Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-19T08:35:08.276Z Has data issue: false hasContentIssue false

A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy

Published online by Cambridge University Press:  18 September 2015

M R Elbadawey*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Tanta University Hospitals, Egypt
H M Hegazy
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Tanta University Hospitals, Egypt Department of Otolaryngology and Head and Neck Surgery, Magrabi Eye and Ear Center, Riyadh, Saudi Arabia
A E Eltahan
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Aswan University Hospitals, Aswan, Egypt
J Powell
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
*
Address for correspondence: Mr M R ElBadawey, Freeman Hospital, University of Newcastle, Freeman Road, Newcastle upon Tyne NE7 7DN, UK Fax: +44 191 2231246 E-mail: [email protected]

Abstract

Objective:

This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients.

Methods:

A total of 120 patients aged 10–15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong–Baker FACES® pain scale.

Results:

The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml; p = 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml; p = 0.0001). Diode laser tonsillectomy had a shorter operative time (p = 0.0001) and less blood loss (p = 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p = 0.042) and coblation (p = 0.04) tonsillectomy groups.

Conclusion:

Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1D'Eredità, R, Marsh, RR. Contact diode laser tonsillectomy in children. Otolaryngol Head Neck Surg 2004;131:732–5CrossRefGoogle ScholarPubMed
2Hegazy, H, Albirmawy, O, Kaka, A, Behiry, A. Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy. J Laryngol Otol 2008;122:369–73CrossRefGoogle ScholarPubMed
3Belloso, A, Chidambaram, A, Morar, P, Timms, M. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:2010–13CrossRefGoogle ScholarPubMed
4Temple, R, Timms, M. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195–8CrossRefGoogle ScholarPubMed
5Weingarten, C. Ultrasonic tonsillectomy: rationale and technique. Otolaryngol Head Neck Surg 1997;116:193–6CrossRefGoogle ScholarPubMed
6Walker, RA, Syed, ZA. Harmonic scalpel tonsillectomy versus electrocautery tonsillectomy: a comparative pilot study. Otolaryngol Head Neck Surg 2001;125:449–55CrossRefGoogle ScholarPubMed
7Principato, J. Cryosurgical treatment of the lymphoid tissue of Waldeyer's ring. Otolaryngol Clin North Am 1987;20:365–70CrossRefGoogle ScholarPubMed
8Bergler, W, Huber, K, Hammerschmitt, N, Hörmann, K. Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage. Laryngoscope 2001;111:1423–9CrossRefGoogle ScholarPubMed
9Isaacson, G, Szeremeta, W. Pediatric tonsillectomy with bipolar electrosurgical scissors. Am J Otolaryngol 1998;19:291–5CrossRefGoogle ScholarPubMed
10Koltai, PJ, Solares, CA, Mascha, EJ, Xu, M. Intracapsular partial tonsillectomy for tonsillar hypertrophy in children. Laryngoscope 2002;112:1719CrossRefGoogle ScholarPubMed
11Johnson, LB, Elluru, RG, Myer, CM. Complications of adenotonsillectomy. Laryngoscope 2002;112:35–6CrossRefGoogle ScholarPubMed
12Pizzuto, MP, Brodsky, L, Duffy, L, Gendler, J, Nauenberg, E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol 2000;52:239–46CrossRefGoogle ScholarPubMed
13O-lee, T, Rowe, M. Electrocautery versus cold knife technique adenotonsillectomy: A cost analysis. Otolaryngol Head Neck Surg 2004;131:723–6CrossRefGoogle ScholarPubMed
14Martinez, SA, Akin, DP. Laser tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 1987;20:371CrossRefGoogle ScholarPubMed
15Auf, I, Osborne, J, Sparkes, C, Khalil, H. Is the KTP laser effective in tonsillectomy? Clin Otolaryngol 1997;22:145–6CrossRefGoogle ScholarPubMed
16Kulaskar, S. KTP-532 laser tonsillectomy – a potential day-case procedure? J Laryngol Otol 1996;110:205–7CrossRefGoogle Scholar
17Wong, DL, Baker, C. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:917Google ScholarPubMed
18Shapiro, NL, Bhattacharyya, N. Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 2007;117:406–10CrossRefGoogle ScholarPubMed
19Magdy, E, Elwany, S, El-Daly, A, Abdel-Hadi, M, Morshedy, M. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122:282–90CrossRefGoogle ScholarPubMed
20Rakesh, S, Anand, T, Payal, G, Pranjal, K. A prospective, randomized, double-blind study of coblation versus dissection tonsillectomy in adult patients. Indian J Otolaryngol Head Neck Surg 2012;64:290–4CrossRefGoogle ScholarPubMed
21Sedlmaier, B, Bohlmann, P, Jakob, O, Reinhardt, A. Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results [in German]. HNO 2010;58:244–54CrossRefGoogle ScholarPubMed
22Havel, M, Sroka, R, Englert, E, Stelter, K, Leunig, A, Betz, CS. Intraindividual comparison of 1,470 nm diode laser versus carbon dioxide laser for tonsillotomy: a prospective, randomized, double blind, controlled feasibility trial. Lasers Surg Med 2012;44:558–63CrossRefGoogle Scholar
23Chang, KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005;132:273–80CrossRefGoogle ScholarPubMed
24Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–13CrossRefGoogle ScholarPubMed
25Matin, M, Chowdhury, MA. Diode laser versus blunt dissection tonsillectomy. Bangladesh J Otorhinolaryngol 2012;18:114–18CrossRefGoogle Scholar
26Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–3CrossRefGoogle ScholarPubMed