Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial

Radiofrequency Versus Electrocautery in Pediatric Tonsillectomy: A Double-Blind, Randomized Controlled Trial

To compare radiofrequency and electrocauterization in reducing the degree of postoperative pain in pediatric patients undergoing tonsillectomy. A double-blind, parallel-group, randomized controlled trial. Pediatric patients with indications for tonsillectomy were randomized to receive either tonsillectomy with radiofrequency or electrocautery. Also recorded were intraoperative blood loss, duration of the surgery, length of hospital stays, and complications from the surgery. Forty pediatric patients participated in the study; 20 were randomized to each group. The participants' ages ranged from 3 to 14 years old, and 65% were male. The overall postoperative pain scale score during the early postoperative period was lower in the radiofrequency group compared to the electrocautery group (mean difference - 1.37 (95%CI - 1.72, - 0.12); p < 0.001). Also, the mean pain scale scores at 6 h, 1, and 2 days were significantly lower in the radiofrequency group. Intraoperative blood loss and length of hospital stay in the radiofrequency group were also significantly lower than in the electrocautery group, whereas the duration of the surgery and complication rate were not different between the two groups. Pediatric tonsillectomy using radiofrequency ablation could reduce the severity of early postoperative pain, intraoperative blood loss, and length of hospital stay compared to tonsillectomy with electrocautery. Therefore, tonsillectomy with radiofrequency may be considered a safe and effective operative option. Trial registration Thai Clinical Trials Registry (TCTR-20210303007), 03-March-2021.

PlasmaBlade vs. cold dissection tonsillectomy: A prospective, randomized, double-blind, controlled study in adults

We conducted a prospective, randomized, double-blind, controlled clinical study to compare the efficacy and safety of the PlasmaBlade device and cold dissection for adult tonsillectomy. Our study group was made up of 20 patients-12 men and 8 women, aged 18 to 50 years (mean: 27.1)-who were undergoing a bilateral tonsillectomy. Each patient had one randomly chosen tonsil removed by the PlasmaBlade and the other by cold instrumentation. We compared the duration of surgery, the amount of intraoperative blood loss, the number of sutures required, the status of tonsillar fossa wound healing at 7 and 14 days postoperatively, the amount of postoperative pain, and postoperative complications. We found statistically significant differences in the amount of blood loss and the number of sutures in favor of the PlasmaBlade technique. No significant differences were observed in any of the other outcomes.

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children

Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.

Molecular resonance tonsillectomy in children: comparative study over standard techniques in an 11-year study

OBJECTIVES

Learn the molecular resonance (MR) technology for tonsillectomy. An analysis of outcomes of MR compared to standard cold-knife (CK) and monopolar cautery (MPC) for pediatric tonsillectomy offers new possibilities, lowering postoperative morbidity.

STUDY DESIGN

Eleven-year, prospective, randomized, 3-group trial.

SETTING

Tertiary care pediatric institution.

SUBJECTS AND METHODS

Eight hundred and seventy-three children undergoing adenotonsillectomy were randomly assigned to MR (n = 283), CK (n = 279), or MPC (n = 279) techniques. Outcome measures included intraoperative time, blood loss, postoperative pain, weight loss, and histopathologic examination on excised tonsils.

RESULTS

Histopathologic evaluation revealed reduced thermal injury with MR over MPC (43 µm vs 186, P < .001), statistically associated with reduced muscular, blood vessel, and nerve fiber damage compared to CK (P < .001). Blood loss was minimal in MR. Significant reduced pain scores were related to MR (P < .002). Two MR, 15 CK, and 12 MPC patients experienced delayed bleeding.

CONCLUSION

MR for pediatric tonsillectomy resulted in reduced histopathologic thermal injury, lower pain scores, and reduced postoperative morbidity compared with CK and MPC techniques in an 11-year study.

Esthetic removal of head and neck nevi and lesions with 4.0-MHz radio-wave surgery: a 30-year experience

PURPOSE

The cosmetic removal of facial nevi and related lesions is a frequent patient request of cosmetic surgeons. Many patients live with esthetically bothersome lesions, unaware that scar-free or minimal scar treatment modalities are available.

MATERIALS AND METHODS

The author has used a protocol of treating thousands of nevi and related benign lesions with 4.0-MHz radio-wave ablation during the past 30 years. A review of this technique is presented with substantiation by before and after images. Indications, diagnosis, and complications also are reviewed.

RESULTS

Conservative ablation of nevi and benign lesions of the face and neck can be predictably removed with minimal and frequently imperceptible scarring.

CONCLUSION

Facial surgeons see multiple patients on a daily basis requesting the removal of nevi and other benign lesions of the face and neck. Many patients are misinformed by experienced practitioners that the resulting scar will be worse than the lesion. This unfortunate dictum has been disproved hundreds of times by the author's treatment using 4.0-MHz radio-wave surgery to ablate benign lesions of the face and neck, with excellent cosmetic results. Even if practitioners do not offer this treatment, they should be aware that it exists and offer patients exposure to this modality.

