Tonsillectomy

Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial

This study aimed to assess the impact of varying monopolar diathermy power settings on postoperative pain, hemorrhage, and wound healing following tonsillectomy. A single-center, prospective, randomized, double-blinded, controlled clinical study was conducted. During bilateral tonsillectomy procedures, one tonsil received low-power settings (15 W, cutting/blend) while the other tonsil received high-power settings (35 W, cutting/blend). Postoperative pain scores (0-10) and wound healing scores (0-3) were evaluated immediately after surgery and at 1, 2, and 4 weeks postoperatively using the visual analog scale. Additionally, histological analysis was performed on electrically resected tonsil tissues to assess tissue damage in the tonsil bed. The allocation of high and low power settings to each side was randomized. Results showed that 1 week after the surgery, the high-power group experienced significantly higher pain scores (mean ± standard deviation: 4.84 ± 2.21) compared to the low-power group (3.56 ± 2.24, p = 0.049). Moreover, the high-power side exhibited slower wound healing during the initial 1-2 weeks postoperatively, as indicated by lower wound scores at 2 weeks (high-power: 1.96 ± 0.64; low-power: 2.43 ± 0.59, p = 0.008). Furthermore, histological analysis revealed significantly deeper tissue degradation on the high-power side compared to the low-power side (p < 0.001), with mean depths of 565.2 ± 291.0 µm and 156.0 ± 36.8 µm, respectively. In conclusion, these findings suggest that when employing monopolar diathermy in tonsillectomy, lower power settings can lead to improved outcomes in terms of postoperative pain, wound healing, and tissue damage.Trial registration: CRIS identifier: KCT0005670 (cris.nih.go.kr, registration date: 11/12/2020).

Current bacteriological profile of tonsillar surface versus core tissue in patients undergoing tonsillectomy

PURPOSE

The current study explored the bacteriological profile in the tonsillar core in patients undergoing tonsillectomy and compared it with tonsillar surface organisms. The antibiotic sensitivity and resistance patterns were also studied.

MATERIALS AND METHODS

This prospective and observational study was conducted in the Department of Otorhinolaryngology, Head and Neck surgery in a tertiary care institute, on a total of sixty-one patients clinically diagnosed as chronic tonsillitis and undergoing tonsillectomy. Tonsillar surface culture swabs and core tissue specimen were sent in separate vials. The culture isolates and their antibiotic sensitivity were analysed and compared.

RESULTS

Bacterial growth was detected in 61% of the cases, in cultures from the surface or the core tissue or both. 50.8% specimens of core tissue versus 31.1% of tonsillar surface samples revealed bacterial growth. Of the 13 cases in which surface and core both had bacterial culture growth, the same pathogens were identified in 8 cases. Pseudomonas aeruginosa was the most commonly reported organism in both tonsillar core as well as surface swab cultures.

CONCLUSION

Our study shows that surface swab culture is not always a reliable indicator of organisms present in core of tonsils in cases of chronic infection. The surface swabs did not always match the pathogens in the core. The higher prevalence and the variability of pathogenic organisms in the core tissue as compared to the surface suggests that a targeted antibiotic treatment based on surface culture swabs is unlikely to eradicate them.

Outcomes of coblation tonsillectomy versus bipolar electrocautery tonsillectomy in pediatric population

Background

Bipolar electrocautery tonsillectomy has been the preferred technique for many otolaryngologists, yet coblation tonsillectomy is gaining popularity in the current practice. This study aims at comparing both techniques in terms of pain, bleeding, and healing.

Results

A total of 120 patients were randomly divided into two equal groups. Overall mean pain score associated with coblation tonsillectomy was statistically less than that caused by bipolar electrocautery throughout the follow-up period (p < 0.001). The difference in pain duration was statistically longer for the bipolar group. The incidence of postoperative hemorrhage—both reactionary and secondary—was statistically higher in the bipolar group. Coblation tonsillectomy showed statistically shorter duration of healing (p < 0.001).

Conclusions

Coblation tonsillectomy is associated with less pain severity and shorter pain duration, fewer bleeding incidents, and more prompt healing.

