Methods which aid and enhance the teaching of surgical procedures to trainees are beneficial to both trainer and trainee. In this article, we suggest a simple way of performing suction diathermy which allows the trainer to provide a template for the trainee to reproduce. Related articles have suggested the use of additional equipment, such as an endoscope; however, the method we describe requires no additional technical elements. Thus, it represents a sound and efficient teaching tool.

Objectives: To determine whether the introduction of a 14-day post-tonsillectomy analgesic regime would be associated with a statistically significant decrease in readmission rate.

Method: A comparative study of tonsillectomy patients over two study periods. A retrospective review was undertaken of 342 patients (group one, five-day analgesic regime) who had undergone tonsillectomy. A prospective study was undertaken of 228 patients (group two, 14-day analgesic regime). The readmission rates for the two study periods were compared.

Results: The median age of group one patients was 8.1 years (range, zero to 43 years). In this group, ‘cold steel’ dissection was performed in 177 patients (52 per cent) and bipolar dissection in 165 patients (48 per cent); seven patients suffered reactionary haemorrhage, all from the cold steel dissection group. The median age of group two patients was 8.0 years (range, one to 47 years). In this group, cold steel dissection was performed in 103 patients (45 per cent) and bipolar dissection in 125 patients (55 per cent); there were no cases of reactionary haemorrhage. The readmission rate for group one was 9.9 per cent (34 patients), with 2.1 per cent (seven patients) returning to the operating theatre for control of haemorrhage. In group two, 8.8 per cent (20 patients) were readmitted and 1.3 per cent (three patients) returned to the operating theatre. The main reason for readmission was secondary haemorrhage: 9.1 per cent from group one and 8.3 per cent from group two. No significant difference in readmission was found between the 5-day analgesia and the 14-day analgesia groups (p=0.443). However, there was a significant difference between the diathermy and cold steel dissection groups (p<0.001). Patients undergoing bipolar diathermy were almost six times more likely to be readmitted than those undergoing cold steel dissection (odds ratio 5.78). The average time to readmission after tonsillectomy did not significantly differ between the two groups.

Conclusion: The post-tonsillectomy readmission rate was not affected by the duration of post-operative analgesia; however, operating technique did have an effect.

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

We describe in this case report a new technique for treatment of hypopharyngeal haemangioma, using the surgical diathermy snare. The snare was easily introduced through the direct laryngoscope, without any difficulties. The procedure was simple, rapid and involved minimal bleeding. We also discuss the histological types of haemangioma, clinical picture, radiological findings and other modalities of treatment.

Objective: To compare the potential risk of blood contamination of the surgeon's conjunctiva during tonsillectomy using disposable bipolar diathermy and reusable monopolar diathermy.

Design: A prospective, single-blind, randomized, controlled trial.

Methods: Elective tonsillectomy was performed using either disposable bipolar diathermy or reusable monopolar diathermy. The operating surgeon wore a ViewsafeTM protective eyeshield which was later examined under an operating microscope by a blinded observer and the number of blood spots counted.

Results: One hundred and sixty-eight patients were enrolled. The relative risk of conjunctival contamination of the surgeon using disposable bipolar diathermy was 2.8 times that with reusable monopolar diathermy (chi-squared test, p < 0.0005). A previous history of peritonsillar abscess and additional adenoidectomy were associated with increased blood splatter.

Conclusion: The use of disposable bipolar diathermy for haemostasis during tonsillectomy poses a greater risk of conjunctival contamination for the surgeon than using reusable monopolar diathermy.

Adenoidectomy Is A Surgical Procedure Frequently Carried Out In Otolaryngological Practice, Traditionally Undertaken Blindly With Curettage Using An Adenotome Following Palpation Of The Adenoid Bed. While A Number Of Alternative Methods Have Been Described For Surgical Removal Of The Adenoid Pad (Power-Assisted/Microdebrider, Transnasal Adenoid Ablation, Suction Coagulation And Liquefaction/Aspiration) None Has Become The Definitive Procedure. Suction Diathermy Adenoidectomy Has Been Known And Used For Some Time; It Has Gained In Popularity Over Recent Years And Is Established As An Alternative To Conventional Curettage, Particularly In Children.

We Describe Several Techniques Which Improve The View Of The Surgical Field While Performing Suction Diathermy Adenoid Ablation.

Coblation is a new soft tissue surgical technique that is being used for tonsillectomy. Published results show a significant decrease in the amount of post-operative pain experienced y patients undergoing coblation tonsillectomy. There has been no published work to date on the incidence of post-operative haemorrhage. From August 2001 to November 2002 one surgeon performed 36 coblation tonsillectomies on adults. On another list he performed 29 by his standard method of dissection and bipolar coagulation. Retrospective analysis found a significant increase in the secondary haemorrhage rate in adult patients undergoing coblation tonsillectomy (22.2 vs. 3.4 per cent). At our department coblation tonsillectomy has been abandoned until further work into its safety has been published.

Endoscopic epiglottectomy is usually performed using a surgical laser. Epiglottectomy may be indicated for the treatment of benign or malignant lesions and for the relief of airway obstruction caused by a floppy epiglottis. We present four patients who had endoscopic partial epiglottectomy using monopolar diathermy to treat a floppy epiglottis. All the four patients were male in their sixth and seventh decades with snoring and/or obstructive sleep apnoea syndrome (OSAS) due partly or wholly to a floppy epiglottis. Diathermy epiglottectomy is easily carried out using the laryngoscope, laryngeal instruments and curved rotating microdissection monopolar scissors (used in laparoscopic surgery). This was found to be safe and effective with minimal morbidity. It requires no elaborate preparation and could be performed in hospitals that have no laser facilities. It may be performed in conjunction with other procedures e.g. uvulopalatopharyngoplasty (UPPP) if necessary.

A prospective randomized study was carried out to assess the post-tonsillectomy morbidity of the selective diathermy technique as opposed to the ligation technique. One hundred and five patients had one tonsillar fossa haemostasis secured by unipolar diathermy and the opposite side by ligation technique. There was significantly less pharyngeal pain on the diathermy side in the first post-operative day. However, there was no significant difference between the two sides, both in pharyngeal discomfort and otalgia for the rest of the post-operative period. There was no difference in the incidence of haemorrhage between the two techniques.

A prospective randomized study was carried out to assess the post-tonsillectomy morbidity of the electrodissection technique as opposed to the blunt dissection and ligation technique. One hundred and four patients, each serving as his or her own control, were randomized to have either the right or left tonsil removed by electrodissection. There was significantly less pharyngeal pain on the electrodissection side in the first postoperative day in adult patients. This, however, was transient as there was increased pharyngeal discomfort and otalgia, both in severity and duration, on the electrodissection side by the end of first week. There was no difference in the incidence of haemorrhage between the two techniques.