Comparison of Axillary Drain Output After Level 2 Dissection Using Monopolar Electrocautery Versus LigaSure
DOI:
https://doi.org/10.36283/ziun-pjmd14-3/003Keywords:
Breast Neoplasms, Mastectomy, Axilla, Lymph Node Excision, ElectrosurgeryAbstract
Background: Conventional monopolar electrocautery in level-II axillary lymph-node dissection is associated with seroma formation and thermal injury. LigaSure, an electrothermal bipolar vessel-sealing system, may reduce postoperative drainage. The study aimed to compare axillary drain output after level II dissection using electrocautery vs. Ligasure.
Methods: In this quasi-experimental study, 60 women with breast cancer undergoing level-II axillary lymph node dissection at Allied Hospital, Faisalabad, were allocated to monopolar electrocautery (Group A) or LigaSure (Group B) from 1st October 2023 to 30th March 2024. A non-probability consecutive sampling technique was used. Axillary drain output was the primary endpoint. Age, body mass index, duration of surgery, number of nodes removed, diabetes, hypertension, residence, radiotherapy, and chemotherapy status were recorded. Data were analyzed in SPSS v25.0. Quantitative variables were expressed as mean ± SD; categorical variables as frequency (%). Mean drain output between groups was compared with an independent-samples t-test, and p≤ 0.05 was considered significant.
Results: Mean age was 52.2 ± 7.2 years in Group A and 49.1 ± 7.1 years in Group B; mean BMI was 28.9 ± 2.4 kg/m². Average surgery time was 78.8 ± 7.5 min with 3.4 ± 0.9 nodes excised. Group A showed significantly higher drain output (290.0 ± 40.0 mL) than Group B (164.6 ± 18.0 mL); mean difference = −125.4 mL (p < 0.001).
Conclusion: LigaSure markedly reduces postoperative axillary drainage compared with monopolar electrocautery during level-II ALND, supporting its routine use to minimize seroma risk in breast-cancer surgery.
References
1. Sha R, Kong X, Li X, Wang Y. Global burden of breast cancer and attributable risk factors in 204 countries and territories, from 1990 to 2021: results from the Global Burden of Disease Study 2021. Biomark Res. 2024;12(1):87. https://doi.org/10.1016/j.breast.2024.103835
2. Smolarz B, Nowak AZ, Romanowicz H. Breast cancer—epidemiology, classification, pathogenesis and treatment (review of literature). Cancers (Basel). 2022 May;14(10):2569. https://doi.org/10.3390/cancers14102569
3. Zaheer S, Yasmeen F. Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis. Pak J Med Sci. 2024 Jan;40(1 Part-I):134. https://doi.org/10.12669/pjms.40.1.7123
4. Jain U, Rahim F, Jain B, Komanduri A, Arkalgud A, Sabet CJ, et al. Cancer burden across the South Asian Association for Regional Cooperation in 2022. BMJ Oncol. 2024;3(1):e000466. https://doi.org/10.1136/bmjonc-2024-000466
5. Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2022 Jun;20(6):691–722. https://doi.org/10.6004/jnccn.2022.0030
6. Spiekerman van Weezelenburg MA, Bakens MJ, Daemen JH, Aldenhoven L, van Haaren ER, Janssen A, et al. Prevention of seroma formation and its sequelae after axillary lymph node dissection: an up-to-date systematic review and guideline for surgeons. Ann Surg Oncol. 2024 Mar;31(3):1643–52. https://doi.org/10.1245/s10434-023-14631-9
7. Eldamshety O, Lamey A, Ismail KA, Esmail T, Tolba M, Ali R. Expanding scope about factors influencing seroma formation after breast cancer surgery. J Pak Med Assoc. 2023 Apr;73(4 Suppl 4):S282–6. https://doi.org/10.47391/JPMA.EGY-S4-55
8. Zahid A, Javed T, Kaleem M, Andrabi WI, Jamil T, Qureshi SS, et al. Comparison of seroma formation with harmonic scalpel versus monopolar electrocautery in axillary dissection following modified radical mastectomy. Pak J Med Health Sci. 2022;16(2):198. https://doi.org/10.53350/pjmhs22162198
9. Kloosterman R, Wright GW, Salvo-Halloran EM, Ferko NC, Mennone JZ, Clymer JW, et al. An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes. BMC Surg. 2023;23(1):180. https://doi.org/10.1186/s12893-023-02057-9
10. Zafar S, Khan MA, Rafiq U, Mahmood N. Comparison of axillary drain output in conventional and advanced compressive energy source like ultrasonic scalpel and LigaSure dissection of axilla in breast cancer surgery. J Ayub Med Coll Abbottabad. 2021;33(3):431–6.
