Low-thermal electrosurgical devices versus conventional monopolar cautery in breast surgery: A scoping review

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Abstract
Background: Conventional monopolar electrosurgery is widely used in breast surgery but is associated with collateral thermal injury, which may contribute to impaired wound healing, increased drainage and compromised pathological assessment. Low-thermal electrosurgical devices have been developed to minimise thermal spread while maintaining effective tissue dissection and haemostasis. However, the clinical evidence supporting their use in breast surgery remains fragmented. Objective: To systematically map and synthesise the available literature evaluating low-thermal monopolar electrosurgical devices compared with conventional monopolar electrocautery or scalpel in breast surgery. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, Embase, Scopus, Web of Science and IEEE Xplore. Eligible studies included clinical investigations involving breast surgery that compared low-thermal monopolar electrosurgical devices with conventional monopolar electrocautery or scalpel and reported operative, pathological, clinical or patient-reported outcomes. Results: A total of 515 records were identified, of which 13 studies met the inclusion criteria. Most studies evaluated the PEAK PlasmaBlade ([Formula: see text]), while limited evidence was available for helium plasma radiofrequency devices, argon plasma coagulation and the ACE blade. Across studies, plasma-assisted electrosurgical systems consistently demonstrated reduced thermal injury depth compared with conventional electrocautery. Reported clinical benefits included reduced drainage volume, shorter drain duration, improved skin flap perfusion, lower rates of selected wound complications and improved pathological margin assessment. However, findings for clinical outcomes were heterogeneous and frequently derived from small, underpowered studies. Evidence for non-plasma-assisted electrosurgical technologies was sparse and largely limited to descriptive or exploratory studies. Conclusions: Current evidence suggests that low-thermal monopolar electrosurgical devices may reduce collateral thermal injury and offer potential perioperative advantages in breast surgery. Nevertheless, the available literature is limited by small sample sizes, heterogeneity of outcome measures and a paucity of comparative effectiveness and economic data. Further well-designed prospective studies are required to establish the clinical and cost-effectiveness of these technologies and to define their role in contemporary breast surgical practice.

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