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

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.

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.

Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study

Radiofrequency (RF) surgery has gained popularity as a safe and effective method for treating patients with snoring and mild obstructive sleep apnoea (OSA). Both interstitial and cutting radiofrequency energy may be used for multi-segmental management of the upper airway. Little is known about the effect of cutting radiofrequency energy on human soft palate. Excessive collateral injury may have an impact on tissue healing and functional outcomes. A histological analysis of specimens of human soft palate and uvula following resection with cutting RF energy was performed. In addition, ultrastructural analysis using scanning electron microscopy of excision margins was performed and compared with CO(2) LASER. Twelve patients were included. In ten patients, specimens of redundant uvula and faucial pillars were collected and underwent formal histological analysis. The maximum depth of tissue injury was 1 mm in two specimens and overall average depth of injury was 0.15 mm. Injury depth was independent of tissue subtype at the resection margin. Ultrastructural analysis demonstrated accurate incision when compared to CO(2) LASER. Cutting RF energy causes minimal collateral injury to the soft palate during resection for the treatment of snoring and mild OSA. A detailed knowledge of local effects on resection specimens allows accurate inference of in vivo tissue injury at the resection margin and may enable more precise prediction of healing patterns and repair.

Bipolar radiofrequency tonsillotomy compared with traditional cold dissection tonsillectomy in adults with recurrent tonsillitis

Objective: To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis.

Study Design: A randomized clinical trial.

Setting: A tertiary referral university hospital.

Subjects and Methods: Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes.

Results: Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively ( P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months.

Conclusion: Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis.

Comparison of radiofrequency and monopolar electrocautery tonsillectomy

OBJECTIVES

To compare the efficacy and safety of radiofrequency and monopolar electrocautery tonsillectomy, regarding operation duration and tonsillectomy morbidity, including post-operative pain and haemorrhage and tonsillar fossa healing, in patients with recurrent chronic tonsillitis.

STUDY DESIGN

A prospective, randomised, double-blind, controlled clinical study.

METHODS

Fifty patients aged over 10 years who required tonsillectomy were randomly assigned to have one tonsil removed by radiofrequency and the other by monopolar electrocautery. Operation duration, post-operative haemorrhage, post-operative pain and tonsillar fossa wound healing were compared.

RESULTS

The mean +/- standard deviation of the operation duration required for the radiofrequency method was significantly longer than that for monopolar electrocautery: 8.1 +/- 1.6 minutes vs 7.3 +/- 1.5 minutes, respectively (p = 0.034). Post-operative haemorrhage was observed in only three patients (13.6 per cent). Inter-group analysis showed no significant differences in post-operative pain scores for the radiofrequency vs monopolar electrocautery methods (3.7 +/- 1.6 vs 3.3 +/- 1.4, respectively; p < 0.126). Inter-group analysis showed that tonsillar fossa wound healing scores evaluated on the fifth, 10th and 14th post-operative days were significantly higher in the radiofrequency group compared with the monopolar electrocautery group (p < 0.001).

CONCLUSION

The present study results indicated that monopolar electrocautery tonsillectomy was superior to radiofrequency tonsillectomy in terms of post-operative tonsillar fossa wound healing; however, both techniques were comparable in terms of post-operative pain.

Making sense out of the tonsillectomy literature

BACKGROUND

With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons.

OBJECTIVES

To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children. To propose the use of specific study parameters that could optimize clinical decision-making and future research.

METHODS

Detailed review of the methodologies and findings in articles which compared one or more tonsillectomy techniques in clinical trials of children, ages 1-23 years from 1987 through 2007.

RESULTS

The Medline search revealed 255 papers of which 89 studies were suitable for inclusion in our review. In these 89 studies (found in 87 papers), 9 dissection techniques, 3 planes of dissection, 8 methods of hemostasis, and 41 different outcome measures were reported. Forty-four (49%) were described as randomized, 63 (71%) prospective, 25 retrospective (28%), 1 case report, 1 matched pair, and 9 case series papers. Sixteen (18%) trials were non-blind, 23 (26%) were single blind, 17 (19%) were double blind, and 7 (8%) were not stated. Seventy-five (84%) were comparative and 14 (16%) non-comparative. Eight (9%) studies reported power analyses. Twelve (13%) had no follow-up; 67 (75%) of the studies performed had short-term follow-up in the peri-operative period; 10 (11%) had follow-up for greater than 1 year. Eleven (12%) mentioned outcomes related to the effectiveness of the procedure itself in relieving symptoms for which the surgery was done.

