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Ikeda N, Akahori T, Yokotani T, Fujii T, Sho M. Total Sealing Technique (TST) with a bipolar vessel sealing system reduces lymphorrhea and seroma formation for axillary lymph node dissection in primary breast cancer. Surg Open Sci 2024; 19:1-7. [PMID: 38590584 PMCID: PMC11000114 DOI: 10.1016/j.sopen.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background The purpose of this study is to evaluate the potential of a novel surgical procedure, the Total Sealing Technique (TST), using the latest bipolar vessel sealing system (BVSS; LigaSure™ Exact Dissector) to reduce lymphatic leakage and seroma formation after electrocautery axillary lymph node dissection (ALND) in breast cancer surgery. Prolonged drainage is a common occurrence after ALND, primarily due to lymphatic leakage. In addition, the presence of seroma often leads to delays in the administration of postoperative adjuvant chemotherapy even after drain removal. Methods We conducted a comparative analysis of 36 patients who underwent total mastectomy with ALND using conventional electrocautery technique (CONV) during the first 3 years, and 35 patients who underwent the same procedure using TST during the subsequent 3 years. The following factors were compared to assess the impact of TST: operation time, blood loss, total drainage volume, mean time to drain removal, postoperative hospital stay, mean time to initiation of postoperative chemotherapy, and postoperative complications in each group. Results TST significantly reduced drainage volume (360.5 vs. 820.6 mL, p < 0.001), days to drain removal (4.8 vs. 6.8 days, p < 0.001), postoperative hospital stay (5.9 vs. 9.6 days, p < 0.001), the incidence of seroma (28.6 % vs. 65.9 %, p = 0.001), and time to chemotherapy initiation (33.1 vs. 61.4 days, p < 0.001) compared to CONV. Conclusions TST in total mastectomy with ALND effectively decreases the incidence of lymphorrhea and seroma formation; thus, it can be recommended for total mastectomy with ALND.
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Affiliation(s)
- Naoya Ikeda
- Department of Surgery, Nara Medical University, Nara, Japan
| | | | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
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Keelan S, Dowling GP, Roche T, Hegarty A, Davey MG, Dhannoon AA, O’Grady S, Downey E, Bolger J, Boland M, Sorensen J, Power C, Butt A, Baban C, Hill ADK. Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial. Br J Surg 2024; 111:znae029. [PMID: 38498075 PMCID: PMC10946413 DOI: 10.1093/bjs/znae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Electrosurgical devices are commonly used during mastectomy for simultaneous dissection and haemostasis, and can provide potential benefits regarding vessel and lymphatic ligation. The aim of this prospective RCT was to assess whether using a vessel-sealing device (LigaSure™) improves perioperative outcomes compared with monopolar diathermy when performing simple mastectomy. METHODS Patients were recruited prospectively and randomized in a 1 : 1 manner to undergo simple mastectomy using either LigaSure™ or conventional monopolar diathermy at a single centre. The primary outcome was the number of days the drain remained in situ after surgery. Secondary outcomes of interest included operating time and complications. RESULTS A total of 86 patients were recruited (42 were randomized to the monopolar diathermy group and 44 were randomized to the LigaSure™ group). There was no significant difference in the mean number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group (7.75 days versus 8.23 days; P = 0.613) and there was no significant difference in the mean total drain output between the monopolar diathermy group and the LigaSure™ group (523.50 ml versus 572.80 ml; P = 0.694). In addition, there was no significant difference in the mean operating time between the groups, for simple mastectomy alone (88.25 min for the monopolar diathermy group versus 107.20 min for the LigaSure™ group; P = 0.078) and simple mastectomy with sentinel lymph node biopsy (107.20 min for the monopolar diathermy group versus 114.40 min for the LigaSure™ group; P = 0.440). CONCLUSION In this double-blinded single-centre RCT, there was no difference in the total drain output or the number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group. REGISTRATION NUMBER EudraCT 2018-003191-13 BEAUMONT HOSPITAL REC 18/66.
