A comparative study of electrocautery thermal dissection versus sharp cold dissection for flap elevation during endoscopic-assisted breast reconstruction

TANG Tian-tian; LIU Zheng-hua; WANG Chen; YI Xin-lu; ZHOU Tao

doi:10.19538/j.cjps.issn1005-2208.2024.11.16

Abstract：Objective To compare the safety and short-term prognosis of thermal and cold dissection in flap elevation for immediate implant-based breast reconstruction by endoscopic mastectomy.Methods The clinical data of 228 patients with early-stage breast cancer who underwent immediate endoscopic breast reconstruction between January 2022 and August 2024 at the Fourth Hospital of Hebei Medical University were retrospectively analyzed.Patients were divided into the thermal separation group and the cold separation group based on the instruments used for flap dissection.The CUSUM learning curve was used to analyze the minimum cumulative number of surgeries required for endoscopic assisted mastectomy and sentinel lymph node biopsy across the learning curve in both groups to determine the final number of included cases in both groups.Clinical and pathological factors,intraoperative information,postoperative complications,and local recurrence were analyzed and compared between the two groups.Results The analysis of CUSUM learning curve showed no significant trend in surgery duration with the increasing number of surgical cases in the cold separation group.In contrast,the CUSUM curve for the thermal separation group achieved the optimal fit at n=26(P＜0.001)and the first 26 patients obviously had a higher incidence of postoperative complications(incision infection,prosthesis exposure,flap necrosis)compared with other patients in this group,with a significant difference(30.8％vs.7.4％,P=0.016).Ultimately,70 patients in the cold separation group and 106 patients in the thermal separation group were included.There were no statistically significant differences between the two groups in the clinical and pathological characteristics(P＞0.05).Compared to the thermal separation group,the cold separation group showed a shorter operative time[(132.7±28.3)min vs.(158.5±38.0)min,P＜0.001],but had more blood loss[(30.9±17.6)mL vs.(22.4±13.7)mL,P＜0.001],and the differences were statistically significant.No statistically significant differences were found between the two groups in terms of the rates of postoperative bleeding,time to drain removal,the proportion of patients with positive posterior nipple margins,postoperative infection,prosthesis exposure,flap necrosis,nipple-areola ischemic necrosis,and capsular contracture(all P＞0.05).With a median follow-up time of 7.1 months(range from 13 to 94 months)across all patients,one case of local recurrence was observed in the thermal separation group and no local recurrences were observed in the cold separation group.No instances of distant metastasis were identified in either group.Conclusion Both thermal and cold separation for flap separation are safe and effective in endoscopic-assisted implant-based breast reconstruction.The cold separation technique offers a shorter operative time but had increased risks of intra-and postoperative bleeding,while the thermal separation approach requires a learning curve.