CONCLUSIONS

Tonsillectomy technique research is of obvious interest to the otolaryngologist. We found deficits in: the precise reporting of surgical techniques, adequate study design and useful outcome measures, all of which make the literature less useful than it could be. Guidelines for study design parameters which could lead to more valuable information for the clinician are suggested.

Molecular resonance vs. coblation tonsillectomy in children

BACKGROUND

Quantum molecular resonance coagulation is an innovative technology that uses molecular resonance to cut and coagulate precisely, cleanly, and hemostatically at low tissue temperature levels. This technology offers a new possibility for tonsillectomy.

OBJECTIVES

To compare molecular resonance (MRT) with coblation (CAT) devices for pediatric tonsillectomy.

STUDY DESIGN

Prospective, two-group, randomized trial in a tertiary care pediatric institution. One hundred fifty-seven children for whom tonsillectomy was indicated were randomly assigned to receive MRT (n = 79) or CAT (n = 78). Main outcome measures included intraoperative time, blood loss, postoperative pain, and weight loss. Histopathologic examination was performed on all excised tonsils. Patients, parents, and pathologist were blinded to surgical modality.

RESULTS

Histopathologic evaluation revealed significantly reduced thermal injury with MRT than with CAT (43 microns vs. 126, respectively, P < .001), and was statistically associated with reduced muscular, blood vessel, and nerve fiber damage. No intraoperative blood loss was observed in patients following MRT. Statistically significant reduced pain scores were related to the MRT (P < .002). In addition, the MRT method showed a quick return to normal diet with even weight gain during the 10-day postoperative period. One child in the CAT group experienced delayed bleeding and required readmission.

CONCLUSIONS

Molecular resonance for pediatric tonsillectomy resulted in significantly reduced histopathologic thermal injury and lower pain scores compared with coblation. Further studies are advised to support these data.

Radiophonosurgery of vocal fold nodules

PURPOSE OF REVIEW

To describe the current support in the literature for radiophonosurgery in cases of vocal fold nodules.

RECENT FINDINGS

Radiophonosurgery is a recent innovation in the field of laryngeal surgery. It is emerging as a reliable and practical method for treating benign superficial vocal fold lesions that is increasingly becoming popular. It induces an excellent subjective and objective improvement in voice parameters. Histologically, it produces unremarkable lateral thermal damage and char penetration, which is quite crucial in a functional surgery such as in phonosurgery. Well designed probes are still lacking in the market.

SUMMARY

Radiophonosurgery provides a new approach for patients with vocal fold nodules. It combines the advantages of both cold knife and laser phonosurgery and is easy, well tolerated, precise and effective with excellent tactile and hemostatic properties.

Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy

OBJECTIVES

To compare the advantages and disadvantages of potassium titanyl phosphate laser with those of bipolar radiofrequency techniques, in paediatric tonsillectomy.

STUDY DESIGN

Prospective, randomised, clinical study.

PATIENTS AND METHODS

From July 2004 to April 2006, 80 patients aged between 10 and 15 years, with tonsillectomy planned for chronic tonsillitis, were included in the study. Children were prospectively randomised into two equal groups: potassium titanyl phosphate laser tonsillectomy and bipolar radiofrequency tonsillectomy. Operative time and intra-operative blood loss were recorded. Patients were scheduled for follow up during the first, second and fourth post-operative weeks. They were asked to record their pain and discomfort on a standardised visual analogue scale, from zero (no pain) to 10 (severe pain). Post-operative complications were also recorded and managed.

RESULTS

The potassium titanyl phosphate laser group showed a slightly longer operative time (mean 12 minutes) than the bipolar radiofrequency group (mean 10 minutes). Intra-operative blood loss was significantly less in the potassium titanyl phosphate laser group (mean 21 cm3) than in the bipolar radiofrequency group (mean 30 cm3). In the first week, post-operative pain scores were less in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 7.5 and 8.5, respectively). However, in the second week pain scores increased more in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 8.5 and 6, respectively). In the fourth week, both groups showed equal and nearly normal pain scores. No case of reactionary post-tonsillectomy haemorrhage was recorded in either group. Only one case of secondary post-tonsillectomy haemorrhage was recorded, in the potassium titanyl phosphate laser group (2.5 per cent), managed conservatively.

CONCLUSION

Both the potassium titanyl phosphate and the bipolar radiofrequency techniques were safe and easy to use for tonsillectomy, with reduced operative time, blood loss and complication rates and better post-operative general patient condition. Potassium titanyl phosphate laser resulted in reduced operative bleeding and immediate post-operative pain, compared with the bipolar radiofrequency technique. However, potassium titanyl phosphate laser required slightly more operative time and caused more late post-operative pain than the bipolar radiofrequency technique. The low rate of recorded complications showed that both techniques cause little damage to the tonsillar bed during dissection, thus minimising complications.