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Affiliation(s)
- Stephen Keelan
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Gavin P Dowling
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Trudi Roche
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Matthew G Davey
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Sorcha O’Grady
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Eithne Downey
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jarlath Bolger
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Michael Boland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jan Sorensen
- Health Outcomes Research Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Colm Power
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Abeeda Butt
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Chwanrow Baban
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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Mehra K, Kapashi K, Khemchandani S, Modi PR, Rizvi SJ. Prospective comparison of suture ligation and electrothermal sealing for the control of perivascular lymphatics in kidney transplant recipients. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:245-252. [PMID: 36704804 PMCID: PMC9832589 DOI: 10.4285/kjt.22.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The use of sutures as ligatures has proven to be safe and reliable for the control of lymphatic vessels. The electrothermal bipolar vessel sealer (EBVS) is a relatively new type of device that can be used to seal lymphatics. We conducted a study to evaluate the safety and efficacy of EBVS for preparation of the recipient vessel during renal transplantation. Methods In this prospective randomized controlled study, EBVS (Medtronic) was compared with conventional ligature for the control of perivascular lymphatics in kidney transplant recipients. A total of 52 kidney transplant recipients were randomly assigned to two groups. In group 1, EBVS was used to control perivascular lymphatics, while conventional silk ligatures were used in group 2. Demographic characteristics, as well as preoperative, perioperative, and postoperative variables, were noted and compared between the groups. Results The mean recipient vessel preparation time was 8.3±1.9 minutes in group 1 and 14.5±4 minutes in group 2 (P<0.001). The mean anastomosis time was 28.2±5.4 minutes in group 1 and 28.2±4.2 minutes in group 2 (P=1.000). The mean estimated blood loss was 101.54±44.60 mL in group 1 and 125.19±74.17 mL in group 2 (P=0.270), and the mean drain output was 51.42 mL per day and 57.50 mL per day in groups 1 and 2, respectively (P=0.590). Conclusions EBVS can be employed safely and effectively for recipient iliac lymphatic vessel dissection and sealing. EBVS is a fast, secure, and effective choice to permanently fuse the vessels and is a good option to avoid posttransplant lymphatic complications.
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Affiliation(s)
- Ketan Mehra
- Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India
| | - Kushal Kapashi
- Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India
| | - Sajni Khemchandani
- Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India
| | - Pranjal Ramanlal Modi
- Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India
| | - Syed Jamal Rizvi
- Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India,Corresponding author: Syed Jamal Rizvi Department of Urology, Institute of Kidney Disease and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016, India, Tel: +91-93-2826-2946, Fax: +91-79-2268-5454, E-mail:
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Wienerroither V, Hammer R, Kornprat P, Schrem H, Wagner D, Mischinger HJ, El-Shabrawi A. Use of LigaSure vessel sealing system versus conventional axillary dissection in breast cancer patients: a retrospective comparative study. BMC Surg 2022; 22:436. [PMID: 36544128 PMCID: PMC9773442 DOI: 10.1186/s12893-022-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and-most frequently-seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome. METHODS A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid. RESULTS Seventy one female patients with a median age of 63 (30-83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005). CONCLUSION LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.