11. Charalambides M, Afxentiou T, Pellino G, Powar M, Fearnhead N, Davies R, et al. A systematic review and network meta-analysis comparing energy devices used in colorectal surgery. Tech Coloproctol. 2022 Jun;26(6):413–23. https://doi.org/10.1007/s10151-022-02586-0
12. Moll X, Fondevila D, García-Arnas F, Burdio F, Trujillo M, Irastorza RM, et al. Comparison of two radiofrequency-based hemostatic devices: saline-linked bipolar vs. cooled-electrode monopolar. Int J Hyperthermia. 2022;39(1):1397–407. https://doi.org/10.1080/02656736.2022.2140840
13. Imran M, Ali M, Umar TP, Ali S, Khalil S, Irfan H, et al. Efficacy and safety of LigaSure in breast surgery with axillary lymph node dissection in patients with breast cancer: a systematic review and meta-analysis. Surg Innov. 2025 Mar;32(2):155–64. https://doi.org/10.1177/15533506241305892
14. Keelan S, Dowling GP, Roche T, Hegarty A, Davey MG, Dhannoon AA, et al. Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial. Br J Surg. 2024 Mar;111(3):znae029. https://doi.org/10.1093/bjs/znae029
15. Gabryel P, Kasprzyk M, Roszak M, Campisi A, Smoliński S, Zieliński P, et al. Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial. Surg Endosc. 2023 Jun;37(6):4449–57. https://doi.org/10.1007/s00464-023-09892-0
16. Hughes DL, Hughes A, Gordon-Weeks AN, Silva MA. Continuous drain irrigation as a risk mitigation strategy for postoperative pancreatic fistula: a meta-analysis. Surgery. 2024 May. https://doi.org/10.1016/j.surg.2024.03.027
17. Idrees M, Ahmad MS, Sher F, Javaid A, Farooq Q, Imran HM, et al. Comparative study between LigaSure (bipolar) cautery versus conventional method for axillary dissection in modified radical mastectomy: a single centred experience in tertiary care settings. Pak Postgrad Med J. 2025;36(1):33–6. https://doi.org/10.1016/j.surg.2024.03.027
18. Ikeda N, Akahori T, Yokotani T, Fujii T, Sho M. Total sealing technique (TST) with a bipolar vessel sealing system reduces lymphorrhea and seroma formation for axillary lymph node dissection in primary breast cancer. Surg Open Sci. 2024;19:1–7. https://doi.org/10.1016/j.sopen.2024.01.011
19. Zia MI, Malik S, Anum S, Zahara FT, Anum Z. Comparison of outcomes of Ligasure system and conventional electrocautery in patients undergoing modified radical mastectomy for breast cancer. Prof Med J. 2023 Jan;30(1):107–12. https://doi.org/10.29309/TPMJ/2023.30.01.7236
20. Oyewale S, Ariwoola A, Oyewale I. The effectiveness of different flap-raising techniques for mastectomy in reducing the rate of complications: a network meta-analysis. BMC Surg. 2024;24(1):415. https://doi.org/10.1186/s12893-024-02723-6
21. Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, et al. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. World J Clin Cases. 2023 Jan;11(2):366. https://doi.org/10.12998/wjcc.v11.i2.366
22. Park HS, Lee J, Kim JY, Park JM, Kwon Y. A prospective randomized study to compare postoperative drainage after mastectomy using electrosurgical bipolar systems and conventional electro-cautery. J Breast Cancer. 2022 Dec;25(4):307. https://doi.org/10.4048/jbc.2022.25.e29
23. Dalli J, Nguyen C, Jindal A, Epperlein J, Hardy N, Pulitano C, et al. A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy. JPRAS Open. 2024;40:32–47. https://doi.org/10.1016/j.jpra.2024.01.012
24. Fairhurst K, Roberts K, Fairbrother P, Potter S. Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey. Breast Cancer Res Treat. 2024 Feb;203(2):187–96. https://doi.org/10.1007/s10549-023-07042-7
25. Papanikolaou A, Minger E, Pais MA, Constantinescu M, Olariu R, Grobbelaar A, et al. Management of postoperative seroma: recommendations based on a 12-year retrospective study. J Clin Med. 2022 Sep;11(17):5062. https://doi.org/10.3390/jcm11175062
26. Kim J, Shin Y, Jeong W. Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta‐analysis. Microsurgery. 2022 Jan;42(1):89-96. https://doi.org/10.1002/micr.30831
27. Kloosterman, R., Wright, G.W., Salvo-Halloran, E.M., Ferko, N.C., Mennone, J.Z., Clymer, J.W., Ricketts, C.D. and Tommaselli, G.A., 2023. An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes. BMC surgery, 23(1), p.180. https://doi.org/10.1186/s12893-023-02057-9
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
