Randomized controlled study comparing tonsillectomy safety and patient satisfaction outcomes between HARMONIC ACE® + shears and monopolar diathermy in an adult population - A pilot study

PURPOSE

Various types of the harmonic scalpel blades have been used for tonsillectomy since the early 2000s with varying successes. The HARMONIC ACE® + 23 cm shears is a relatively new blade which has not been studied in an adult population yet.

METHODOLOGY

A randomized controlled pilot study was performed comparing the HARMONIC ACE® + 23 cm shears (HS) and monopolar electrocautery (EC) tonsillectomy in 20 patients. Intraoperative blood loss, pain control, return to normal diet and activity as well as patient satisfaction outcomes were compared between these two arms.

RESULTS

The operative time was comparable. Compared to the EC arm, there was less intraoperative bleeding, lower risks of delayed haemorrhage and readmission in the HS arm. Post-operative pain scores and use of analgesia were similar. There was earlier return to normal diet and activity in the HS arm compared to the EC arm. More patients in the HS arm recommended using HARMONIC ACE® + 23 cm shears compared to those in the EC arm. This is a non-inferiority study which suggests that the HARMONIC ACE® + 23 cm shears is comparable to monopolar electrocautery in terms of efficacy and post-operative complication rates with better patient satisfaction outcomes. The main weakness of the study is a small study population.

CONCLUSION

This is the first reported study comparing the use of the HARMONIC ACE® + 23 cm shears with monopolar cautery in tonsillectomy. A prospective adequately powered study validated by objective outcome measures would be useful to verify the findings from this pilot study.

A comparison of intraoperative haemostatic techniques during tonsillectomy: Suture vs electrocautery-A study to assess postoperative pain scores and duration to resumption of normal diet

OBJECTIVES

To assess postoperative pain and pattern of recovery to normal diet in children who underwent tonsillectomy.

METHODS

Cold steel tonsillectomy (or adenotonsillectomy) was performed in 61 children. Haemostasis was attained with sutures in Group 1 (n = 30, 8 tonsillectomy and 22 adenotonsillectomy), and electrocautery in Group 2 (n = 31, 6 tonsillectomy and 25 adenotonsillectomy). Information obtained included postoperative pain scores and the number of postoperative days taken to resume normal diet. The pain score was evaluated with the Wong-Baker FACES^® Pain Rating Scale (WBFS).

RESULTS

Pain values in Group 1 (haemostasis with sutures) were significantly lower than those in Group 2 (haemostasis with cauterisation) from the 6th hour to the 7th postoperative day (P < .05). For both liquid and solid food, Group 1 returned to normal diet earlier, compared to Group 2 (P < .05). When comparing patients undergoing tonsillectomy vs adenotonsillectomy, resumption of normal diet was achieved later in the adenotonsillectomy patients (P < .05). In terms of postoperative bleeding, there were 2 significant events in Group 2 (electrocautery group), occurring on the 1st (severe) and 10th day (slight) in 2 children (6.5%). There were no postoperative bleeding events in Group 1.

CONCLUSION

Our results showed that suture haemostatis causes less pain and faster resumption of normal diet compared to electrocautery. In view of this, we recommend the use of sutures for achieving intraoperative haemostasis in paediatric patients.

Bipolar cautery tonsillectomy using different energy doses: pain and bleeding

OBJECTIVE

Tonsillectomies are the most frequently applied operations in the ENT practice. Even though different surgical tonsillectomy techniques have been used, bipolar cautery is the most frequently used one. Our aim was to compare postoperative bleeding rates, pain scores and recovery times in tonsillectomies performed by using bipolar cautery in Joules (1Watt·sec or Ws) calculated by multiplying Watts by the duration of cauterization.

METHODS

Adenotonsillectomy and tonsillectomy patients, admitted to the Department of otorhinolaryngology of Izmir Ataturk Training and Research Hospital and Mardin State Hospital, between January 2007 and December 2012 constituted the study group prospectively. The patients divided into 4 groups due to the energy they exposed.

RESULTS

Patients in Group 1 recovered most rapidly (mean recovery time, 13.9 ± 1.8 days). Statistically significant results were obtained between Groups 1 and 4 and also Groups 2 and 4 when recovery times of the patient groups were evaluated with Bonferroni correction test.

CONCLUSION

As a result, for hemostatic control, electrocauterization should be used at lower doses and short-term as possible so as to decrease frequency of bleeding episodes, alleviate postoperative pain and accelerate wound healing.

Harmonic scalpel versus bipolar tonsillectomy: a double-blind clinical trial

This is a double bind clinical trial which evaluated harmonic scalpel versus bipolar diathermy tonsillectomy The study was conducted at Diyarbakir government hospital, Diyarbakir, Turkey. The study population comprised 144 patients, aged 4-18 years (mean 9 years ± 4.12 SD). All patients underwent tonsillectomy with or without adenoidectomy. The indications for tonsillectomy were obstructive sleep apnea (84 patients [58.3%]) and chronic tonsillitis (60 patients [41.7%]). All 144 patients were randomly divided into two groups: bipolar dissection (81 patients [56.2%] with mean age 8.98 years ± 4.22) and harmonic scalpel (63 patients [43.8%] with mean age 9 years ± 4.02). BD group showed statistically significantly less intraoperative bleeding (< 0.05). There was no statistically significant difference on postoperative day 1 but a statistically significant difference was determined on postoperative days 4, 7 and 14. There was no statistically significant difference between the two techniques with regard to immediate and delayed bleeding. The mean operative time was the same in both the groups. Bipolar dissection group showed statistically significant less intraoperative bleeding than harmonic scalpel group. An analysis of postoperative pain scores showed that the harmonic scalpel group pain scores are lower than the bipolar dissection group on all recorded days, and no statistically significant complications was seen in both groups. The results of this study indicate that the HS technique is associated with lower pain scores with the same complication rates as the BD technique.

Anesthesia for pediatric airway surgery: recommendations and review from a pediatric referral center

Pediatric airway surgery presents many significant challenges to the anesthesia provider. The clinical experience of the Massachusetts Eye and Ear Infirmary serves as a guide in this review to describe the clinical reasoning and perioperative management of the pediatric patient needing airway surgery, with specific emphasis on diagnostic procedures, trauma, laryngotracheal reconstruction, juvenile recurrent respiratory papillomatosis, and adenotonsillectomy.