Efficacy and Safety of LigaSure in Breast Surgery With Axillary Lymph Node Dissection in Patients With Breast Cancer: A Systematic Review and Meta-Analysis

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Abstract
Background: Conventional axillary lymph node dissection (ALND) is associated with significant post-operative morbidity in patients undergoing breast surgery due to increased lymphatic leakage. LigaSure, an electrothermal bipolar vessel sealing system, provides better closure of the leakage. This study aims to compare the efficacy and safety of LigaSure against conventional techniques in patients with breast cancer underwent ALND and breast surgery. Methods: We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using odd ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4. Results: Twelve studies with the total of 895 patients (LigaSure = 441; Conventional technique = 454) with breast cancer underwent breast surgery with ALND were included. LigaSure was associated with significantly lower post-operative drain volume (SMD: −0.39, 95% CI [-0.53, −0.24], P < 0.00001), shortened duration of drain (SMD: −0.51, 95% CI [-0.67, −0.34], P < 0.00001), and reduced hospital stay length (SMD: −0.57, 95% CI [-0.96, −0.18], P = 0.004) compared to conventional techniques. However, no difference observed in total operation time, intra-operative blood loss, seroma related outcomes and post-operative complications between the two groups. Conclusion: LigaSure significantly reduced the lymphorrhea, duration of drain and hospital stay, however, it did not prove be effective in seroma-related outcomes.

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