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Russo E, Festa BM, Costantino A, Bernardocchi A, Spriano G, De Virgilio A. Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis. Laryngoscope 2024; 134:1696-1704. [PMID: 37843298 DOI: 10.1002/lary.31116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score. RESULTS A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43). CONCLUSIONS ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings. LEVEL OF EVIDENCE NA Laryngoscope, 134:1696-1704, 2024.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Alice Bernardocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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Yun JH, Jang JY, Shin YS, Kim HJ, Kim CH, Park DY. Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial. Sci Rep 2024; 14:267. [PMID: 38167450 PMCID: PMC10761731 DOI: 10.1038/s41598-023-50633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
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).
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Affiliation(s)
- Ju Hyun Yun
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
- Sleep Center, Ajou University Hospital, Suwon, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
- Sleep Center, Ajou University Hospital, Suwon, Republic of Korea.
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Kandemir S, Pamuk AE, Özel G, Şencan Z. Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation. Int Arch Otorhinolaryngol 2023; 27:e694-e698. [PMID: 37876704 PMCID: PMC10593530 DOI: 10.1055/s-0042-1758715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 03/31/2023] Open
Abstract
Introduction Tonsillectomy is among the most common otolaryngological surgeries. Objective To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation. Methods The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted. Results The CSD group had less analgesic use and shorter return to normal activity than the MEC group ( p = 0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery ( p < 0.016). The postoperative bleeding rate was similar in all groups ( p = 0.096). Conclusion Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.
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Affiliation(s)
- Süheyla Kandemir
- Department of Otorhinolaryngology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Ahmet Erim Pamuk
- Department of Otorhinolaryngology, Private Practice, Ankara, Turkey
| | - Gökçe Özel
- Department of Otorhinolaryngology, Private Practice, Ankara, Turkey
| | - Ziya Şencan
- Department of Otorhinolaryngology, Kırıkkale University, Faculty of Medicine, Kırıkkale Turkey
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Singh U, Arunachalam R. Postoperative Outcomes Following KTP-532 LASER Versus Coblation Assisted Paediatric Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:880-885. [PMID: 37275102 PMCID: PMC10235235 DOI: 10.1007/s12070-022-03271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/26/2022] [Indexed: 02/15/2023] Open
Abstract
Aim: The aim of the study was to compare postoperative outcomes such as pain, healing of tonsillar fossa and return to normal diet following KTP-532 LASER versus Coblation assisted tonsillectomy. Methods: A prospective randomised clinical study was conducted over a 24-month period at a tertiary referral centre. Children aged 3-16 years underwent KTP-532 LASER assisted versus Coblation assisted tonsillectomy. A total of 60 children were randomly allocated into two groups-Group A underwent KTP-532 LASER assisted tonsillectomy, and Group B underwent Coblation assisted tonsillectomy (n = 30 in each). Postoperative pain and tonsillar fossa slough formation was evaluated on postoperative day 0, 1, 7, 14 and 28, and average duration taken to resume regular diet. Result: There was no statistically significant difference in postoperative pain between the two groups. There was significantly lesser slough formation in Group B on 1st postoperative day (p < 0.000), 7th postoperative day (p < 0.014), and 14th postoperative day (p < 0.010) when compared with Group A. Complete mucosalisation was achieved significantly earlier in Group B when compared to Group A (p < 0.01). Average duration for resumption of normal diet was 13.5 days for Group A and 12.6 days for Group B postoperatively, which was statistically insignificant (p < 0.830). Conclusion: There was no significant difference in postoperative pain between the two groups. Postoperative slough formation was significantly lesser and tonsillar fossa mucosalisation was faster in Group B. There was no statistical difference in time taken to resume normal diet.
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Affiliation(s)
- Urvashi Singh
- Department of Otorhinolaryngology, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Sri Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116 India
- Department of ENT, Head and Neck Surgery, SRM Medical College Hospital and Research Center, Chengalpet, Chennai, Tamil Nadu 603203 India
| | - Ravikumar Arunachalam
- Department of Otorhinolaryngology, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Sri Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116 India
- Department of ENT, Head and Neck Surgery, SRM Medical College Hospital and Research Center, Chengalpet, Chennai, Tamil Nadu 603203 India
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Shah R, Shah HP, Rohrbaugh T, Reeder A, Kohli N, Maurrasse SE. Comparing nationally reported adverse events associated with coblation vs. PlasmaBlade for tonsillectomy. Am J Otolaryngol 2023; 44:103894. [PMID: 37178539 DOI: 10.1016/j.amjoto.2023.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE(S) Coblation, or radiofrequency ablation, and pulsed-electron avalanche knife (PEAK) plasmablade are newer approaches for tonsillectomy that reduce exposure to thermal heat. This study aims to describe and compare adverse events related to these devices for tonsillectomy. STUDY DESIGN Retrospective cross-sectional study. SETTING The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database. METHODS The MAUDE database was queried for reports involving coblation devices and the PEAK plasmablade from 2011 to 2021. Data were extracted from reports pertaining to tonsillectomy with and without adenoidectomy. RESULTS There were 331 reported adverse events for coblation and 207 for the plasmablade. For coblation, 53 (16.0 %) of these involved patients and 278 (84.0 %) were device malfunctions. Similarly for the plasmablade, 22 (10.6 %) involved patients and 185 (89.4 %) were device malfunctions. The most frequent patient-related adverse event was burn injury, which was significantly more common with the plasmablade compared to coblation (77.3 % vs. 50.9 %, respectively, p = 0.042). For both the coblator and plasmablade, the most common device malfunction was intraoperative tip or wire damage (16.9 % vs. 27.0 %, respectively, p = 0.010). The Plasmablade tip caught fire in five reports (2.7 %) with one causing burn injury. CONCLUSIONS While coblation devices and the plasmablade have demonstrated utility in tonsillectomy with or without adenoidectomy, they are associated with adverse events. Plasmablade use may require greater caution for intraoperative fires and patient burn injuries compared to coblation use. Interventions to improve physician comfort with these devices may help reduce adverse events and inform preoperative discussions with patients.
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Affiliation(s)
- Rema Shah
- Yale University School of Medicine, New Haven, CT, USA.
| | - Hemali P Shah
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Allison Reeder
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nikita Kohli
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Maurrasse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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CO 2 laser or dissection tonsillectomy: A systematic review and meta-analysis of clinical outcomes. Auris Nasus Larynx 2023; 50:2-16. [PMID: 35597696 DOI: 10.1016/j.anl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Recent evidence has suggested that performing a tonsillectomy with CO2 laser results in favorable intraoperative and postoperative outcomes. This study aimed to compare the clinical outcomes of CO2 and dissection tonsillectomy. METHODS We conducted a systematic search in PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of September 2021 for completed studies comparing intraoperative and postoperative outcomes of CO2 laser and dissection tonsillectomy. Primary outcomes were operative time, intraoperative blood loss, and postoperative pain. Secondary outcomes included postoperative hemorrhage and tonsillar fossa healing. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was performed. A subgroup analysis considering the randomization of trials was carried out, and sensitivity analyses linked to the quality of included papers or the age of patients were executed. Quality assessment was appraised with the Cochrane risk of bias and ROBINS-I tools for randomized and non-randomized trials, respectively. RESULTS Eight trials with 632 cases contributed data to this review. For operative time, a significant difference in favor of CO2 laser tonsillectomy was documented (SMD = -1.32; 95% CI = -2.24 to -0.40; p < 0.005). This was also the case for intraoperative blood loss (SMD = -3.94; 95% CI = -5.62 to -2.26; p < 0.00001). For postoperative pain, no significant differences were detected on day one and seven between the intervention groups (SMD = -0.24; 95% CI = -1.11 to 0.63; p = 0.59 and SMD = 1.31; 95% CI = -0.14 to 2.75; p = 0.08, respectively). CO2 laser tonsillectomy was not superior to conventional dissection tonsillectomy regarding postoperative bleeding rates (OR = 0.50; 95% CI = 0.10 to 2.53; p = 0.40). CONCLUSION This study demonstrates that CO2 laser tonsillectomy is more likely to result in a clinically meaningful decrease in operative time and blood loss compared to the conventional dissection technique in both pediatric and adult patients. We found no significant difference in postoperative pain and bleeding. Performing further level-1 trials on this topic with a standardized and validated outcome measurement method will enable more robust conclusions to be drawn.
