Sentinel + Axillary Lymph Node Dissection

Sentinel plus Axillary Lymph Node Dissection

When performing a sentinel lymph node biopsy or axillary lymph node dissection, minimizing damage to surrounding soft tissue while dissecting near vital structures is important.

HARMONIC FOCUS

HARMONIC FOCUS® Curved Shears employs ultrasonic energy to cut and coagulate soft tissue simultaneously.

The HARMONIC FOCUS Device:

  • Seals vessels up to 5mm, as well as lymphatics.*
  • Allows fine dissection near vital structures like axillary nerves and veins.1
  • Minimal thermal spread and desiccation of tissue.
  • Improves procedural efficiency, since you can grasp, dissect, cut and coagulate with a single device.1
  • When used in Axillary dissection, HARMONIC FOCUS resulted in a 37% reduction in serous drain volume and a 43% reduction in drain days, as compared to conventional surgery.†

To achieve excellent wound closure outcomes following a lymph node dissection, Ethicon offers several innovative technologies, including:

DERMABOND Advanced

DERMABOND ADVANCED™ Topical Skin Adhesive – a unique formulation that provides patients with a triad of benefits when used in addition to sutures

  • Adds strength ex vivo1
  • Inhibits bacteria in vitro117,‡
  • Provides a flexible microbial barrier117,§
MONOCRYL Plus

MONOCRYL™ Plus Antibacterial (poliglecaprone 25) Sutures provide benefits required for ideal subcuticular skin closure

  • Provides strength through critical healing period (5-7 days)
  • Protection against bacterial colonization of the suture by organisms commonly associated with surgical site infections
  • Monofilament design that passes smoothly through tissue186,187

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Site References

  • * Based on pre-clinical testing of lymphatic vessels up to and including 1mm in diameter
  • † Mean axillary drainage and mean drain days were 82.5 ml (56.3-115.0) and 2.0 (1.8-3.0) for HARMONIC FOCUS and 131.5 ml (72.8-283.8) and 3.5 (3.0-4.3) for conventional surgery. Conventional surgery is defined as scissors in combination with monopolar and bipolar electrocautery.115
  • ‡ Clinical significance is unknown
  • § Effective in vitro against S. epidermidis, S. aureus, E. coli, Enterococcus faecium, Pseudomonas aeruginosa
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Sentinel plus Axillary Lymph Node Dissection

HARMONIC® Devices use ultrasonic energy to cut and coagulate soft tissue. The low-temperature, directed mechanical energy reduces tissue damage and may reduce inflammation which has been linked to increased perceptions of pain as compared to monopolar electrosurgery,* making HARMONIC Technology excellent for use in breast cancer diagnosis and treatment.

How it works:

  • The handset converts electricity into longitudinal motion, making the blade vibrate at 55,500 Hz.
  • This low-frequency ultrasonic energy creates cellular friction when applied to soft tissue.
  • Amino acids in the proteins reshape, and hydrogen bonds break down, for an efficient cut.
  • The amino acids reform into a sticky coagulum that reliably seals small vessels – and it does it at a temperature under 100ºC.1

HARMONIC SYNERGY® Blades provide reduced trauma because energy is applied parallel to the applied force.1
HARMONIC FOCUS® Curved Shears provide:

  • 62.5% reduction in breast drainage and a 36% reduction in drain days, as compared to conventional surgery.†
  • Minimal lateral damage and desiccation of soft tissue due to the device’s lower operating temperature.

Both HARMONIC FOCUS and SYNERGY Devices:

  • Effectively seal lymphatic vessels.‡
  • Because no electricity is passed to or through your patient, HARMONIC® Instruments do not cause current-induced neuromuscular stimulation.1

Site References

  • * In a pre-clinical study, necropsy and histological evaluations indicated a significant reduction in acute inflammation for skeletal muscle wounds created by the HARMONIC Blade vs. monopolar electrosurgery at 3, 7, and 21 days post-op (p value = 0.011 for all post-operative periods). Per NIH, the definition of inflammation is "A response of redness, swelling, pain, and a feeling of heat in certain areas that is meant to protect tissues affected by injury or illness." (http://ghr.nlm.nih.gov/glossary=inflammation)1
  • † Mean breast drainage and mean drain days were 22.5 ml (11.3-40.0) and 2.1 (±1.1) for HARMONIC FOCUS® and 60.0 ml (40.0-111.2) and 3.3 (±1.1) for conventional surgery. Conventional surgery is defined as scissors in combination with monopolar and bipolar electrocautery. Breast conserving surgery is lumpectomy or segmentectomy with removal of the tumor and sufficient normal breast tissue to ensure both tumor free specimen margins and a satisfactory cosmetic result.115
  • ‡ Based on pre-clinical testing of lymphatic vessels up to and including 1mm in diameter.1

 



 
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