Intraoperative and postoperative outcomes of Harmonic Focus versus monopolar electrocautery after neoadjuvant chemotherapy in breast conservative surgery: a comparative study

Background Surgical devices are commonly used during breast conservative surgery (BCS) to provide better hemostasis. The Harmonic scalpel has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of BCS after neoadjuvant chemotherapy (CTH) compared to the conventional method using monopolar diathermy. Results A prospective, nonrandomized, comparative study was conducted on patients scheduled to undergo BCS with axillary dissection after neoadjuvant CTH. Patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.32 ± 27.3 vs. 139.3 ± 31.9 min, respectively; p < 0.001). Besides, blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 vs. 187 ± 49.8 mL, respectively; p < 0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p < 0.001) and shorter time until drain removal (p < 0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). The incidence of postoperative complications was comparable between both groups (p = 0.128). Conclusions This study confirmed the superiority of Harmonic Focus compared to monopolar electrocautery among patients receiving neoadjuvant CTH before BCS.

Intraoperative and Postoperative Outcomes of Harmonic Focus Versus Monopolar Electrocautery after Neoadjuvant Chemotherapy in Breast Conservative Surgery: A Comparative Study

Background: Surgical devices are commonly used during breast conservative surgery (BCS) to provide better hemostasis. The Harmonic scalpel has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic Focus in reducing postoperative complications of BCS after neoadjuvant chemotherapy (NCTH) compared to the conventional method using monopolar diathermy.Results: A prospective, nonrandomized, comparative study was conducted on patients scheduled to undergo BCS with axillary dissection after NCTH. Patients in the Harmonic Focus group had significantly shorter operative times than the monopolar electrocautery group (101.32 ± 27.3 vs. 139.3 ± 31.9 min, respectively; p < 0.001). Besides, blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 vs. 187 ± 49.8 mL, respectively; p < 0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p < 0.001) and shorter time until drain removal (p < 0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter time until drain removal than monopolar electrocautery (p < 0.001). The incidence of postoperative complications was comparable between both groups (p = 0.128).Conclusions: This study confirmed the superiority of Harmonic Focus compared to monopolar electrocautery among patients receiving NCTH before BCS.

Ultrasonic Shear Device versus Monopolar Electric Cautery in Conservative Breast Surgery Following Neoadjuvant Chemotherapy: A Comparative Study

Background: Surgical devices are commonly used during breast-conservative surgery (BCS) to provide better hemostasis. Ultrasonic shear has recently gained momentum as an effective tool for intraoperative bleeding reduction. This comparative study was designed to determine the efficacy of Harmonic focus in reducing postoperative complications of BCS following neoadjuvant chemotherapy (CTH), in comparison to the conventional method using monopolar diathermy.Methods: We conducted a prospective, non-randomized, comparative, study on patients scheduled to undergo BCS with axillary dissection or sentinel lymph node biopsy after neoadjuvant CTH. Patients were recruited consecutively throughout the study period and were divided in an equal manner to undergo either monopolar electrocautery or Harmonic focus®.Results: Patients in the Harmonic Focus group had significantly shorter operative time than the monopolar electrocautery group (101.32 ± 27.3 versus 139.3 ± 31.9 minutes, respectively; p <0.001). Besides, the blood loss was significantly lower in the Harmonic Focus group (117.14 ± 35.6 versus 187 ± 49.8mL, respectively; p <0.001). Postoperatively, patients in the Harmonic Focus group had a significantly lower volume of chest wall drain (p <0.001) and shorter rime till drain removal (p <0.001). Likewise, patients in the Harmonic Focus group had a significantly lower volume of axillary drain and shorter rime till drain removal than monopolar electrocautery (p <0.001). The incidence of postoperative complications was comparable between both groups (p =0.128). Conclusions: In conclusion, the current study confirms the superiority of Harmonic Focus, compared to monopolar electrocautery, amongst patients receiving neoadjuvant CTH before BCS.

