Harmonic Scalpel versus Electrocautery in Modified Radical Mastectomy: A Comparative Study

Introduction: Breast cancer is a major public health problem in the world. Amongthe multidisciplinary approach of surgery, chemotherapy, radiotherapy andhormonal therapy, Modified Radical Mastectomy (MRM) is the most commonsurgery performed to treat breast cancer wherein use of thermal energy hasbeen associated with seroma formation, increased blood loss, wound infection,flap necrosis, hematoma, and prolonged axillary drainage. Harmonic scalpelis an emerging alternative where high frequency mechanical vibrations allowcutting and coagulation at the same time causing little thermal injury. In thisstudy, we compared the outcome between use of harmonic scalpel andelectrocautery in modified radical mastectomy. Methods: A prospective comparative study was conducted at a tertiary carecentre of Nepal from November 2018 to October 2019.A total of 30 patientswere randomized into harmonic scalpel and electrocautery group andcompared in terms of seroma formation, operative time, amount of blood loss,total drain volume, total duration of drain, and post-operative pain. Results: The patients in harmonic scalpel group had significantly less amountof seroma formation (13.3% vs 46%, p=0.046), intraoperative blood loss (150 vs200 ml, p=0.026), total drain volume (483.33 ± 107.718 vs 636.33 ± 239.620ml,p=0.032),total duration of drain requirement(8.73 ±1.907 vs12.13± 4.121, p= 0.007)and post-operative pain (p=0.002). However, operative time (p=0.20) andsurgical site infection (p=0.14) was not significant. Conclusions: Harmonic scalpel has better surgical outcome than electrocauteryin terms of intraoperative blood loss, total drainage volume, total durationof drain and postoperative pain without change in operative time. We thusrecommend preferential use of harmonic scalpel in MRM.