The purpose of this study is to evaluate the potential of a novel surgical procedure, the Total Sealing Technique (TST), using the latest bipolar vessel sealing system (BVSS; LigaSure™ Exact Dissector) to reduce lymphatic leakage and seroma formation after electrocautery axillary lymph node dissection (ALND) in breast cancer surgery. Prolonged drainage is a common occurrence after ALND, primarily due to lymphatic leakage. In addition, the presence of seroma often leads to delays in the administration of postoperative adjuvant chemotherapy even after drain removal. We conducted a comparative analysis of 36 patients who underwent total mastectomy with ALND using conventional electrocautery technique (CONV) during the first 3 years, and 35 patients who underwent the same procedure using TST during the subsequent 3 years. The following factors were compared to assess the impact of TST: operation time, blood loss, total drainage volume, mean time to drain removal, postoperative hospital stay, mean time to initiation of postoperative chemotherapy, and postoperative complications in each group. TST significantly reduced drainage volume (360.5 vs. 820.6 mL, p < 0.001), days to drain removal (4.8 vs. 6.8 days, p < 0.001), postoperative hospital stay (5.9 vs. 9.6 days, p < 0.001), the incidence of seroma (28.6 % vs. 65.9 %, p = 0.001), and time to chemotherapy initiation (33.1 vs. 61.4 days, p < 0.001) compared to CONV. TST in total mastectomy with ALND effectively decreases the incidence of lymphorrhea and seroma formation; thus, it can be recommended for total mastectomy with ALND.

The primary goal in treating patients with breast cancer who have positive axillary lymph nodes is to achieve optimal tumor control while minimizing side effects that include breast cancer-related lymphedema (BCRL)

Background/Objectives: In a previous study, we reported a novel surgical procedure called the Total Sealing Technique (TST), which uses a bipolar vessel-sealing system to reduce lymphatic leakage during axillary dissection for breast cancer. Follow-up ob-servations showed a lower incidence of breast cancer-related lymphedema (BCRL) in patients in the TST group. Therefore, in this current study, we aim to investigate and compare the incidence of BCRL between two groups (TST and conventional electrocautery (CONV)) and discuss why the incidence of BCRL was significantly lower in the TST group than in the CONV group. Methods: We conducted a comparative analysis of 36 patients who underwent total mastectomy with axillary lymph node dissection (ALND) using the CONV procedure during the first three years, and 35 patients who underwent the same procedure using TST during the subsequent three years. We evaluated the incidence of BCRL and its association with the risk factors in both groups. Results: The incidence of BCRL was 2.9% in the TST group and 22.2% in the CONV groups, respectively (p = 0.028). In the TST group, no significant association was found between the incidence of BCRL and known risk factors. However, in the CONV group, the incidence of BCRL was signifi-cantly higher in younger patients and in those who received neoadjuvant or postoperative chemotherapy, a taxane-containing regimen, or > 600 mL of drainage. Conclusions: TST with LigaSure™ Exact Dissector significantly reduces BCRL incidence, suggesting that it may become an important surgical procedure for axillary dissection in breast cancer in the future.

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