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Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2022; 279:5511-5520. [PMID: 35810212 DOI: 10.1007/s00405-022-07534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
AIM This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated coblation versus laser (carbon dioxide and diode) tonsillectomy, with regard to various surgical and clinical outcomes. METHODS We searched PubMed, CENTRAL, Scopus, and Web of Science for relevant from inception until March 2021. We evaluated risk of bias using the Cochrane Collaboration Tool. We summarized the outcomes as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with 95% confidence interval (CI). We conducted subgroup analysis based on the day of postoperative pain (day 1, day 7, and day 14) and type of postoperative hemorrhage (reactionary and secondary). In addition, we conducted subgroup analysis according to the type of laser. RESULTS Five RCTs were analyzed. Three and two RCTs were evaluated as having "some concerns" and "low risk of bias", respectively. Coblation tonsillectomy correlated with lower intraoperative blood loss (MD = -5.08 ml, 95% CI [- 7.33 to - 2.84], P < 0.0001) and lower operative time (MD = - 4.50 min, 95% CI [- 6.10 to - 2.90], P < 0.0001) compared with the laser tonsillectomy. However, there was no significant difference between both groups regarding the postoperative pain score (SMD = - 0.27, 95% CI [- 0.72 to 0.17], P = 0.27) and rate of postoperative hemorrhage (RR = 0.95, 95% CI [0.27-3.40], P = 0.23). Subgroup analysis reported similar insignificant difference between both groups according to the day of postoperative pain and type of postoperative hemorrhage. CONCLUSIONS Coblation tonsillectomy correlated with a significant reduction in intraoperative blood loss and operative time compared with the laser technique. Nevertheless, these effects do not seem clinically meaningful in surgical practice.
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Samdani SK, Kishore J, Yogi V, Sharma S, Amreen. A Comparative Study of Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy Under Microscope- Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:5395-5403. [PMID: 36742737 PMCID: PMC9895539 DOI: 10.1007/s12070-021-02586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Tonsillectomy is one of the most common proceduresin routine otolaryngology.Given that the pediatric demographic is usually in question, ENT surgeons are resorting to newer modalities that minimize the dreaded complication of intra-operative and post-operative hemorrhage and have shorter operative time. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3-4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3-4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. In our study Mean operation time, mean blood loss, Analogue score for post-operative pain at 24hrs and 7th postoperative day respectively and Healing of wound on 14th post-operative day were significantly lower in cases of tonsillectomy with harmonic scalpel than cold dissection method tonsillectomy. The novel technique of tonsillectomy harmonic scalpel is proven to be better with regard to lesser operative time, blood loss and lesser post-operative morbidity.
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Affiliation(s)
- Sunil Kumar Samdani
- Departmen of Otorhinolaryngology and Head and Neck Surgery, SMS Medical College, Jaipur, India
| | - Jugal Kishore
- Departmen of Otorhinolaryngology and Head and Neck Surgery, SMS Medical College, Jaipur, India
| | - Vipasha Yogi
- Departmen of Otorhinolaryngology and Head and Neck Surgery, SMS Medical College, Jaipur, India
- 20, Brijlalpura Scheme, Santosh Nagar, Opp Ganga Jamuna Petrol Pump,Gopalpura By Pass, Jaipur, 302019 India
| | - Sanjay Sharma
- Departmen of Otorhinolaryngology and Head and Neck Surgery, SMS Medical College, Jaipur, India
| | - Amreen
- Departmen of Otorhinolaryngology and Head and Neck Surgery, SMS Medical College, Jaipur, India
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Piitulainen JM, Uusitalo T, Sjöblom HM, Ivaska LE, Jegoroff H, Kauko T, Kokki H, Kytö E, Mansikka I, Ylikoski J, Jero J. Intracapsular tonsillectomy in the treatment of recurrent and chronic tonsillitis in adults: a protocol of a prospective, single-blinded, randomised study with a 5-year follow-up (the FINITE trial). BMJ Open 2022; 12:e062722. [PMID: 36104143 PMCID: PMC9476145 DOI: 10.1136/bmjopen-2022-062722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The standard surgical treatment for recurrent or chronic tonsillitis is extracapsular tonsillectomy. Recent studies show that intracapsular tonsillectomy has the potential to reduce the postoperative morbidity of patients undergoing tonsil surgery. The Finnish Intracapsular Tonsillectomy (FINITE) trial aims to provide level I evidence to support the hypothesis that the recovery time from tonsil surgery can be reduced with intracapsular tonsillectomy. Additionally, from this trial, major benefits in quality of life, reduction of postoperative complications, treatment costs and throat symptoms might be gained. METHODS AND ANALYSIS The FINITE trial is a prospective, randomised, controlled, patient-blinded, three-arm clinical trial. It is designed to compare three different surgical methods being extracapsular monopolar tonsillectomy versus intracapsular microdebrider tonsillectomy versus intracapsular coblation tonsillectomy in the treatment of adult patients (16-65 years) suffering from recurrent or chronic tonsillitis. The study started in September 2019, and patients will be enrolled until a maximum of 200 patients are randomised. Currently, we are in the middle of the study with 125 patients enrolled as of 28 February 2022 and data collection is scheduled to be completed totally by December 2027. The primary endpoint of the study will be the recovery time from surgery. Secondary endpoints will be the postoperative pain scores and the use of analgesics during the first 3 weeks of recovery, postoperative haemorrhage, quality of life, tonsillar remnants, need for revision surgery, throat symptoms, treatment costs and sick leave. A follow-up by a questionnaire at 1-21 days and at 1, 6, 24 and 60 months will be conducted with a follow-up visit at the 6-month time point. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethics Committee of the Hospital District of Southwest Finland (reference number 29/1801/2019). Results will be made publicly available in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03654742.