[Modern approaches to the surgical treatment of chronic tonsillitis]

At the moment, all over the world there are a large number of various methods of surgical treatment of chronic tonsillitis. In particular: classical tonsillectomy, cryosurgical method for removing the palatine tonsils, shaver tonsillectomy, monopolar and bipolar tonsillectomy, tonsillectomy with an ultrasonic scalpel, bipolar dissection using cutting instruments, laser tonsillectomy, coldablation. This article analyzes the existing methods, describes the fundamental technique for their implementation, as well as their advantages and disadvantages. Given the abundance of various surgical approaches to the treatment of chronic tonsillitis, there is a need for studies aimed at comparative study of their clinical and microbiological efficacy, including the postoperative period.

The embodiment of practice thresholds: from standardization to stabilization in surgical education

Surgeons practice their own variations on a procedure. Residents experience shifting thresholds between variations that one surgeon holds firmly as principle and another takes more lightly as preference. Such variability has implications for surgical education, but the impact is not well understood. This is a critical problem to investigate as programs seek to define procedures for competency-based medical education (CBME) and improve learning through deliberate practice. Our study analyzes the emergence of procedural variation in an early-adopter CBME program through a situational analysis of tonsillectomy, a foundation level procedure in this otolaryngology, head and neck surgical program. An earlier phase of the study identified frequent variations (n = 12) on tonsillectomy among co-located surgeons who routinely perform this procedure (n = 6). In the phase reported here we interviewed these surgeons (n = 4) and residents at different stages of training (n = 3) about their experiences of these variations to map the relations of contributing social and material actors. Our results show that even a basic procedure resists standardization. This study contributes a sociomaterial grounded theory of surgical practice as an embodied response to conditions materialized by intra-relations of human and more-than-human actors. Shifting root metaphors about practice in surgical education from standardization to stabilization can help residents achieve stable-for-now embodiments of performance as their practice thresholds continue to emerge.

Coblation tonsillectomy versus cold steel dissection tonsillectomy: a morphological study

Objective

To compare the extent of tissue damage produced by conventional cold steel and coblation tonsillectomy.

Methods

Twenty patients underwent conventional and 18 underwent coblation tonsillectomy. The removed tonsils were histopathologically evaluated.

Results

Analgesic use was lower in the coblation group during the early post-operative period. Histological investigation of tonsils removed by the conventional method showed intensive haemorrhage and hyperaemia in the tonsillar capsules, which was not seen in the coblation group. Furthermore, in the coblation group, there was less mast cell degranulation (p = 0.0081) and a smaller amount of skeletal muscle tissue (p = 0.0043) in the tonsillar capsules, indicating less tissue damage.

Conclusion

Compared to the cold steel technique, coblation tonsillectomy is superior in terms of less early post-operative pain and less damage to surrounding tissues. Significantly lower mast cell degranulation in coblation tonsillectomy may contribute to the reduction of post-operative pain.

Prospective, controlled clinical trial of Ankaferd Blood Stopper in children undergoing tonsillectomy

OBJECTIVES

This is a prospective study evaluating the efficacy of Ankaferd Blood Stopper as a hemostatic agent compared to hemostasis by means of knot-tie after cold knife dissection tonsillectomy.

METHODS

Study design was the use of ABS and the KT to reach hemostasis for patients undergoing tonsillectomy. ABS is applied on right side tonsil fossa and KT is used on left side tonsil fossa. Measured outcomes such as blood loss, surgical time, and complication will be assessed. In total, 47 consecutive patients undergoing cold knife dissection tonsillectomy were studied, in all of whom Ankaferd Blood Stopper wet tampon was used for right side tonsil hemorrhage and knot-tie technique for left side tonsil hemorrhage. Data were collected intraoperatively. Follow-up visits of all patients were completed at postoperative days 1, 3, 7, and 10.

RESULTS

Ankaferd Blood Stopper side had shorter hemostasis time after tonsil removal than knot-tie side (3.19+/-0.74 min vs 7.29+/-2.33 min [mean+/-SD], p<0.01) and less blood loss (1.57+/-2.26 ml vs 14.04+/-7.23 ml [mean+/-SD], p<0.01). In addition, KT number was less with ABS side as compared to KT side (p<0.01).

CONCLUSIONS

The side on which Ankaferd Blood Stopper was used had statistically significant differences in hemostasis time, blood loss, and knot-tie number in the operation period. Ankaferd Blood Stopper is safe and efficient, and it decreases intraoperative bleeding, reduces operating time, as compared to the traditional hemostasis methods after cold knife dissection tonsillectomy.