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Affiliation(s)
- V. Wienerroither
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - R. Hammer
- Department of Surgery, LKH Graz II, Graz, Austria
| | - P. Kornprat
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. Schrem
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - D. Wagner
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. J. Mischinger
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - A. El-Shabrawi
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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Park HS, Lee J, Kim JY, Park JM, Kwon Y. A Prospective Randomized Study to Compare Postoperative Drainage After Mastectomy Using Electrosurgical Bipolar Systems and Conventional Electro-Cautery. J Breast Cancer 2022; 25:307-317. [PMID: 35914746 PMCID: PMC9411027 DOI: 10.4048/jbc.2022.25.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Advanced energy devices, including electrosurgical bipolar systems or ultrasonic shears, are widely used in various surgeries. An electrosurgical bipolar device allows surgeons to grasp and dissect tissues, as well as simultaneously ligate and cut vessels and lymphatics during surgery. This study aimed to evaluate the effects of advanced bipolar energy devices on the reduction in seroma formation during mastectomy, axillary staging, and/or reconstruction. METHODS This prospective randomized clinical trial with a 1:1 ratio compared the use of an electrosurgical bipolar device, LigaSureTM (LGS), against conventional cut-and-ligate techniques in mastectomy with axillary procedures for patients with breast cancer. A total of 82 patients with breast cancer who underwent definitive surgery were enrolled in this study. The primary endpoint was the total drainage volume after surgery. RESULTS The clinicopathological characteristics of the two groups were not significantly different. The total postoperative drainage volume was significantly lower in the LGS group than in the control group (756.26 mL vs. 1,167.74 mL, p = 0.009). The actual postoperative drainage volume and duration also decreased significantly in the LGS group compared with those in the control group (all p < 0.05). The rate of postoperative complications was lower in the LGS group than in the control group (9.8% vs. 27.5%, p = 0.05). CONCLUSION Electrosurgical bipolar devices showed better performance in terms of decreasing postoperative drainage during mastectomy and axillary staging and/or reconstruction.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
| | - Jeea Lee
- Department of Surgery, Uijeongbu Eulji, Medical Center, Eulji University, Uijeongbu, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Mi Park
- Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
| | - Yonghan Kwon
- Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
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Gambardella C, Clarizia G, Patrone R, Offi C, Mauriello C, Romano R, Filardo M, Conzo A, Sanguinetti A, Polistena A, Avenia N, Conzo G. Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation. BMC Surg 2019; 18:125. [PMID: 31074399 PMCID: PMC7402581 DOI: 10.1186/s12893-018-0454-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is the most frequent neoplasm in women. Axillary lymph nodes dissection represents the treatment of choice in locally advanced breast cancer for prognostic and curative purposes. Seroma formation, an abnormal collection of fluid in the dead space of the axilla, is described in Literature with a wide range of incidence (3–85%). It is a source of significant morbidity and discomfort. The aim of the study is to compare the different haemostasis devices used in breast surgery, investigating the eventual superiority of an instrument among the others in terms of intraoperative and postoperative outcome, especially of seroma formation. Methods Clinical cases of female patients undergone axillary lymph nodes dissection for local advanced breast cancer between January 2013 and July 2017 at the Surgery Unit of University of Campania “Luigi Vanvitelli” were retrospectively reviewed. Patients were divided into four groups, according to device utilized during surgery: Electrocautery, Harmonic Scalpel, LigaSure and Thunderbeat. All patients underwent II level axillary lymph nodes dissection associated to radical mastectomy or quadrantectomy. Results One hundred consecutives patients were enrolled in the study. Intra-operative blood loss resulted statistically significant different (P < 0,01) between the Electrocautery group (94,7 ml) and the Thunderbeat group (57,2 ml), while the Harmonic Scalpel group and the Ligasure group, despite presented a lower amount of blood loss, did not differ significantly. Drainage volume resulted significantly lower (P = 0,002) in the comparison between the Electrocautery group and the Thunderbeat group; the Ligasure group and Harmonic Scapel group showed no difference between them and Electrocautery group. About the seroma formation, the Electrocautery group resulted affected by the highest seroma formation rate (64%). Seroma incidence in Harmonic Scalpel group was 24%, in Ligasure group was 44%, while Thunderbeat group showed the lowest presentation of seroma with 16%. Conclusions In patients affected by breast cancer requiring axillary lymphnodes dissection, the use of advanced hemostasis devices is highly desirable. Among the non-traditional tools, Thunderbeat resulted to be superior in terms of reduction of intra-operative blood loss and post-operative drainage output, moreover associated to a substantial reduction of postoperative seroma incidence.