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Affiliation(s)
- Jaakko Matias Piitulainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tapani Uusitalo
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Henrik M Sjöblom
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Lotta E Ivaska
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Henri Jegoroff
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tommi Kauko
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, Joensuu, Finland
| | - Eero Kytö
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Iisa Mansikka
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jenni Ylikoski
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jussi Jero
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Hohmann M, Kühn D, Späth M, Rohde M, Stelzle F, Klämpfl F, Schmidt M. Development and evaluation of a scoring system for assessing incisions in laser surgery. Sci Rep 2022; 12:14741. [PMID: 36042339 PMCID: PMC9427958 DOI: 10.1038/s41598-022-18969-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The idea of laser surgery is nearly as old as the laser itself. From the first trials to modern laser surgery systems, it was and is the aim to selectively cut the tissue in the focus spot without causing harm to surrounding structures. This is only possible when the correct parameters for the surgical laser are chosen. Usually, this is done by parameter studies. However, the concrete evaluation scheme often differs between groups and more precise approaches require staining and microscopic evaluation. To overcome these issues, a macroscopic scoring system is presented and evaluated. It can be shown that the scoring system works well and, thus, a laser cut can be evaluated within a few seconds. At the same time, the whole cutting front is taken into account. The presented scoring system is evaluated by the intra class correlation (ICC). The final agreement between different raters is more than 0.7. Therefore, the scoring system can be used to optimize and evaluate the cutting process and it should be suitable for comparing the results between different groups. Definitely, it can be applied for scoring within a group to enable e.g., a profound statistical analysis for a parameter study.
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Affiliation(s)
- Martin Hohmann
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany. .,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany.
| | - David Kühn
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
| | - Moritz Späth
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
| | - Max Rohde
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Florian Stelzle
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Florian Klämpfl
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
| | - Michael Schmidt
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
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11
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Cai FG, Hong W, Ye Y, Liu YS. Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy. Gland Surg 2022; 11:175-185. [PMID: 35242679 PMCID: PMC8825514 DOI: 10.21037/gs-21-832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/07/2022] [Indexed: 01/24/2024]
Abstract
BACKGROUND Surgical removal of the primary lesion is a common treatment for chronic tonsillitis, recurrent tonsillitis, and tonsillar hypertrophy, and is the most widely performed surgery in otorhinolaryngology. With the development and progress of medical science and technology, the methods of tonsillectomy have gradually diversified, and it is of great significance to seek the best tonsillectomy method. This meta-analysis explored the advantages and disadvantages of coblation tonsillectomy (CT) and electrocautery tonsillectomy (ET). METHODS The keywords "coblation", "radiofrequency ablation", "electrocautery", and "tonsillectomy" were used to search the PubMed, Embase, Cochrane library, Clinicaltrials.gov, and Google Scholar databases, and randomized controlled trials (RCTs) of the 2 procedures since the establishment of the database were included. After screening and bias risk assessment, a meta-analysis was performed using Stata 16.0 software. RESULTS A total of 10 articles met the inclusion criteria and entered the final meta-analysis. There were 1,056 participants, including 547 patients who underwent CT and 509 patients who underwent ET. There was no significant difference in the operation time between CT and ET [standard mean difference (SMD) =0.39, 95% CI: -0.35 to 1.13, Z=1.044, P=0.296]. CT resulted in less intraoperative blood loss than ET (SMD =-2.62, 95% CI: -4.83 to -0.41, Z=-2.322, P=0.020). The postoperative pain score of CT was less than ET, but the difference was not statistically significant (SMD =-0.28, 95% CI: -0.58 to 0.01, Z=-1.866, P=0.062). CT resulted in less time to return to normal diet after surgery than ET, and the difference was statistically significant (SMD =-0.36, 95% CI: -0.60 to -0.12, Z=-2.918, P=0.004). DISCUSSION CT resulted in less intraoperative blood loss and faster postoperative recovery than ET, but there was no significant difference in operation time, postoperative pain, and the incidence rate of postoperative complications between the 2 groups.
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Affiliation(s)
- Fu-Guo Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Wei Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Yu Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Ye-Song Liu
- Department of Otorhinolaryngology, Yancheng Third People’s Hospital (The Affiliated Yancheng Hospital of Southeast University Medical School), Yancheng, China
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12
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Shkolnik GS, Tsyplakov DE, Shkolnik SF, Krasnozhen VN, Magomedov MM. [Comparative morphological assessment of the damaging effects of cold plasma and radio wave energy on the mucous membrane of the lip in the experiment]. Vestn Otorinolaringol 2021; 86:61-65. [PMID: 34269026 DOI: 10.17116/otorino20218603161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was a comparative morphological assessment of changes in the mucous membrane of the lip in the field of radio wave and cold plasma exposure in the experiment. MATERIAL AND METHODS Experimental animals removed a portion of the mucous membrane of the inner surface of the lip with a Surgitron radio knife (group 1) and an electrode of the Coblator II cold plasma apparatus (observation group 2). Tissue was taken from the edge of the surgical wound as a trapezoidal flap containing mucous and submucous membranes immediately after the incision and 3 weeks after the surgery. Histological sections were prepared, which were stained with hematoxylin and eosin, as well as according to van Gieson. RESULTS It was found that, both in cases of using a radio knife and a coblator along the edges and in the depth of the wound, coagulation tissue necrosis was observed, which was more evident in group 1 of observations. In addition, after the radio wave exposure, in the areas close to the defect, the epithelial lining was disrupted to one degree or another, which was not observed when using the coblator. After 3 weeks of the experiment, the stratified squamous non-keratinizing epithelium in both groups had a normal histological structure. At the same time, when using the coblator, the lamina propria of the mucous membrane was completely restored, and in cases with the use of a radio knife, sclerotic processes with the formation of scar tissue took place in the lamina propria of the mucous membrane in some areas. CONCLUSIONS The use of a coblator should be recognized as a more gentle method, since a comparative analysis of histological changes immediately after the incision showed a more intense damaging effect of the radio knife on the surrounding tissues, which in later stages was accompanied by incomplete regeneration (substitution) of the lip mucosa.
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Affiliation(s)
- G S Shkolnik
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary, Russia
| | | | - S F Shkolnik
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary, Russia
| | - V N Krasnozhen
- Kazan State Medical Academy - branch of the Russian Medical Academy for Continuing Professional Education, Kazan, Russia
| | - M M Magomedov
- Pirogov Russian National Research Medical University, Moscow, Russia
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13
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Bipolar loop device versus bipolar diathermy for tonsillectomy: A pilot randomized controlled trial. Int J Pediatr Otorhinolaryngol 2021; 141:110505. [PMID: 33239197 DOI: 10.1016/j.ijporl.2020.110505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Tonsillectomy is one of the most common surgeries performed in the pediatric population. Although different forms of instruments and various methods are used to perform tonsillectomy, none of them is still recognized as the best global technique. This study aimed to compare the outcomes of the new Bipolar Loop tonsillectomy versus bipolar diathermy technique. METHODS This study is a pilot randomized clinical trial and was conducted on 40 pediatric patients who were the candidate of tonsillectomy. Patients were divided into two groups of Bipolar Loop or bipolar diathermy. Operation time, intraoperative bleeding, tonsillar fossa wound, postoperative complications, and duration of return to normal diet were evaluated in the current study. RESULTS In both of the Bipolar Loop and bipolar diathermy groups, no significant difference was found in terms of sex, age, and weight. The average amount of the operative time, intra-operative blood loss, and postoperative pain loss were significantly less in the Bipolar Loop group (P < .001). In addition, the tonsillar fossa wound healing scores were significantly better (on the 14th day, P = 0.009). However, there was no significant difference between the two groups in terms of postoperative bleeding, duration of return to a normal diet, and postoperative symptoms of fever, otalgia, or voice change between the groups. CONCLUSION The study showed that blood loss and postoperative pain through day 7 were significantly less in the Bipolar Loop group. Tonsillectomy with Bipolar Loop can be recommended as one of the methods for tonsillectomy, especially in pediatric patients.
