A Systematic Review and Meta-analysis of Harmonic Technology Compared With Conventional Techniques in Mastectomy and Breast-conserving Surgery With Lymphadenectomy for Breast Cancer

Total complications

Compared to conventional techniques in breast surgery, Harmonic technology resulted in a statistically significant reduction in total complications with an RR of 0.48 (95% CI: 0.30–0.77; P=0.002; two studies; I²=0%; Table 3). This translates to a 52% decrease with Harmonic technology compared to conventional techniques in breast surgery. For the surgery subgroups, the observed reductions with the Harmonic technology were statistically significant for the study of mastectomy patients and nonstatistically significant for the study including both mastectomy and BCS.

Overall seroma

Harmonic technology use was associated with a statistically significant decrease in overall seroma (RR =0.54; 95% CI: 0.43–0.69; P<0.00001; eleven studies; I²=25%) (Figure 6; Table 3), a 46% decrease, compared to conventional methods in breast surgery. All surgical subgroups, with the exception of the single study of mastectomy only (no lymph node dissection), showed a statistically significant reduction in seroma with Harmonic technology.

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Hematoma

Hematoma events were reduced with Harmonic technology use with an RR of 0.57 (95% CI: 0.30–1.10; P=0.09; nine studies; I²=0%) (Table 3); however, results demonstrated no statistically significant difference compared with conventional methods. Most study subgroups showed a nonsignificant reduction in the risk of hematoma with Harmonic technology (low event rates).

Wound infection

No significant differences were reported between Harmonic technology and conventional methods for the outcome of wound infection in breast surgery (RR =0.71; 95% CI: 0.32–1.56; P=0.39; nine studies; I²=0%) (Table 3). Study subgroups showed a nonsignificant reduction in the risk of wound infection with Harmonic technology (low event rates). No data were available for studies of only BCS.

Necrosis

In contrast to conventional methods in breast surgery, Harmonic technology resulted in a statistically significant reduction in necrosis with an RR of 0.51 (95% CI: 0.28–0.96; P=0.04; eight studies; I²=0%) (Figure 7; Table 3), a 49% decrease, compared to conventional methods in breast surgery. Study subgroups showed a nonsignificant reduction in the risk of necrosis with Harmonic technology (low event rates). No data were available for studies of only BCS.

(To view a larger version of Figure 7, click here.)