Vessel-Sealing Capability of Novel Microwave Sealer: Experimental Study in Animal Models

Background. Ultrasonically activated dissectors (UADs) and radiofrequency-based devices have been considered excellent surgical devices because of their reliability and flexibility. Meanwhile, microwave-based devices have demonstrated potential with their unique heating mechanism. This study aims to compare the sealing function of a newly invented forceps-like microwave sealer (MS) with that of currently available UADs. Materials and Methods. MS and 2 examples of UADs (Harmonic Focus+ [HF+] and Sonicision [SNC]) were employed to perform mesenterectomies (in vivo) and sealing sizable vessels (ex vivo). Vessel diameter, seal time, burst pressure (BP), sealing completion, and instrument sticking were recorded. The samples underwent histological investigation for thermal damage evaluation. Results. During mesenterectomies, MS required 3 seconds and 30 W to secure a complete seal. The BP achieved by the MS seal was higher than that of HF+ and SNC on arteries (851 ± 203.7 vs 682.4 ± 287.3, P < .05; vs 833.1 ± 251.2 mmHg, P = .4523, respectively) but was not statistically different on veins (324.9 ± 203.5 vs 460.1 ± 320.3 vs 508.3 ± 350.7 mmHg, P = .215). In all trials, MS caused less sticking but exhibited similar heat-induced alterations to UADs. MS’s thermal spread was not statistically more extended than that of UADs on either arteries or veins. Conclusions. MS was capable of not only sealing tiny vessels but also achieving high-pressure endurance on sizable vessels. Its forceful grasping and synchronous heating process helped create solid stumps with an acceptable thermal spread.

Bilateral hypoglossal nerve damage due to the use of the harmonic focus scalpel

We describe the case of a 68-year-old man who presented with an anterior floor of mouth squamous cell carcinoma and underwent bilateral neck dissection. Subsequently, the patient developed permanent bilateral hypoglossal palsies, causing significant dysphagia, dysarthria and breathing difficulties. Hypoglossal nerve damage from surgical causes is uncommon, occurring in only 0.42% of functional neck dissections. However, it is the bilateral and permanent features of this case which make it unique. This injury may have been caused by incorrect use of the Harmonic Focus scalpel. Therefore, we discuss the literature demonstrating that the Harmonic Focus scalpel causes more lateral thermal damage than alternative tools, and the widely accepted 3 mm safety limit is not enough to protect important surrounding structures. This case report aims to highlight the need for proper training and specific identification of the hypoglossal nerve to prevent this rare and debilitating complication occurring in future patients.

Spinal Accessory Dysfunction Following Neck Dissection with Harmonic Scalpel V/S Electrocautery – A Single Centre Experience

Aims: This study is an effort towards comparing the efficacy of the Harmonic Focus and Electrosurgical technique with regard to nerve injury especially spinal accessory nerve and its morbidity postoperatively after neck dissection. Sample: Ninety patients of oral carcinoma who required neck dissection were included in the study. Study Design: This is a prospective study. Place and Duration of Study: Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur, Rajasthan, India for a period of 17 months from November 2016 to March 2018. Methodology: Patients’ post-operative recovery was studied prospectively by using parameters pertaining to shoulder function and shoulder pain. Results: There were significant differences in the pain and abduction deformity at various time periods after surgery. However differences in the quality of life did not show significant difference at the end of 3 months. For up to one month pain scores were lower for Harmonic Focus and shoulder function was better through 3 months. Conclusion: Though the technique of neck dissection (harmonic v/s electro cautery) has significant impact on shoulder dysfunction, despite that in postoperative period shoulder function measured by way of shoulder pain and shoulder abduction recover almost fully during follow-up period without causing significant morbidity and with minimal effect on quality of life. There are few recommendations we would like to suggest that if incorporated, they might significantly affect the outcome and better results.