Total Sealing Technique: A Novel Surgical Approach that Sig-nificantly Reduces the Incidence of Upper Extremity Lymphedema Following Axillary Dissection in Patients with Breast Cancer

Background: /Objectives: In a previous study, we reported a novel surgical procedure called the Total Sealing Technique (TST), which uses a bipolar vessel-sealing system to reduce lymphatic leakage during axillary dissection for breast cancer. Follow-up ob-servations showed a lower incidence of breast cancer-related lymphedema (BCRL) in patients in the TST group. Therefore, in this current study, we aim to investigate and compare the incidence of BCRL between two groups (TST and conventional electrocautery (CONV)) and discuss why the incidence of BCRL was significantly lower in the TST group than in the CONV group. Methods: We conducted a comparative analysis of 36 patients who underwent total mastectomy with axillary lymph node dissection (ALND) using the CONV procedure during the first three years, and 35 patients who underwent the same procedure using TST during the subsequent three years. We evaluated the incidence of BCRL and its association with the risk factors in both groups. Results: The incidence of BCRL was 2.9% in the TST group and 22.2% in the CONV groups, respectively (p = 0.028). In the TST group, no significant association was found between the incidence of BCRL and known risk factors. However, in the CONV group, the incidence of BCRL was signifi-cantly higher in younger patients and in those who received neoadjuvant or postoperative chemotherapy, a taxane-containing regimen, or > 600 mL of drainage. Conclusions: TST with LigaSure™ Exact Dissector significantly reduces BCRL incidence, suggesting that it may become an important surgical procedure for axillary dissection in breast cancer in the future.