Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy

Olivier Gié, Marie-Laure Matthey-Gié, Pedro-Manuel Marques-Vidal, Nicolas Demartines, Maurice Matter, Olivier Gié, Marie-Laure Matthey-Gié, Pedro-Manuel Marques-Vidal, Nicolas Demartines, Maurice Matter

Abstract

Background: Seroma formation and lymphoedema are frequently encountered complications after radical lymph node dissection (RLND). Attempts to reduce the lymphatic morbidity include the use of Ultrasonic Scalpel. The aim of the present analysis was to assess the impact of the ultrasonic scalpel on the amount of drained lymph after lymph node dissection.

Methods: Patients listed for a RLND or completion lymph node dissection (CLND) were enrolled in a prospective randomized trial to compare the impact of two surgical dissection techniques (USS versus control) on the amount of drained lymph. The lymph drained in 24 h was collected. Our primary endpoint was to compare the daily amount of drained lymph between the two groups. Secondary endpoints were the comparison of drained lymph with the BMI of the patients, the gender and the surgical site (axilla, groin).

Results: Eighty patients were randomly assigned to the USS group or the Control (C) group. No difference was measured in the total amount of lymph drained (USS: 2908 ± 2453 ml vs. C: 3898 ± 5791 ml; p-value = 0.382). The result was also similar after adjusting for gender, age, and BMI. A significant higher amount of lymph was measured after inguinal dissection with USS compared to axillary (p < 0.001).

Conclusion: The study suggests that the use of Harmonic scalpel did not influence the amount of lymph drained after RLND and not support the theory that USS induces oversealing of lymphatics.

Trial registration: Clinical Trial NCT02476357 . Registered 20 of February 2015.

Keywords: Harmonic scalpel; Lymphatics; Radical lymph node dissection; Surgical morbidity.

Figures

Fig. 1
Fig. 1
Time to drain removal according to scalpel. Comparison of control vs. harmonic scalpel using Cox proportional hazards regression adjusting for gender, age (continuous), body mass index (−25.0 [, [25–30 [and [30+), procedure and sentinel node biopsy : hazard ratio 0.85, 95% confidence interval (0.51; 1.33), p = 0.426

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