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14
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Prussin AJ, Babajanian E, Error M, Grimmer JF, Ku J, McRae B, Meier J, Thiesset H, Skirko JR. Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes. Otolaryngol Head Neck Surg 2020; 164:1186-1192. [PMID: 33079009 DOI: 10.1177/0194599820964737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patients' return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. STUDY DESIGN Randomized double-blinded clinical trial based on prospective parallel design. SETTING Academic medical center and tertiary children's hospital between March 2018 and July 2019. METHODS Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient's return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. RESULTS Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P = .89), daily pain scores over 15 postoperative days (P = .46), postoperative narcotic use (P = .61), or return to hospital for any reason (P = .60), including bleeding as an adverse event (P = .13). CONCLUSIONS As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.
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Affiliation(s)
- Aaron J Prussin
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Eric Babajanian
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Marc Error
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - J Fredrik Grimmer
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jessica Ku
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Bryan McRae
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Heather Thiesset
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
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15
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Ahmed J, Arya A. Lasers in Tonsillectomy: Revisited With Systematic Review. EAR, NOSE & THROAT JOURNAL 2020; 100:14S-18S. [PMID: 33048574 DOI: 10.1177/0145561320961747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In 2005, the National Prospective Tonsillectomy Audit was conducted by the Royal College of Surgeons England, reporting hot tonsillectomy techniques being associated with more postoperative pain and hemorrhage when compared with dissection. In 2006, the National Institute of Clinical Excellence declared its position on laser tonsillectomy reporting that bleeding may be less intraoperatively but is more postoperatively, that initial pain may be less but medium term is more and that healing is delayed. AIM To revisit the literature surrounding laser tonsil surgery and assess the aforementioned factors for any trend changes. METHODOLOGY A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style systematic review conducted in July 2019 searched Embase, Medline, and Cochrane databases for randomized controlled trials comparing laser tonsil surgery with other techniques with the terms laser, tonsillectomy, and tonsillotomy for nonmalignant indications. A total of 14 articles were evaluated. RESULTS A total of 1133 patients received surgery accounting for a total of 2266 tonsil removals. A variety of laser techniques were used including CO2 (66%) potassium-titanyl-phosphate (19%) and contact diode (15%). Nonlaser techniques included dissection (62%), diathermy (20%), and coblation (18%). The summated conclusions suggest that laser techniques are superior regarding intraoperative bleeding and procedure duration. Laser techniques also provide equivocal or superior outcomes regarding postoperative hemorrhage, pain, and total healing time. CONCLUSION Outcomes following laser surgery in recent years suggest an overall improvement. This could be due to enhanced familiarity with techniques and established centers performing laser procedures more routinely.
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Affiliation(s)
- Jake Ahmed
- 97655Wrexham Maelor Hospital, BCUHB, Wrexham, United Kingdom
| | - Arvind Arya
- 97655Wrexham Maelor Hospital, BCUHB, Wrexham, United Kingdom
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16
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Parab SR, Khan MM. Endoscope holder-assisted endoscopic coblation tonsillectomy. Eur Arch Otorhinolaryngol 2020; 277:3223-3226. [PMID: 32761273 DOI: 10.1007/s00405-020-06249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tonsillectomy is being performed either with a headlight, surgical loupe magnification or with microscopic aid. We report the technique of endoscope holder-assisted endoscopic tonsillectomy using coblation. Coblation tonsillectomy has the primary advantage of limited thermal damage compared with alternative forms of surgery. METHODS Our endoscope holder, primarily designed for endoscopic ear surgery, has been extrapolated for the use in two-handed technique of tonsillectomy. The method is described in detail. CONCLUSION Endoscope gives a panoramic view, better optics, magnified image of the bleeders and hence there is applicability of the endoscope holder for endoscopic tonsillectomy.
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Affiliation(s)
| | - Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan's ENT Research Center, Talegaon Dabhade, Pune, India
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17
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Lee YC, Hsin LJ, Lin WN, Fang TJ, Tsai YT, Luo CM. Adolescents and Adults Undergoing Temperature-Controlled Surgical Instruments vs Electrocautery in Tonsillectomy: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Otolaryngol Head Neck Surg 2020; 146:339-346. [PMID: 32027341 DOI: 10.1001/jamaoto.2019.4605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Several temperature-controlled surgical instruments (TCSIs) have been used in tonsillectomy. However, to our knowledge, a meta-analysis of the differences between modern TCSIs and electrocautery (EC) has not been conducted. Objective To compare TCSIs with EC with regard to the intraoperative and postoperative parameters of tonsillectomy. Data Sources PubMed (MEDLINE), Embase, and the Cochrane Library were searched independently by 2 authors for relevant articles. Study Selection A literature search identified randomized clinical trials comparing the outcomes of TCSIs vs EC. The search keywords were harmonic scalpel, ultracision, PlasmaBlade, coblation, radiofrequency ablation, and tonsillectomy. Studies of adult and adolescent patients were included. Data Extraction and Synthesis Data from each study were extracted. A random-effects model was used in the pooled analysis. Main Outcomes and Measures Four outcomes were analyzed: postoperative pain level on days 1, 2, 7, and 14 after surgery; postoperative bleeding; operative time; and intraoperative blood loss. Results This meta-analysis included 11 studies with a total of 629 unique patients. (Mean ages ranged from 16 to 55 years.) The studies were further categorized by the methods of comparison. Five articles used between-participant comparisons, and 6 used within-participant comparisons (of the left vs right sides of the participant's body). The pooled results of the studies with between-participant measures showed that postoperative pain scores were lower in the TCSI group on the first day (standardized mean differences [SMD], -0.41 [95% CI, -0.77 to -0.06]) and seventh day (SMD, -0.76 [95% CI, -1.47 to -0.04]). The pooled results of the studies with within-participant measures showed that the postoperative pain scores were lower in the TCSI group on the first day (SMD, -0.37 [95% CI, -0.63 to -0.12]) and second day (SMD, -0.60 [95% CI, -1.10 to -0.10]). The pooled analysis of overall bleeding, major bleeding, minor bleeding, primary bleeding, and secondary bleeding in both the types of studies with between-participant measures and those with within-participant measures showed no significant differences between the TCSI and EC groups. Intraoperative blood loss and operative time were not significantly different between the groups. Conclusions and Relevance Compared with EC, TCSIs were associated with significantly reduced pain on the first day after tonsillectomy, per this meta-analysis. The rates of overall bleeding, primary bleeding, secondary bleeding, major bleeding, and minor bleeding between TCSIs and EC were comparable. Intraoperative blood loss and operative time also showed no significant intergroup differences. Surgeons may consider using these modern instruments according to personal experiences, preferences, and cost-effectiveness criteria.
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Affiliation(s)
- Yi-Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wan-Ni Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Luo
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
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Coblation tonsillectomy versus cold steel dissection tonsillectomy: a morphological study. The Journal of Laryngology & Otology 2019; 133:770-774. [DOI: 10.1017/s0022215119001762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractObjectiveTo compare the extent of tissue damage produced by conventional cold steel and coblation tonsillectomy.MethodsTwenty patients underwent conventional and 18 underwent coblation tonsillectomy. The removed tonsils were histopathologically evaluated.ResultsAnalgesic 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.ConclusionCompared 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.
