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

Abstract 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.