LigaSure™ (LS) (Covidien, CO, USA) is an electro-thermal bipolar vessel-sealing system, providing hemostasis by a combination of pressure and electro-thermal energy. The direct application of ultrasound produces surgical dissection and hemostatic effect, with obliteration of vessels up to 6 mm in diameter. Mechanical energy, transmitted by an active blade, results in collagen molecules within the tissue denaturation, generating coagulum with lower thermal injury (< 150 ☌) compared to EC. It is based on mechanical energy at a high frequency of 55.5 kHz and it have long been proven to decrease complications and operative time in both open and laparoscopic surgery. Introduced in 1990, the Harmonic Scalpel™ (HS) (Ethicon, Somerville, NJ) is a system that allows cutting and hemostasis without the application of electrical energy to the patient. Electrocautery (EC) is an efficient device for ALND surgery, due to an easy manageability and a successful hemostasis, but the high emanated heat strongly affects the incidence of seroma. The utilization of new devices, widely used in laparoscopic surgery, providing a lower cellular damage and a better vessel sealing and hemostasis, could reduce seroma formation and improve post-operative healing, allowing an earlier beginning of adjuvant therapy. ĭrain placement is nowadays the only valid method to reduce and treat seroma formation, but on the other hand it leads to discomfort, pain, functional limitation of the arm and its prolonged maintenance may be a cause of infection. Many procedures have been proposed in order to reduce the seroma formation (physiotherapy, external compression and use of pharmacological aids such as hemostatic biological adhesives), but none of them produced effective and definitive results. Risk factors and physiopathology of post-operative seroma are still matter of debate, but the main hypotheses are the cellular damage by thermal effect, and the incomplete vessels and lymph ducts obliteration during the dissection. Therefore, seroma formation may implicate delayed beginning of adjuvant therapy, affecting oncological outcomes. ĭespite many surgeons consider seroma as a mere post-operative side effect, this complication leads to prolonged hospital stay, discomfort and delayed wound healing. In particular, post-operative seroma formation, a collection of fluid in the dead space of the axilla, is described in Literature with an extremely wide range of incidence, from 3 to 85%. ĪLND is associated to different postoperative complications, such as lymphorrhea, seroma formation, lymphedema and functional limitation of the shoulder and of the upper limb. Presence of regional lymphadenopathy (clinically fixed or matted axillary lymph nodes, or any of infraclavicular, supraclavicular, or internal mammary lymphadenopathy) regardless of tumour stage. The definition includes breast cancer that fulfils any of the following criteria in the absence of distant metastasis: Recent guidelines from the US National Comprehensive Cancer Network describe locally advanced breast cancer as the American Joint Committee on Cancer stage III breast cancer. Nevertheless, axillary lymph node dissection (ALND) is still considered the gold standard approach in association with radical mastectomy (RM) either quadrantectomy (Qu), for the treatment of locally advanced breast cancer with positive lymph nodes, determined by fine needle cytology (FNC) or a core-needle biopsy, or in selected cases of stage IV tumors. The introduction of new screening programs permits to diagnose breast cancer in earlier stages, allowing a conservative surgery for tumor stages I-II, associated to sentinel lymph-node biopsy (SLNB), in case of clinically and imaging negativity of Axillary Lymph Nodes (ALN). Oncological treatment for breast cancer experienced substantial modifications in the past decades, tending to a less invasive approach. Breast cancer is the most frequent neoplasm in women, with an incidence of fifty thousand new cases diagnosed in Italy in 2017.
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