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19
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Demir B, Binnetoglu A, Kersin B, Mammadova U, Kucuk N. Could digital photography be an alternative to postoperative physical examination for pediatric tonsillectomy patients? Int J Pediatr Otorhinolaryngol 2019; 123:66-68. [PMID: 31075709 DOI: 10.1016/j.ijporl.2019.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate and compare the efficacy of postoperative control with digital photographs and physical examination for children who underwent tonsillectomy? METHODS In this prospective study, 86 children (46 boys (53.5%) and 40 girls (46.5%) were enrolled for postoperative clinical visit and for obtaining photographs of the tonsillar bed with a digital camera at clinic control. RESULTS No difference in tonsillar fossa healing was observed between the two methods 2 weeks after surgery. CONCLUSIONS Digital photographs proved to be a safe method for postoperative control of pediatric patients who underwent tonsillectomy. Adding control with outpatient follow-up will be useful for minimizing postoperative complications.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey.
| | - Adem Binnetoglu
- St. Elizabeth's Medical Center, 736 Cambridge St., Brighton, MA, 02135, USA
| | - Burak Kersin
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
| | - Ulker Mammadova
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
| | - Nurten Kucuk
- Memorial Şişli Hospıtal Kaptanpasa Mahallesi, No: 1, 34385, Istanbul, Turkey
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20
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Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage. Eur Arch Otorhinolaryngol 2019; 276:2061-2067. [DOI: 10.1007/s00405-019-05464-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
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Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK. The Journal of Laryngology & Otology 2019; 132:1119-1127. [DOI: 10.1017/s0022215118002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractObjectiveThis study aimed to estimate the cost-effectiveness of Coblation compared with cold steel tonsillectomy in adult and paediatric patients in the UK.MethodDecision analysis was undertaken by combining published clinical outcomes with resource utilisation estimates derived from a panel of clinicians.ResultsUsing a cold steel procedure instead of Coblation is expected to generate an incremental cost of more than £2000 for each additional avoided haemorrhage, and the probability of cold steel being cost-effective was approximately 0.50. Therefore, the cost-effectiveness of the two techniques was comparable. When the published clinical outcomes were replaced with clinicians’ estimates of current practice, Coblation was found to improve outcome for less cost, and the probability of Coblation being cost-effective was at least 0.70.ConclusionA best-case scenario suggests Coblation affords the National Health Service a cost-effective intervention for tonsillectomy in adult and paediatric patients compared with cold steel procedures. A worst-case scenario suggests Coblation affords the National Health Service an equivalent cost-effective intervention for adult and paediatric patients.
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Oghan F, Guvey A, Aydemir O, Erdogan O, Topuz MF, Celiker M, Terzi S, Akbal S. Comparison of post-tonsillectomy morbidity operated with Cold Knife and Coblation in patients with Sleep Apnea. ENT UPDATES 2018. [DOI: 10.32448/entupdates.499040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wound healing after tonsillectomy - a review of the literature. The Journal of Laryngology & Otology 2018; 132:764-770. [PMID: 30289104 DOI: 10.1017/s002221511800155x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To summarise the available literature related to wound healing post tonsillectomy, including the stages of healing, experimental models for assessing healing (in animals and humans) and the various factors that affect wound healing. METHODS A search of the English literature was conducted using the Ovid Medline database, with the search terms 'tonsillectomy' or 'tonsil' and 'wound healing'. Thirty-one articles that objectively assessed tonsillectomy wound healing were included for analysis. RESULTS The majority of assessments in humans investigating tonsillectomy wound healing involve serial direct clinical examinations of the oral cavity. Many patient and surgical factors have been shown to affect wound healing after tonsillectomy. There is some research to suggest that the administration of adjunctive treatment in the post-operative period may be beneficial to tonsillectomy wound healing. CONCLUSION Wound healing post tonsillectomy has been poorly researched. Having a better understanding of the process of wound healing would allow surgeons to potentially prevent, anticipate and manage complications from the surgery that arise as part of the healing process.
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Akcan FA, Dündar Y. Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial. Eur Arch Otorhinolaryngol 2018; 275:2879-2887. [DOI: 10.1007/s00405-018-5148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/24/2018] [Indexed: 12/15/2022]
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Fornazieri MA, Miyazato ES, Yamamoto HM, de Lima Navarro P, de Rezende Pinna F, Voegels RL. Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial. Int J Pediatr Otorhinolaryngol 2018; 111:63-68. [PMID: 29958616 DOI: 10.1016/j.ijporl.2018.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery. METHODS Randomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa. RESULTS No differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa. CONCLUSION These results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.
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Affiliation(s)
- Marco Aurélio Fornazieri
- Pontifical Catholic University of Paraná, Londrina, PR, Brazil; Londrina State University, Department of Surgery, Londrina, PR, Brazil; University of São Paulo, São Paulo, São Paulo, Brazil.
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Comparison of the thermal effects of Coblation and Radiofrequency waves in a porcine turbinate model. ACTA ACUST UNITED AC 2018. [DOI: 10.2478/rjr-2018-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
BACKGROUND. Radiofrequency reduction and Coblation are widely used procedures for the treatment of functionally enlarged turbinates with an appropriate outcome. Bleeding and crusting are postoperative complications for Coblation. Thermographic measurements and histological analyses were used to elucidate the causes.
MATERIAL AND METHODS. In a porcine turbinate model, double-needle electrodes of different lengths were tested using a 4MHz radiofrequency current with either automatic energy limitation or a predetermined energy amount of 200 J. Coblation, according to the manufacturer’s instructions, was carried out with a Reflex Ultra 45 wand. The generated temperature was measured with thermo-probes at the tip of the electrodes. The mucosa was subsequently investigated histologically.
RESULTS. Without preoperative saline injection, all procedures generate temperatures < 100° C. After saline injection, excessive temperatures are reached by Coblation after the release of plasma in a closed system. The follow-up is a severe deterioration of the microscopic structures of the mucosa. The low-temperature advantages of Coblation are only effective if the mandatory saline solution rinses the surface. The Radiofrequency applications deliver more predictable results.
CONCLUSION. For the treatment of the functional enlargement of the turbinates, Radiofrequency current with proofed settings should be chosen.
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Palierne S, Meynaud P, Bilmont A, Delverdier M, Semin MO, Stieglitz M, Riviere G, Autefage A. Plasma-Mediated Bipolar Radiofrequency Ablation of Overlong Soft Palate in the Dog: A Pilot Study. J Am Anim Hosp Assoc 2018; 54:267-275. [PMID: 30040441 DOI: 10.5326/jaaha-ms-6668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to compare the clinical, biological, macroscopic, and histologic outcomes after resection of the soft palate by plasma-mediated bipolar radiofrequency ablation (PBRA) or traditional incisional techniques (incisional soft palate resection [INC]) in dogs. Ten dogs were divided in two groups. In the INC group, the soft palate was incised with scissors and the wound was sutured in a continuous pattern. In the PBRA group, a wand was used to ablate the desired portion of the soft palate, without suture. Clinical, biological, macroscopic, and histologic assessments were scheduled over 14 days. The duration of surgery was significantly shorter for the PBRA group. The C-reactive protein concentrations were significantly higher in the PBRA group at 6 hr and on day 3 (P < .05) but with values very close to the baseline. C-reactive protein concentrations were maximal, but with low values (<25 mg/L), at day 1 for both techniques. The irregularity scores for the soft palate caudal border on days 1, 3, and 14 were significantly higher in the INC group than in the PBRA group (P < .05). The main histopathologic changes were the presence of superficial granulomas and a significantly greater depth of tissue damage in the INC group (2.5 ± 0.3 mm) compared with the PBRA group (1.5 ± 0.1 mm; P < .05). PBRA compared favorably with the traditional technique in terms of ease, duration of surgery, and depth of tissue damage. Future studies are warranted to validate its effectiveness for treating brachycephalic airway obstruction syndrome in dogs.