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Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Renato Patrone
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Roberto Romano
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marco Filardo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Alessandra Conzo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery - Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
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Seroma in breast surgery: all the surgeons fault? Arch Gynecol Obstet 2018; 298:951-959. [PMID: 30196358 DOI: 10.1007/s00404-018-4880-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite a trend for less radical surgical approaches in breast cancer due to better understanding of tumour biology and new treatment options such as neoadjuvant chemotherapy (NAC) and intra-operative radiotherapy (IORT), seroma production remains one of the main surgical side effects that can result in prolonged recovery, delay of radiotherapy and patient discomfort. The aim of this study is to provide an update on risk factors for seroma production after breast cancer surgery considering the latest treatment options. METHODS A retrospective analysis of seroma production in primary breast cancer patients treated between 01.01.2010 and 31.12.2014 at the Breast Cancer Centre, University Hospital Ulm, was performed. Patients with previous breast/axillary surgery or more than one intervention were excluded. Seroma formation was measured using wound drains placed in breast and axilla. RESULTS In total, 581 patients met the inclusion criteria. Median age at diagnosis was 60 years, and median BMI 25.6 kg/m2. 60 (10.3%) patients had a mastectomy, 175 (30.1%) patients received IORT, and 72 (12.4%) patients received NAC. Median amount of seroma production was 82.5 ml (range 0-3012.5 ml). Multivariate analysis revealed that most of the observed variation in seroma production was due to type of surgery (mastectomy vs. breast conserving), length of surgery and number of removed lymph nodes. Both NAC and IORT explained a significant but very small amount of the observed variation in seroma production. CONCLUSION The most important factors for seroma production are extent and duration of breast surgery.
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Lucan CV, Jurchis I, Suciu M, Selicean SE, Buttice S. Modern lymphatic dissection techniques for preventing post renal transplant lymphocele. Med Pharm Rep 2017; 90:416-419. [PMID: 29151791 PMCID: PMC5683832 DOI: 10.15386/cjmed-716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aims Development of a lymphocele is a well-known complication following kidney transplant. Among causative factors, recipient iliac lymphatics dissection plays an important role. Electrothermal bipolar sealing devices (LigaSureTM) have been shown to decrease lymphatic leakage in a number of instances. The aim of this study was to investigate whether the use of this device decreases post-operative lymphatic complications in kidney transplant. Methods 48 patients admitted for renal transplant were included in the study. They were randomly assigned to either conventional ligation or LigaSureTM during lymphatic dissection. Results One patient in the LigaSureTM arm and 5 patients in the conventional ligation arm developed lymphocele (p=0.04). Lymphatic drainage volumes were 99.8±39.87 ml in the LigaSure arm and 131.46±54.2 ml in the conventional ligation arm (p=0.02). Conclusion Electrothermal bipolar sealing devices exhibit safety and efficiency when used in renal transplant lymphatic dissection. In the present study, this technique proved to be superior to conventional ligation in terms of post-operative lymphatic complications.
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Affiliation(s)
- Ciprian Valerian Lucan
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Jurchis
- Department of Urology, St. Ioan County Hospital, Suceava, Romania
| | - Mihai Suciu
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Salvatore Buttice
- Department of Urology, Messina University Hospital; Hospital Clinic Barcelona, Italy
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Greuter L, Klein HJ, Rezaeian F, Giovanoli P, Lindenblatt N. Evaluation of factors in seroma formation and complications in sentinel and radical lymph node dissections in skin cancer patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1242-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seki T, Hayashida T, Takahashi M, Jinno H, Kitagawa Y. A randomized controlled study comparing a vessel sealing system with the conventional technique in axillary lymph node dissection for primary breast cancer. SPRINGERPLUS 2016; 5:1004. [PMID: 27398279 PMCID: PMC4937003 DOI: 10.1186/s40064-016-2710-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022]
Abstract
Objective This study aimed to compare the efficacy and safety of the newest bipolar vessel sealing system (BVSS; LigaSure™ Small Jaw) to that of conventional technique in axillary dissection. Methods Sixty-one patients with breast cancer were randomized to a conventional dissection surgical technique (CONV group; n = 30) by scalpel and monopolar cautery or that using a vessel sealing system (BVSS group; n = 31). Results There was a significant difference between both groups in the mean number of days until drain removal (6.4 ± 2.9 vs. 8.2 ± 3.8 days; P value = 0.033), and the mean total volume of drainage fluid (365.3 ± 242.2 vs. 625.1 ± 446.6 mL; P value = 0.009). The incidence of seroma was similar in both groups (43.3 vs. 37.9 %; P value = 0.673). There was no statistically significant difference in axillary dissection operating time (66 vs. 70 min; P value = 0.371), or the mean volume of blood loss (18.2 ± 31.1 vs. 20.6 ± 26.3 mL; P value = 0.663). Conclusions Our results suggest that BVSS is a more effective device when compared to the conventional techniques in axillary dissection.
