{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:06:20Z","timestamp":1774029980736,"version":"3.50.1"},"reference-count":54,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science (JSPS) KAKENHI","award":["JP 24K11748"],"award-info":[{"award-number":["JP 24K11748"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 \u00b1 187.9 vs. 820.6 \u00b1 661.6 mL; p &lt; 0.001) and shortened time to drain removal (4.8 \u00b1 1.3 vs. 6.8 \u00b1 2.1 days; p &lt; 0.001). Postoperative hospital stay was reduced by 3.7 days on average (5.9 \u00b1 1.3 vs. 9.6 \u00b1 3.4 days; p &lt; 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.<\/jats:p>","DOI":"10.3390\/cancers18061016","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:02:43Z","timestamp":1774026163000},"page":"1016","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1498-8713","authenticated-orcid":false,"given":"Naoya","family":"Ikeda","sequence":"first","affiliation":[{"name":"Department of Surgery, KIWA Hospital, Wakayama 648-0085, Japan"},{"name":"Department of Forensic Medicine, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teiji","family":"Umemura","sequence":"additional","affiliation":[{"name":"Department of Surgery, KIWA Hospital, Wakayama 648-0085, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruhito","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Surgery, KIWA Hospital, Wakayama 648-0085, Japan"},{"name":"Department of Breast Surgical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichiro","family":"Kashiwagi","sequence":"additional","affiliation":[{"name":"Department of Breast Surgical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1038\/s41591-025-03502-3","article-title":"Global patterns and trends in breast cancer incidence and mortality across 185 countries","volume":"31","author":"Kim","year":"2025","journal-title":"Nat. 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Open"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/6\/1016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:06:43Z","timestamp":1774026403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/6\/1016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":54,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["cancers18061016"],"URL":"https:\/\/doi.org\/10.3390\/cancers18061016","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}