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Affiliation(s)
- Sophie Palierne
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Patricia Meynaud
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Alexis Bilmont
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Maxence Delverdier
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Marie-Odile Semin
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Mailys Stieglitz
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Guillaume Riviere
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - André Autefage
- From the Clinical Research Unit (S.P., P.M., A.B., M.S., G.R., A.A.) and Department of Biological and Fundamental Sciences (M.D., M-O.S.), Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
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Yilmazer R, Yazici ZM, Balta M, Erdim I, Erdur O, Kayhan FT. PlasmaBlade vs. cold dissection tonsillectomy: A prospective, randomized, double-blind, controlled study in adults. EAR, NOSE & THROAT JOURNAL 2018; 96:250-256. [PMID: 28719708 DOI: 10.1177/014556131709600718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Rasim Yilmazer
- Department of Otolaryngology, Yeditepe University Hospital, Kulak Burun Bogaz Hastaliklari Anabilim Dali, Icerenkoy Mah. Hastane Sok. No:4 D:1 Atasehir, Istanbul, Turkiye.
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Schneider D, Goppold K, Kaemmerer PW, Schoen G, Woehlke M, Bschorer R. Use of ultrasonic scalpel and monopolar electrocautery for skin incisions in neck dissection: a prospective randomized trial. Oral Maxillofac Surg 2018; 22:169-175. [PMID: 29492789 DOI: 10.1007/s10006-018-0686-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/19/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are standard equipment for soft tissue surgery. The aim of the present study was to compare intraoperative and postoperative patterns of patients using either UC or ME for skin incisions in neck dissection. MATERIAL AND METHODS In a prospective randomized study of 30 patients, the thermal effects of UC (n = 15) and ME (n = 15) were examined using real-time infrared thermographic imaging. Additionally, tissue damage was evaluated histopathologically. The other measured variables were operation and bleeding time, postoperative pain score (only neck incision area), in-patient time, and complications. RESULTS UC significantly reduces the thermal effects, compared to ME (p < 0.001). The mean depth of tissue damage (i.e., necrosis) was 272.7 μm for UC and 284.7 μm for ME with no significant difference (p = 0.285). From the third postoperative day, patients treated using UC had noticeably less pain in the neck incision area (t3 p = 0.010; t4 p < 0.001; t5 p < 0.005). Cutting time was reduced for ME by 36.1 s (p < 0.001) and the bleeding time was decreased by 40.9 s for UC (p < 0.001). The total preparation time was the same (p = 0.402). When comparing in-patient time (p = 0.723), as well as complications, no significant differences were seen. CONCLUSION UC results in less postoperative pain and less bleeding in the neck incision area. Accordingly, UC is superior to ME for skin incisions in neck dissection.
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Affiliation(s)
- Daniel Schneider
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany.
| | - Kai Goppold
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany
| | - Peer W Kaemmerer
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Gerhard Schoen
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Woehlke
- Institute of Pathology, Helios Kliniken Schwerin, Schwerin, Germany
| | - Reinhard Bschorer
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany
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The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques. The Journal of Laryngology & Otology 2017; 132:240-245. [PMID: 29151376 DOI: 10.1017/s0022215117002328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients. METHODS A total of 137 patients, aged 2-50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected. RESULTS Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001). CONCLUSION Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.
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Hussain Z, Thu HE, Katas H, Bukhari SNA. Hyaluronic Acid-Based Biomaterials: A Versatile and Smart Approach to Tissue Regeneration and Treating Traumatic, Surgical, and Chronic Wounds. POLYM REV 2017. [DOI: 10.1080/15583724.2017.1315433] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Zahid Hussain
- Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
| | - Hnin Ei Thu
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Haliza Katas
- Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syed Nasir Abbas Bukhari
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Histological analysis of tonsillectomies: relationship with surgical technique, post-operative pain and haemorrhage. The Journal of Laryngology & Otology 2016; 130:1142-1146. [DOI: 10.1017/s0022215116009312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:There is no consensus on the optimal technique to decrease post-tonsillectomy morbidity. Histopathological analysis can estimate collateral tissue damage. This study compared histological findings for tonsils removed by cold or electrocautery dissection and their relationship with post-operative complications.Methods:Two adult out-patient groups were included in the study: 37 who underwent cold dissection and 37 who underwent electrocautery dissection. Histological analysis was used to assess tissue damage.Results:Tissue damage was significantly higher in the electrocautery dissection group (p = 0.002), as were the number of emergency department visits (p = 0.01) and the need for supplemental analgesia (p = 0.013). Patients in the cold dissection group experienced less pain (p = 0.001) and fewer secondary haemorrhage episodes.Conclusion:Cold dissection produces less tissue damage, which is associated with lower incidence of complications. This study suggests that cold dissection is the technique of choice for tonsillectomy.
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Fastenberg JH, Roy S, Smith LP. Coblation-assisted management of pediatric airway stenosis. Int J Pediatr Otorhinolaryngol 2016; 87:213-8. [PMID: 27368474 DOI: 10.1016/j.ijporl.2016.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/11/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The treatment of pediatric airway stenosis represents a major challenge for the otolaryngologist. The aim of this study is to evaluate the use of bipolar radiofrequency plasma ablation (Coblation) in the treatment of pediatric airway stenosis. STUDY DESIGN Retrospective case series. Tertiary care pediatric academic medical center. METHODS The medical records of 6 pediatric patients at Cohen Children's Medical Center from July 2009 to December 2015 were reviewed. All cases involved the use of radiofrequency plasma ablation to address airway stenosis. Patient presentation, surgical intervention(s), post-operative course and complications were analyzed. RESULTS All 6 cases involved pediatric airway stenosis, including glottic stenosis (2), bilateral vocal fold immobility (2), and intratracheal lesions (2). Coblation was used to perform a range of different procedures, including removal of scar/granulation tissue, partial arytenoidectomy, and posterior cordectomy. All patients experienced good results without major complications, perioperative, or post-operative sequellae. CONCLUSION The results of this study suggest that radiofrequency plasma ablation may be an effective endoscopic tool for the treatment of pediatric airway stenosis. Further study and more patients are required as this technique becomes increasingly applied.
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Affiliation(s)
- Judd H Fastenberg
- Albert Einstein College of Medicine, Department of Otorhinolaryngology-Head & Neck Surgery, 430 Lakeville Road, New Hyde Park, NY, 11042, USA.
| | - Soham Roy
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Department of Otorhinolaryngology-Head & Neck Surgery, 6400 Fannin St. Ste 2700, Houston, TX, 77030, USA.
| | - Lee P Smith
- Albert Einstein College of Medicine, Department of Otorhinolaryngology-Head & Neck Surgery, 430 Lakeville Road, New Hyde Park, NY, 11042, USA; Steven and Alexandra Cohen Children's Medical Center, Hofstra Northwell School of Medicine, Department of Otorhinolaryngology & Communicative Disorders, 430 Lakeville Road, New Hyde Park, NY, 11042, USA.
