A recent study at the European Institute of Oncology (IEO) has found that for removal of lymph nodes from the armpit, to treat breast cancer, the use of the new surgical device known as LigaSure, is not financially viable.
Axillary lymph node dissection (ALND) is an integral part of breast cancer treatment and is required in around 40-50% of patients. A drain is placed in the armpit after the operation, to prevent the build up of fluids. This drainage often lasts up to 14 days after the operation, so a method of surgery which avoided the subsequent build up of fluid would reduce costs and improve the patient’s recovery.
LigaSure works by permanently fusing vessels up to 7 mm in diameter and tissue bundles without dissection, using a precise combination of pressure and energy from a high frequency alternating electric current between two poles on the instrument. This melts the collagen and elastin in the vessel walls and reforms it into a permanent, plastic-like seal.
The device, manufactured by Valleylab, USA, also stops the sealing process automatically when complete, preventing damage, and keeps unwanted heating of tissue to a small spread of around 1.5mm.
Researchers at the Breast Unit of La Maddalena Cancer Centre in Palermo, Italy, studied 100 patients, with treatment assigned at random; half were treated using LigaSure and half using the conventional method.
It was found that although the device was extremely effective at preventing blood loss, there was little or no time saved during the operation, and the amount of residual fluid, and thus drainage time, was not reduced either.
LigaSure requires an initial purchase of a generator at a cost of 21,000 Euros and adds an additional cost to the operation (about 223 Euros per disposable diathermy forceps). Hence, although it represents a good haemostatic device in abdominal surgery, where it decreases the duration of the operation, its employment is not cost-effective in breast cancer treatment.