Sughra Parveen, Sarwar Qureshi, Ovais Sarwar, Shireen Ramzanali Damani.
Modified radical mastectomy with axillary clearance using harmonic scalpel.
Pak J Surg Jan ;28(3):168-71.

Introduction: The surgical treatment of the breast cancer has shifted dramatically from radical operation to the breast conserving surgical technique. The most comman complications of the conventional modified radical mastectomy with axillary dissection, electrocautery (diathermy) & the suture ligation are seroma, lymphodema with the incidence of 11% to 85% and 2% to 50% respectively Objective: This study was conducted to evaluate the feasibility, safety & effi cacy of modified radical mastectomy with axillary dissection using the harmonic scalpel in terms of operative time, lymph vessel sealing, haemostasis and post operative complications. Design: Prospective observational study. Setting and duration: This study was carried out in Ward–26 (Surgical unit III), Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to June 2010. Methodology: A total of 60 patients underwent Modified Radical Mastectomy and Axillary Clearance during this period. Patients with indications of modified radical mastectomy and ASA (American society of anaesthesia) score 1 and 2 were included in the study. Patients withearly breast cancers (T1), previous breast surgery, neo-adjuvant therapy, patient with diabetes and other co-morbid were excluded from the study group. Results: All the data was entered and analyzed in SPSS version 17. Descriptive statistics was used to summarize the continuous variables and presented as mean ± S.D and categorical variables in frequencies and percentages because this is observational study no statistical test and p-value is required. The mean intraoperative blood loss was 45 ± 12 ml and the mean operative time was 90 ± 7 minutes. No postoperative bleeding or haematoma occurred. But on the other hand, seroma (2), lymphodema (1) and wound infection (1) occurred. The mean drainage volume of fl ap drain and axillary drain was 20 ± 8 ml and 155 ± 35 ml respectively and mean drainage duration was 1.3 ± 0.2 and 2.7 ± 0.5 days respectively. The mean hospital stay was 3.7 ± 0.6 days. Among 60 patients, 19 (31.6%) patients had positive axillary nodes, out of which 6 patients (10%) had 1-2 positive lymph nodes and 13 patients (21.6%) had four or more positive nodes. Conclusion: The Modified Radical Mastectomy & Axillary Dissection using the harmonic scalpel was safe , feasible , effective. This device simplifi es the surgical procedure, reduces the operative time, peri-operative blood loss , drainage volume and duration of drainage . Furthermore the incidence of seroma and lymphodema was also reduced.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com