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Pang Y, Gong J, Huang J, He S, Zhou H. Coblation tonsillectomy under surgical microscopy: A retrospective study. J Int Med Res 2016; 44:923-30. [PMID: 27217239 PMCID: PMC5536629 DOI: 10.1177/0300060516628705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/31/2015] [Indexed: 11/16/2022] Open
Abstract
Objective A retrospective study to compare surgical parameters and postoperative pain in patients undergoing coblation tonsillectomy with or without microscopic guidance. Methods Data regarding duration of surgery and hospital stay, intraoperative blood loss, incidence of haemorrhage and postoperative pain scores were retrieved from the medical records of adult patients undergoing coblation tonsillectomy under direct vision or with microscopic guidance. Results The incidence of secondary haemorrhage (>24 h postoperatively) was significantly lower and the duration of hospital stay was significantly shorter in the microscope group (n = 92) than the direct vision group (n = 76). Pain scores both at rest and while swallowing reached ≤3 (no significant impact on quality-of-life) significantly faster in the microscope group than the direct vision group. Conclusions Microscope-assisted coblation tonsillectomy decreases the duration of hospital stay and the incidence of postoperative secondary haemorrhage, and results in an early improvement in postoperative pain scores.
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Affiliation(s)
- Yufeng Pang
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jingrong Gong
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Juan Huang
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Shuangzhu He
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Hong Zhou
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy. The Journal of Laryngology & Otology 2015; 129:1058-63. [PMID: 26383189 DOI: 10.1017/s0022215115002376] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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.
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Coblator Arytenoidectomy in the Treatment of Bilateral Vocal Cord Paralysis. Case Rep Otolaryngol 2015; 2015:487280. [PMID: 26457217 PMCID: PMC4589618 DOI: 10.1155/2015/487280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/10/2015] [Indexed: 12/26/2022] Open
Abstract
A 77-year-old female with bilateral vocal cord paralysis and dependent tracheostomy status after total thyroidectomy presented to clinic for evaluation of decannulation via arytenoidectomy. Preliminary data suggests coblation versus standard CO2 laser ablation in arytenoidectomy may provide benefits in terms of decreased tissue necrosis and patient outcome. The patient elected to proceed with arytenoidectomy by coblation. The initial procedure went well but postoperative bleeding required a return trip to the operating room for hemostasis. In the coming months the patient's tracheostomy tube was gradually downsized and eventually capped. She was decannulated eight months after surgery, speaking well and without complaints. Details of the surgical procedure and outcome will be discussed.
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Hancı D, Altun H. Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: a prospective, double-blind, controlled clinical study. Int J Pediatr Otorhinolaryngol 2015; 79:1388-92. [PMID: 26228496 DOI: 10.1016/j.ijporl.2015.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/10/2015] [Accepted: 07/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To find the effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing. METHODS Fifty patients were included in this prospective, double-blind, controlled clinical study (20 males, 30 females mean age of 13.56 years). Hyaluronic acid was applied to one side and the other side was used as a control during tonsillectomy. Therefore, the same patient evaluated and scored the post-tonsillectomy pain, excluding individual bias. RESULTS Results indicated that patients had significantly lower pain scores for hyaluronic acid treated side (p<0.001). At the end of two weeks follow-up period, the wound in the hyaluronic acid side was almost completely healed, indicating that the healing was faster with hyaluronic acid compared to control side (p<0.001). CONCLUSION Hyaluronic acid could be recommended as an effective treatment for the management of post-tonsillectomy pain and wound healing.
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Affiliation(s)
- Deniz Hancı
- Okmeydanı Education and Research Hospital, ENT Department, Istanbul, Turkey
| | - Huseyin Altun
- Yunus Emre Hospital, ENT Department, Istanbul, Turkey.
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Surgical management of airway stenosis by radiofrequency coblation. The Journal of Laryngology & Otology 2014; 129 Suppl 1:S21-6. [DOI: 10.1017/s0022215114002783] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Acquired airway stenosis can be challenging to manage endoscopically because of difficult field visualisation, instrument limitations and the risk of laser fire. At our institution, radiofrequency coblation has been successfully used for the resection of subglottic and tracheal stenosis in adults. This paper presents our experience with this technique.Method:A retrospective case note analysis of all cases of airway stenosis in adults from 2007 to 2012 was performed.Results:Ten adult patients underwent coblation resection for airway stenosis. All lesions were classified as McCaffrey stage I (i.e. less than 1 cm long). Causes of stenosis included: idiopathic stenosis (40 per cent), previous tracheostomy (30 per cent) and endotracheal intubation (20 per cent). Six patients (60 per cent) required a single procedure and 4 (40 per cent) required multiple interventions. All patients reported significant improvement in their symptoms following treatment. All patients were alive at the time of writing and none have required open resection.Conclusion:Radiofrequency coblation is an attractive alternative technique for the treatment of idiopathic or acquired airway stenosis in adults.
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Bleeding following coblation tonsillectomy: a 10-year, single-surgeon audit and modified grading system. The Journal of Laryngology & Otology 2014; 129 Suppl 1:S32-7. [DOI: 10.1017/s0022215114002138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractObjective:Coblation tonsillectomy can be controversial. This study assessed post-tonsillectomy haemorrhage outcomes for patients operated on by a single experienced coblation-trained ENT surgeon.Study design:A retrospective audit of coblation tonsillectomies was performed using the Flinders modification of Stammberger criteria for post-tonsillectomy haemorrhage.Method:Case note review, interview and database interrogation were utilised to obtain the dataset. Haemorrhage results were compared to reports in the current literature.Results:Of those who underwent coblation tonsillectomy, 3.4 per cent were readmitted to hospital with haemorrhage and 1.3 per cent returned to the operating theatre (0.4 per cent primary haemorrhage and 0.9 per cent secondary haemorrhage). Younger children had a lower risk of returning to the operating theatre than older children or adults (0.3 per cent under the age of 12 years vs 2.0 per cent aged 12 years or older).Conclusion:Coblation can be a safe method for tonsillectomy with low complication rates when performed by an experienced ENT surgeon. The Flinders modification of the Stammberger criteria for post-tonsillectomy haemorrhage provides a simple system for data comparison.
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Cardesín A, Escamilla Y, Martínez À, Cardelús S, Aguilà AF, Saiz JM, López S, Marco J, Díaz JJ, Bargués R, Rosell R, Samarà L. Electrodissection Tonsillectomy With Laryngeal Mask. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cardesín A, Escamilla Y, Martínez A, Cardelús S, Aguilà AF, Saiz JM, López S, Marco J, Díaz JJ, Bargués R, Rosell R, Samarà L. Electrodissection tonsillectomy with laryngeal mask. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:204-10. [PMID: 23489969 DOI: 10.1016/j.otorri.2012.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/11/2012] [Accepted: 12/19/2012] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The Colorado® microdissection needle has been used for 30 years as an alternative to cold dissection. Alexander was the first to publish the results of laryngeal mask in otorhinolaryngology and maxillofacial surgery. Later on it was introduced as a standard anaesthetic technique in our speciality. Objective The objective of this study was to compare the results of using laryngeal mask combined with Colorado® microdissection needle in tonsillectomies. The benefits of each of these 2 techniques are already known. Methods We present a prospective observational study of 107 paediatric tonsillectomies associated or not to adenoidectomy. Variables analysed are pain (Brodman scale), analgesia, bleeding, uvula oedema and days up to the restoration of diet and normal life. Surgical, anaesthetic and total surgery room times are also discussed. Results The Colorado® electrodissection technique minimised intraoperative bleeding and the need for haemostasis. However, uvula oedema and local pain increased compared with cold dissection. There were no clinical variations in the recovery of normal life. Combining the Colorado® microdissection needle and laryngeal mask reduced intraoperative, anaesthetic and total surgery room times. Conclusions The combination of these two techniques is a secure, quick and effective method that derives benefits from the advantages of both of them, without increasing surgical or anaesthetic risks.
