lymph Nodes ◽  
P Value ◽  
Axillary Lymph ◽  
Modified Radical Mastectomy ◽  
Prolonged Stay ◽  
Group A ◽  
Group B

Background: Accumulation of seroma in axilla and under mastectomy flaps is a common side effect after axillary lymph nodes dissection in mastectomy, which requires repeated aspirations and prolonged stay of the drain causing discomfort to person. Objective: To determine the effectiveness of axillary exclusion technique versus no axillary exclusion in Modified Radical Mastectomy in terms of mean drain output. Study Design: Randomized control trial. Settings: The study was conducted in department of Surgery, Allied Hospital Faisalabad Pakistan. Duration: 1 year from August 08, 2018 to August 07, 2019. Methodology: After permission from Hospital Ethical Review Committee, 60 Patients presenting for mastectomy were included in the study. They were randomly divided into two equal groups of 30 patients each applying computer generated random number table. Group A (underwent axillary exclusion) and Group B (did not undergo axillary exclusion) after modified radical mastectomy. Total amount of fluid collected in drain bag postoperatively was noted till the removal of drain and compared between the groups. Data was entered in a pre-designed proforma. Results: Comparison of axillary exclusion technique with no exclusion after modified radical mastectomy was done, it showed that the mean of the total drain output (+SD) in Group A was 1112.4ml (+66.78) whereas mean output in Group-B was 2184ml (+117.06). (Table No.1). p-value was <0.001 showing a considerable decrease in the total volume of the seroma fluid drained between the two groups. Conclusion: Study concluded that the axillary exclusion technique significantly reduces drain output in patients following modified radical mastectomy as compared to those who do not undergo axillary exclusion.

scholarly journals A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast

2021 ◽  
Vol 28 (1) ◽  
pp. 97-104
Author(s):  
Ananya Deori ◽  
Nikhil Gupta ◽  
Arun Kumar Gupta ◽  
Raghav Yelamanchi ◽  
Himanshu Agrawal ◽  
...  
Keyword(s):  
Axillary Dissection ◽  
Operating Time ◽  
Seroma Formation ◽  
Controlled Study ◽  
Ultrasonic Dissector ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Background: Axillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM. Methods: A parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared. Results: Group A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups. Conclusion: Ultrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.

Prospective, randomized trial comparing harmonic scalpel and electrocautery in breast surgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12014-e12014
Author(s):  
Tsuyoshi Mori ◽  
Hajime Abe ◽  
Yuki Kawai ◽  
Koichiro Murakami ◽  
Hiroya Akabori ◽  
...  
Keyword(s):  
Lymph Node ◽  
Blood Loss ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Harmonic Scalpel ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Group A ◽  
Group B

e12014 Background: The objective of this study was to compare the potential advantages of the harmonic scalpel with those of electrocautery for axillary lymph node dissection in breast surgery. Methods: A prospective randomized study of axillary lymph node dissection procedures performed between March 2011 and September 2012 was conducted. Primary breast cancer patients with axillary node-positive status (n = 25) were randomly assigned to the harmonic scalpel (group A, n = 13) or electrocautery (group B, n = 12) groups.The patients underwent breast-conservation surgery or mastectomy with a level I and II axillary dissection, which was performed by one surgeon. The time required for resection and the blood loss during the lymphadenectomy were recorded. The HARMONIC FOCUS (Ethicon Endo-Surgery, Inc.) was used as the ultrasonic scalpel. A low-pressure vacuum drain was placed in the axilla and removed when the drainage volume reduced to less than 50 ml over 24 hours. After the operations, the patients were assessed for the presence of seroma in an outpatient setting. Results: Resection timein group A was significantly shorter than that in group B (mean, 28.6 ± 5.1 vs. 40.3 ± 5.6 min; P = 0.0001). Similarly, blood loss in group A was significantly lower than that in group B (mean, 7.9 ± 5.3 vs. 22.9 ± 11.5 ml; P = 0.001). Duration of drain placement in group A was significantly lower than that in group B (mean, 3.5 ± 1.1 vs. 5.0 ± 0.9 days; P = 0.01), and the seroma rate in group A was lower than that in group B (23% vs. 66%; P = 0.04). Conclusions: For axillary lymph node dissection, the harmonic scalpel is more effective in terms of resection time, blood loss, duration of drain placement, and postoperative seroma formation.

scholarly journals Thoracic fascial planes blocks in operative bed of modified radical mastectomy and their role in alleviating post-mastectomy pain: a prospective randomized study

2021 ◽  
Vol 9 (1) ◽  
pp. 6
Author(s):  
Mohamed F. Abdelhalim ◽  
Mohamed A. Elbegawy
Keyword(s):  
Breast Surgery ◽  
Randomized Study ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Pain Scores ◽  
Lower Pain ◽  
Group A ◽  
Metastatic Activity ◽  
Group B ◽  
Better Than

Background: Proper pain management after modified radical mastectomy is crucial for improving postoperative outcomes, reducing tumor recurrence, enhancing anti-metastatic activity and achieving excellent patient`s satisfaction. Thoracic fascial planes (TFP) blocks are novel, and safe analgesia modalities to control postmastectomy pain. This study was designed to assess the efficacy and safety of intraoperative TFP blocks for providing postoperative analgesia after modified radical mastectomy.Methods: During the period from March 2020 to April 2021, 30 females (ages 25–67 years) were scheduled for elective MRM and selected randomly to one of two groups; group-A included 15 patients who underwent MRM and anesthetized with both general anesthesia and regional anesthesia (TFP blocks), group-B included 15 patients who underwent MRM and anesthetized with only general anesthesia.Results: The group-A had statistically significantly lower pain scores. The time of first rescue nalbuphine dose post-operatively was statistically significantly longer in group-A compared to group-B. The total 24h nalbuphine consumption and postoperative non-steroidal ketorolac requirements/48h were significantly lower in group-A compared to group-B. Satisfaction score in group-A was statistically significantly better than that in group-B.Conclusions: Intraoperative thoracic fascial planes blocks are simple, safe, and highly effective analgesic modalities after breast surgery.

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