# Total Sealing Technique Using an Advanced Bipolar Vessel-Sealing System in Axillary Lymph Node Dissection: A Technical Note and Review of Clinical and Economic Outcomes

## TL;DR

A new surgical technique called Total Sealing Technique reduces complications like lymphedema and seroma after axillary lymph node dissection in breast cancer patients.

## Contribution

The Total Sealing Technique is a reproducible surgical approach that significantly reduces lymphatic complications compared to conventional methods.

## Key findings

- TST reduced drainage volume and shortened hospital stay and drain removal time compared to conventional electrocautery.
- TST significantly lowered seroma incidence and the need for aspiration procedures.
- Long-term follow-up showed a 22.2% reduction in breast cancer-related lymphedema with TST.

## Abstract

Axillary lymph node dissection (ALND) remains necessary for selected patients with breast cancer, but it is frequently associated with lymphatic complications such as seroma formation and breast cancer-related lymphedema (BCRL), which can significantly impair long-term quality of life. The Total Sealing Technique (TST) is a technique-centered surgical approach that emphasizes systematic sealing of lymphatic and vascular structures during axillary dissection. Clinical cohort data demonstrate that TST reduces postoperative drainage, shortens drain placement and hospital stay, lowers seroma burden, and is associated with a statistically significant decrease in BCRL incidence compared with conventional electrocautery-based ALND. These findings suggest that optimization of surgical technique—rather than device substitution alone—may meaningfully influence long-term lymphatic outcomes. While further independent validation is warranted, TST represents a reproducible operative strategy aimed at minimizing morbidity when ALND remains indicated.

Background: Axillary lymph node dissection (ALND) remains necessary for selected patients with breast cancer but is associated with lymphatic morbidity, including seroma formation and breast cancer-related lymphedema (BCRL). The Total Sealing Technique (TST) is a technique-centered operative concept that emphasizes systematic sealing of lymphatic and vascular structures during ALND. Methods: This review integrates mechanistic rationale and clinical evidence derived from comparative cohort studies evaluating TST (using advanced bipolar vessel-sealing systems) versus conventional electrocautery (CONV). Key perioperative and long-term outcomes are summarized quantitatively. Results: In a comparative cohort of total mastectomy with ALND, TST significantly reduced total drainage volume (360.5 ± 187.9 vs. 820.6 ± 661.6 mL; p < 0.001) and shortened time to drain removal (4.8 ± 1.3 vs. 6.8 ± 2.1 days; p < 0.001). Postoperative hospital stay was reduced by 3.7 days on average (5.9 ± 1.3 vs. 9.6 ± 3.4 days; p < 0.001). The incidence of seroma decreased from 65.9% to 28.6% (p = 0.001), with fewer aspiration procedures (1.8 vs. 4.6 per patient; p = 0.022). Importantly, long-term follow-up demonstrated a statistically significant reduction in BCRL incidence (2.9% vs. 22.2%; p = 0.028). Operative time and blood loss were not increased. Conclusions: Current single-center data indicate that TST is associated with substantial reductions in postoperative lymphatic morbidity and a statistically significant decrease in BCRL incidence. While independent multicenter validation is warranted, TST represents a reproducible technique-centered approach with meaningful clinical impact in ALND.