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Affiliation(s)
- Alda Cardesín
- Servicio de Otorrinolaringología, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
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Trial C, Brancati A, Marnet O, Téot L. Coblation Technology for Surgical Wound Debridement. INT J LOW EXTR WOUND 2012; 11:286-92. [DOI: 10.1177/1534734612466871] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Debridement is required to prepare the wound bed, essentially in removing undesired tissues observed both in acute wound after burns or trauma and in chronic wounds such as pressure ulcers, leg ulcers, and diabetic foot ulcers. Surgical debridement has been described as one of the most effective methods but can be contraindicated in the elderly, arteriopathic context, or patients under effective anticoagulation. Recently described debridement technologies are based on application of important mechanical severing forces over the wound surface using high-power hydrojets. High water flux acts as a vector for separating necrotic and sloughy tissues from the wound bed and aspirates them out of the wound immediately. Electrical powered techniques and lasers were also scarcely described. The Coblation debridement technology presented here is based on the local induction of a focused plasma field chemically deleting undesired tissues. This technique is a modification of conventional electrosurgical devices, developed in 1928 where tissue excision and coagulation of tissues were observed. Principles of plasma-mediated debridement are based on a bipolar radiofrequency energizing the molecules, thus creating a plasma field. This glow discharge plasma produces chemically active radical species from dissociation of water, breaking molecular bonds, and causing tissue dissolution. The thermal effects are a by-product, which can be modulated by modifying the electrode construction, limiting the local temperature to less than 50°C in order not to induce wound bed renecrosis. The authors describe here the principle, the first technical adaptation for wound debridement, and the potential clinical interest of the Coblation technology
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Affiliation(s)
| | | | | | - Luc Téot
- Hôpital Lapeyronie, Montpellier, France
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Coblation of the Canine Vocal Fold: A Histologic Study. J Voice 2012; 26:811.e9-13. [DOI: 10.1016/j.jvoice.2011.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/21/2011] [Indexed: 11/21/2022]
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Parker NP, Walner DL. Post-operative pain following coblation or monopolar electrocautery tonsillectomy in children: a prospective, single-blinded, randomised comparison. Clin Otolaryngol 2012; 36:468-74. [PMID: 21854552 DOI: 10.1111/j.1749-4486.2011.02384.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare post-operative pain following tonsillectomy by either coblation or monopolar electrocautery in children. DESIGN A parallel-designed, prospective, single-blinded, randomised trial. SETTING Ambulatory surgical facility. STUDY PARTICIPANTS Eighty otherwise healthy paediatric patients undergoing coblation or electrocautery tonsillectomy by a fellowship-trained paediatric otolaryngologist. MAIN OUTCOME MEASURES (i) The number of post-operative days with severe pain based on subjective qualification by the caretaker, (ii) post-operative days with pain rated ≥ 5 on a scale of 1-10, (iii) post-operative days requiring oral paracetamol/acetaminophen with codeine solution and (iv) post-operative days until resumption of a regular diet were assessed and recorded daily using a post-operative pain survey as a form of daily diary that was returned at the 2-week follow-up visit. RESULTS Patients were consecutively enrolled into two groups of 40 patients. Average ages were 5.2 years for coblation tonsillectomy and 6.0 years for electrocautery tonsillectomy. The average number of post-operative days with severe pain was 4.2 for coblation and 5.9 for electrocautery (P = 0.006), days rating pain ≥ 5 were 3.6 for coblation and 4.8 for electrocautery (P = 0.037), days of codeine use were 2.5 for coblation and 2.9 for electrocautery (P = 0.324), and days until resumption of a regular diet were 5.2 for coblation and 6.2 for electrocautery (0.329). CONCLUSIONS Coblation tonsillectomy may reduce post-operative pain and the time until resumption of a regular diet compared to electrocautery tonsillectomy.
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Affiliation(s)
- N P Parker
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
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Joshi H, Carney AS. Use of coblation in otolaryngology, head and neck surgery. Br J Hosp Med (Lond) 2011; 72:565-9. [DOI: 10.12968/hmed.2011.72.10.565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Himani Joshi
- Royal Australasian College of Surgeons Surgical Education and Training 1 in Otolaryngology
| | - A Simon Carney
- Consultant and Professor in Otorhinolaryngology Surgery, Flinders Medical Centre, Flagstaff Hill, South Australia, 5159, Australia
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Peters G, McLaughlin K, Nuss DW. Treatment of nasopharyngeal papillomatosis with coblation: a case series. Int Forum Allergy Rhinol 2011; 1:405-8. [DOI: 10.1002/alr.20016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 09/23/2010] [Accepted: 09/30/2010] [Indexed: 11/10/2022]
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Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques. Eur Arch Otorhinolaryngol 2011; 269:667-71. [DOI: 10.1007/s00405-011-1678-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 06/09/2011] [Indexed: 11/26/2022]
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Coblation tonsillectomy: is it inherently bloody? Eur Arch Otorhinolaryngol 2011; 269:579-83. [DOI: 10.1007/s00405-011-1609-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
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Jones DT, Kenna MA, Guidi J, Huang L, Johnston PR, Licameli GR. Comparison of Postoperative Pain in Pediatric Patients Undergoing Coblation Tonsillectomy versus Cautery Tonsillectomy. Otolaryngol Head Neck Surg 2011; 144:972-7. [DOI: 10.1177/0194599811400369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective. To compare postoperative pain scores between monopolar electrocautery and coblation subcapsular tonsillectomy. Study Design. Prospective double-blind randomized study. Setting. Tertiary care children’s hospital. Subjects and Methods. Between December 2004 and April 2008, 61 children, ages 4 to 20 years (mean age, 10 years; SD, 4 years), were randomized to have one tonsil removed by electrocautery and the other tonsil removed by coblation. Subjects used the FACES scale to rate pain on each side immediately postoperatively, 2 days postoperatively, and 2 weeks postoperatively. Postoperative hemorrhage was also tracked. Results. Coblation tonsillectomy resulted in statistically less pain than electrocautery immediately after surgery, but this difference was not clinically significant. Conclusions. Pediatric pain is similar following monopolar electrocautery or coblation subcapsular tonsillectomy.
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Affiliation(s)
- Dwight T. Jones
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret A. Kenna
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Guidi
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
| | - Lin Huang
- Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R. Johnston
- Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts, USA
| | - Greg R. Licameli
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011; 268:807-16. [PMID: 21373898 PMCID: PMC3087106 DOI: 10.1007/s00405-011-1535-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/07/2011] [Indexed: 11/09/2022]
Abstract
After the surgical procedure of tonsillectomy, hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using the coblation technique. 24 prospective, randomized, and controlled studies were included in the meta-analysis. Data of 796 patients who had undergone coblation tonsillectomy were analyzed. Hemorrhages occurred in 33 patients: 2 classified as primary and 26 as secondary hemorrhages. 5 could not be classified into either group. Overall, the total hemorrhage rate for the coblation procedure was 4.1% with a 95% confidence interval from 2.8 to 5.5%. The overall hemorrhage rate of 4.1% found in this meta-analysis shows that coblation is a safe and effective technique for tonsillectomies with a secondary bleeding rate similar to what is reported for comparable techniques such as bipolar diathermia.
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