Eur J Plast Surg (1998) 21:230±235
W.G.N. Steinmetz ´ B.J. Bauer ´ P. Eckert
Experiences with the use of an argon beam coagulator
in reduction mammaplasty
Received: 23 October 1996 / Accepted:16 October 1997
W.G.N. Steinmetz (
) ´ B.J. Bauer ´ P. Eckert
Department of Plastic Surgery and Hand Surgery,
University Hospital, Josef-Schneider-Strasse 2,
D-97078 Würzburg, Germany
Phone: +49-93-201-3318; Fax: +49-931-201-3286
E-mail: 100330.3047 @compuserve.com
Abstract Argon beam coagulation is a method that is
steadily gaining popularity in plastic surgery procedures.
In an attempt to judge its true value, a prospective, ran-
domized trial was performed in reduction mammaplasty.
Fifty-six patients were studied; in 28 the Valleylab Force
System was used and in 28 conventional electro-
cautery. Pre-, intra- and postoperative hemoglobin and he-
matocrit values for the two groups were compared; the in-
tra- and early postoperative levels were higher in the ar-
gon beam group. A pilot study promised significant dif-
ferences between the two groups, however, the main
study failed to show this. An analysis of this situation re-
vealed problems related to individual surgeon experience
with the device, and the technique needed to be changed
in order to benefit from argon gas enhanced surgery. Mi-
nor complications occurred equally in both study groups.
Key words Argon beam coagulator ´ Reduction
mammaplasty ´ Electrosurgery ´ Hemostasis
In the past there have been many attempts to reduce blood
loss in reduction mammaplasty, these include acute nor-
movolemic hemodilution and autologous blood transfu-
sion. These can cause problems and therefore reduction
of blood loss intraoperatively is more appealing. In
1987, the argon beam coagulator
became available (Bard
System 6000 Argon Beam Coagulator). Since 1994, the
Valleylab Force GSU
System, an argon beam enhanced
coagulation device with multiple adjustment options, has
been used for a variety of procedures.
Because of controversy over the use of argon beam co-
agulators (ABC), a standardized prospective, randomized
trial to further compare conventional electrocoagulation
devices was instituted. This was preceded by a pilot study
which was more strictly controlled and showed consider-
able reduction in blood loos as measured by hemoglobin
and hematocrit (Fig. 5).
Materials and methods
From February 1995 until April 1996, 56 reduction mammaplasty
patients were included in the trial. The mean age was 30.3 years
with a range of 15 to 64 years. Reduction was by the Lejour 
or by the Robbins technique . Thirty-two patients were injected
with solutions containing epinephrine. The surgery was performed
quasi-simultaneously by two surgeons, the more senior controlling
all crucial steps.
The individuals were randomized into two study arms.
Group 1: ABC used on 28 patients; mean age 31.7 years; average
resection weight per side: 549 g
Group 2: Conventional electrocoagulation used; 28 patients; mean
age 29.0 years; average resection weight per side: 439 g.
Blood loss was assessed by red blood cell counts (RBC) at given in-
· Day prior to surgery
· Intraoperatively every 30 min
· Postoperatively on days 1, 2, 3, 5, 6, and 7
Changes due to dilution effects were maintained for three days by a
strict intake and output protocol; this includes fluid in the suction
drains. The time of surgery and complications was noted.
Hospital stay for each group was compared and analyzed.
One patient from the ABC group with significant postoperative
bleeding required blood transfusion and was excluded from the he-
matological part of the study.
The Valleylab Force GSU System has a number of different op-
tions for the cutting and the coagulation mode. There is a separate
control unit for the electrical high frequency current system and
the gas circuit. Argon gas is supplied from two pressure tanks on
the bottom part of the machine. The handpiece functions much in
the same way as that of a conventional electrocoagulation unit but
has additional features. On the main body of the handle there is a
rocker switch which controls cutting and coagulation current, and
also a sliding switch which controls the gas flow around the needle
tip (Fig. 1). In the forward position of the switch a steady flow of
Birtcher Electromedical Systems, Inc., Englewood, Colorado, USA