Clinical trial NCT00943605: PEAK PlasmaBlade™ 4.0 Versus Traditional Electrosurgery in Mastectomy
Official title: A Prospective, Randomized, Controlled Superiority Study to Evaluate Use of the PEAK PlasmaBlade™ 4.0 in Mastectomy
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Mastectomy
Keywords: Mastectomy
PlasmaBlade
Electrosurgery
PEAK Surgical
Medtronic Advanced Energy
Medtronic
Lead sponsor: Medtronic Surgical Technologies
Sponsor class: INDUSTRY
First posted: 2009-07-22
Enrollment: 60
Sex: FEMALE
Minimum age (years): 20
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The objective of this clinical study is to evaluate the incidence of partial skin necrosis following modified-radical mastectomy with or without same-day (two-stage) reconstruction with the PEAK PlasmaBlade 4.0; to monitor and record operative performance, post-operative pain, drain output, and skin scarring following surgery; and to compare these endpoints to the current standard of care (SOC).

Detailed description: Mastectomy is a surgical procedure performed to remove breast tissue that contains cancer, or has a high probability of containing cancer. During the procedure, a scalpel is used for the skin incision and a traditional electrosurgical device is used to cut away the breast tissue from the chest and control bleeding. Once the breast tissue is removed the remaining skin edges are brought together with sutures.

Following mastectomy, the most common complication is persistent serous wound drainage and seroma, a collection of fluid in the closed surgical space. To help prevent this complication a tissue drain is used to remove serous fluid from the surgical space via bulb suction. The rate of serous fluid collection is used to determine the time the drain remains in place. Although suction drains help reduce seroma formation, prolonged use may delay healing, cause injury, and increase the risk of infection and patient discomfort.

The PEAK PlasmaBlade™ uses pulsed radiofrequency (RF) energy to enable precision cutting and coagulating at the point of application, without the thermal damage to surrounding tissues that is normally seen with traditional electrosurgery. The PlasmaBlade has received FDA clearance for use in plastic, general, and ENT surgery, and has demonstrated significantly reduced serous drainage in tissue reduction surgeries, like mastectomy.

This multi-site study was granted IRB approval and conducted between June 2009 and January 2011. Potential subjects were screened against the inclusion and exclusion criteria of the study protocol and were then required to provide informed consent prior to enrollment. Following enrollment, subjects were prospectively randomized to the SOC or PlasmaBlade (PB or PEAK) study groups and scheduled for mastectomy with or without same day reconstruction.

Eligibility criteria: Inclusion Criteria:

1. Age between 20 and 70 years old
2. Physically healthy, stable weight
3. Requiring single or bilateral simple mastectomy, with or without sentinel lymph node biopsy
4. Subject must understand the nature of the procedure and provide written informed consent prior to the procedure
5. Subject must be willing and able to comply with all follow-up evaluations

Exclusion Criteria:

1. Age younger than 20 or greater than 70 years old
2. Anticoagulation therapy which cannot be discontinued
3. Prior external beam or implanted radiotherapy
4. Tobacco use (any kind)
5. Infection (local or systemic)
6. Cognitive impairment or mental illness
7. Severe cardiopulmonary deficiencies
8. Known coagulopathy
9. Immunocompromised
10. Kidney disease (any type)
11. Desiring or requiring same-day breast reconstruction
12. Prior breast reduction or augmentation surgery
13. Unable to follow instructions or complete follow-up
14. Currently taking any medication known to affect healing
15. Subjects who are status-post gastric banding or gastric bypass
16. Currently enrolled in another investigational device or drug trial
17. Time from most recent neoadjuvant therapy less than 4 weeks

Primary outcomes:
measure: Total Serous Drainage (mL) From Time of Drain Placement to Removal.
timeFrame: 0 to 10 days postoperatively
measure: Area of Skin Necrosis Measured With a Standard Ruler
timeFrame: 1 and 6 weeks postoperative
Secondary outcomes:
measure: Pain Score by Visual Analog Scale, Narcotic Consumption, Operative Time, Time to Surgical Drain Removal
timeFrame: 0 to 10 days postoperatively
Other outcomes:
Locations:
city: Burbank
country: United States
facility: Providence St. Joseph's Medical Center
state: California
city: Mountain View
country: United States
facility: El Camino Hospital
state: California
city: Marietta
country: United States
facility: Advanced Breast Care
state: Georgia
city: Towson
country: United States
facility: St. Joseph Medical Center
state: Maryland
Study officials:
affiliation: Elliot Breast Health Center
name: Teresa Ponn, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Elliot Breast Health Center
name: Edward Dalton, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Advanced Breast Care
name: Richard Fine, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Midpeninsula Surgical Associates
name: Peter Naruns, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Midpeninsula Surgical Associates
name: Saul Eisenstat, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: St. Joseph Medical Center
name: Michael Schultz, MD
role: PRINCIPAL_INVESTIGATOR
References: