Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance

• Despite ardent touting, Harmonic Focus is not necessarily superior to Conventional Diathermy in preventing seroma formation after Axillary Lymph Node Dissection.
• Mastectomy and Axillary Lymph Node Dissection increased seroma formation; when compared to Wide Local Excision and Axillary Lymph Node Dissection.
• More the surgical perturbation of tissue (as in mastectomy), the more the incidence and magnitude of seroma after Axillary Lymph Node Dissection.

IntroductionSeroma 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).Methods(and patients)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.ResultsOf 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.Discussion(and conclusion)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.