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Six years of evidence-based adult dissection tonsillectomy with ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection

Published online by Cambridge University Press:  19 September 2012

S M Ragab
S M Ragab*
Affiliation:
Department of Otolaryngology, Tanta University Hospital, Egypt
*
Address for correspondence: Mr Sameh M Ragab, Department of Otolaryngology, Tanta University Hospital, El Bahr St, Tanta, Gharbia, Egypt Fax: +20 403416781 E-mail: [email protected]
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Abstract

Objective:

To conduct an adequately powered, prospective, randomised, controlled trial comparing adult dissection tonsillectomy using either ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection.

Methods:

Three hundred patients were randomised into four tonsillectomy technique groups. The operative time, intra-operative bleeding, post-operative pain, tonsillar fossa healing, return to full diet, return to work and post-operative complications were recorded.

Results:

The bipolar radiofrequency group had a shorter mean operative time. The mean intra-operative blood loss during bipolar radiofrequency tonsillectomy was significantly less compared with cold dissection and ultrasonic scalpel tonsillectomy. Pain scores were significantly higher after bipolar electrocautery tonsillectomy. Patients undergoing bipolar electrocautery tonsillectomy required significantly more days to return to full diet and work. The bipolar electrocautery group showed significantly reduced tonsillar fossa healing during the first and second post-operative weeks.

Conclusion:

In this adult series, bipolar radiofrequency tonsillectomy was superior to ultrasonic, bipolar electrocautery and cold dissection tonsillectomies. This method combines the advantages of ‘hot’ and ‘cold’ tonsillectomy.

Keywords

TonsillectomyAdultElectrocoagulationRandomized Controlled Trial
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 10 , October 2012 , pp. 1056 - 1062
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Kelley, PE. Painless tonsillectomy. Curr Opin Otolaryngol Head Neck Surg 2006;14:369–74CrossRefGoogle ScholarPubMed
2Leinbach, RF, Markwell, SJ, Colliver, JA, Lin, SY. Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 2003;129:360–64CrossRefGoogle ScholarPubMed
3Noordzij, JP, Affleck, BD. Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients. Laryngoscope 2006;116:1303–9CrossRefGoogle ScholarPubMed
4Smith, TL, Smith, JM. Electrosurgery in otolaryngology-head and neck surgery: principles, advances, and complications. Laryngoscope 2001;111:769–80CrossRefGoogle ScholarPubMed
5Maddern, BR. Electrosurgery for tonsillectomy. Laryngoscope 2002;112:11–13CrossRefGoogle ScholarPubMed
6Ragab, SM. Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial. Otolaryngol Head Neck Surg 2005;133:961–5CrossRefGoogle ScholarPubMed
7Collison, PJ, Weiner, R. Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J 2004;83:707–10CrossRefGoogle ScholarPubMed
8Gilbey, P, Gadban, H, Letichevsky, V, Talmon, Y. Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study. Ann Otol Rhinol Laryngol 2008;117:46–50CrossRefGoogle ScholarPubMed
9McCarus, SD. Physiologic mechanism of the ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc 1996;3:601–8CrossRefGoogle ScholarPubMed
10Pinder, DK, Wilson, H, Hilton, MP. Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 2011;(3):CD002211Google Scholar
11Sheahan, P, Miller, I, Colreavy, M, Sheahan, JN, McShane, D, Curran, A. The ultrasonically activated scalpel versus bipolar diathermy for tonsillectomy: a prospective, randomized trial. Clin Otolaryngol 2004;29:530–4CrossRefGoogle ScholarPubMed
12Silverman, EB, Read, RW, Boyle, CR, Cooper, R, Miller, WW, McLaughlin, RM. Histologic comparison of canine skin biopsies collected using monopolar electrosurgery, CO2 laser, radiowave radiosurgery, skin biopsy punch, and scalpel. Vet Surg 2007;36:50–6CrossRefGoogle ScholarPubMed
13Akural, EI, Koivunen, PT, Teppo, H, Alahuhta, SM, Lopponen, HJ. Post-tonsillectomy pain: a prospective, randomised and double-blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaesthesia 2001;56:1045–50Google Scholar
14Cardozo, AA, Hallikeri, C, Lawrence, H, Sankar, V, Hargreaves, S. Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity. Clin Otolaryngol 2007;32:366–71CrossRefGoogle ScholarPubMed
15Salonen, A, Kokki, H, Nuutinen, J. Recovery after tonsillectomy in adults: a three-week follow-up study. Laryngoscope 2002;112:94–8CrossRefGoogle ScholarPubMed
16Lowe, D, van der Meulen, J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;364:697–702Google ScholarPubMed
17Hopkins, C, Geyer, M, Topham, J. Post-tonsillectomy haemorrhage: a 7-year retrospective study. Eur Arch Otorhinolaryngol 2003;260:454–5CrossRefGoogle ScholarPubMed
18Lowe, D, Cromwell, DA, Lewsey, JD, Copley, LP, Brown, P, Yung, M et al. Diathermy power settings as a risk factor for hemorrhage after tonsillectomy. Otolaryngol Head Neck Surg 2009;140:23–8CrossRefGoogle ScholarPubMed