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Affiliation(s)
- Tomoko Seki
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582 Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582 Japan
| | - Maiko Takahashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582 Japan
| | - Hiromitsu Jinno
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582 Japan ; Department of Surgery, Teikyo University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582 Japan
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Ebner F, deGregorio N, Vorwerk E, Janni W, Wöckel A, Varga D. Should a drain be placed in early breast cancer surgery? Breast Care (Basel) 2014; 9:116-22. [PMID: 24944555 DOI: 10.1159/000360928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. This reduction in surgical procedures calls the need for a drain into question. METHOD Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score. RESULTS The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. The data regarding wound infection and drain insertion is inconclusive. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in outpatient seroma aspirations. CONCLUSION The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments.
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Toishi M, Yoshida K, Agatsuma H, Sakaizawa T, Eguchi T, Saito G, Hashizume M, Hamanaka K, Shiina T. Usefulness of vessel-sealing devices for ≤7 mm diameter vessels: a randomized controlled trial for human thoracoscopic lobectomy in primary lung cancer. Interact Cardiovasc Thorac Surg 2014; 19:448-55. [PMID: 24893872 DOI: 10.1093/icvts/ivu176] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Vessel-sealing devices (VSDs) are widely used for various surgical procedures, including thoracoscopic surgery, but very few reports have compared their safety and usefulness with human thoracoscopic lobectomy procedures not employing VSDs. METHODS Primary lung cancer patients for whom a thoracoscopic lobectomy involving mediastinal lymph node dissection was planned in our department from April 2011 to March 2013 were recruited for the study. Patients were randomly allocated to a control group (n = 14) or a VSD group (n = 44), which comprised three sub-groups, namely EnSeal (n = 17), LigaSure (n = 15) and Harmonic (n = 12). The control group comprised patients undergoing surgery solely with ligation and conventional electrocautery. EnSeal, LigaSure and Harmonic were chosen because they are the three most popular disposable VSDs used in Japan. In the VSD groups, the proximal side of pulmonary artery stumps (≤7 mm diameter) were ligated and then treated with respective devices. Primary end-points were burst pressure of the pulmonary artery stump (measured using resected specimens), operative time, intraoperative blood loss, instances of endostapler use, intraoperative surgeon stress (assessed by visual analogue scale) and postoperative drainage volume and duration. As a secondary objective, the individual VSD groups were also compared with each other. RESULTS The burst pressure of ligation-treated pulmonary artery stumps was higher than that of VSD-treated stumps (P <0.0001). The burst pressure of <5-mm-wide VSD-treated stumps was higher than that of ≥5-mm-wide stumps (P = 0.0421). However, the burst pressure for all groups and all vessel diameters was sufficient to withstand the physiological pulmonary artery pressure. The VSD group demonstrated reduced intraoperative blood loss (P = 0.0241), surgeon stress (P = 0.0002), postoperative drainage volume (P = 0.0358) and shortened postoperative drainage duration (P = 0.0449). Operative time and the instances of endostapler use did not significantly differ. Comparison between each of the VSD groups revealed no significant differences. None of the patients experienced serious perioperative complications or died because of surgery. CONCLUSION VSD is simple and safe to use in thoracoscopic lobectomy involving mediastinal lymph node dissection for primary lung cancer. Furthermore, none of the VSDs used in this study presented any observable differences in quality that could lead to clinical problems.
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Affiliation(s)
- Masayuki Toishi
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuo Yoshida
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Agatsuma
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takao Sakaizawa
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Gaku Saito
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahiro Hashizume
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takayuki Shiina
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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