Telescopic-Assisted Radiofrequency Adenoidectomy: A Prospective Randomized Controlled Trial

A Comparative Study of Endoscopic Assisted Powered Adenoidectomy Versus Conventional Adenoidectomy

Adenoidectomy is one of the most common procedures performed in children today, either alone or in conjunction with tonsillectomy or insertion of ventilating tubes. The present study was planned to compare the endoscopic powered adenoidectomy versus conventional adenoidectomy. The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan. Fifty patients with adenoid hypertrophy in the age group between 5-13 years were enrolled in the study and divided in to two groups viz. cases undergoing conventional adenoidectomy using curettage method (group A = 25) and cases undergoing endoscopic powered adenoidectomy (group B = 25). Intra operative time, primary bleeding, completeness of adenoid removal, depth of resection, and collateral damage were noted intra operatively in both the groups. Postoperative pain, recovery time, postoperative complications were also compared. Intra operative time taken in Group A was 25.6 ± 2.90 min while it was 35.04 ± 5.24 min in Group B. (p < 0.0001) Average blood loss in Group A was 18.4 ± 4.72 ml compared to an average blood loss of 29.32 ± 2.59 ml in Group B. (p < 0.0001) The postoperative recovery time in Group A was 4.93 days and it was 3.06 days in group B. (p = 0.00). The present study concluded that newer method of endoscopic powered adenoidectomy was found to be a safe and useful tool for adenoidectomy in terms of completeness of resection, better control of depth of resection and minimal collateral damage intra-operatively and less postoperative pain, complications and fast recovery period.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03633-4.

Comparative analysis of conventional cold curettage versus endoscopic assisted coblation adenoidectomy

Objective

To compare conventional cold curettage adenoidectomy with endoscopic assisted coblation adenoidectomy in terms of operative time, primary blood loss, post-operative residual tissue and post-operative pain.

Methods

This prospective non-randomised study was carried out on 60 patients aged 5–12 years. One group underwent conventional cold curettage adenoidectomy and the other underwent endoscopic assisted coblation adenoidectomy, with 30 patients per group.

Results

Mean operation duration was significantly higher for endoscopic assisted coblation adenoidectomy. Mean blood loss was 44.33 ml in conventional cold curettage adenoidectomy and 32.47 ml in endoscopic assisted coblation adenoidectomy. The pain grade was significantly lower in endoscopic assisted coblation adenoidectomy. Forty per cent of patients who underwent conventional cold curettage adenoidectomy had adenoid tissue post-surgery, while it was completely absent in endoscopic assisted coblation adenoidectomy patients.

Conclusion

Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of reduced blood loss, no post-operative residual tissue and lower pain grade on day 1 after surgery.

[S1 Clinical guideline"adenoids and adenoidectomy"]

On behalf of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, a clinical guideline for adenoids and adenoidectomy was developed in 5 consensus meetings after taking into consideration the current literature. This guideline was released by the presidium on 13 April 2011. Anatomy, pathology and pathophysiology, symptoms, diagnosis, therapy, and course are presented.

Endoscopic adenoidectomy with microdebrider

To describe endoscopic power assisted adenoidectomy and review the experience with the procedure demonstrating its safety and efficacy. Prospective study of 44 patients aged between 7 to 15 years undergoing power assisted adenoidectomy between Jan 2004 and July 2006. Tertiary care private teaching hospital. Forty four consecutive children with adenoid hypertrophy undergoing power assisted adenoidectomy. Therapeutic endoscopic adenoidectomy using microdebrider. Operative time, blood loss, complications, completeness and depth of removal, surgeon's satisfaction and recovery period. The average operative time was 12 min (range: 8-16 min) and average blood loss was 30 ml (range: 24-42 ml). Complete resection was possible under vision with few complications. The surgeon satisfaction was high and post-operative recovery good. Power assisted adenoidectomy is quick, precise and safe. There is good visualization during resection thus improving precision and ensuring complete removal of adenoid tissue.

Residual adenoid tissue post-curettage: role of nasopharyngoscopy in adenoidectomy

OBJECTIVE

Curettage adenoidectomy is one of the most common methods of adenoidectomy. This study reports the incidence of residual adenoid tissue after curettage and grades the degree of post-nasal space obstruction using fibre-optic nasopharyngoscopy.

METHODS

A retrospective study of 425 consecutive patients undergoing curette adenoidectomy in a 5-year period.

RESULTS

Of the 425 patients, 288 (68%) had some residual adenoid tissue evident with nasopharyngoscopy, of which 104 (24%) had significant obstruction (grade 2 or 3). No age or sex difference was found in the likelihood or severity of residual adenoid tissue.

CONCLUSIONS

A significant proportion of patients will have residual adenoid tissue following curette adenoidectomy alone. Nasopharyngoscopy permits a more complete resection in a cost-effective, quick and easily performed additional step.

Radiophonosurgery of vocal fold nodules

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial

OBJECTIVES

To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage.

MATERIALS AND METHODS

From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with.

RESULTS

There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications.

CONCLUSION

BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

Radiofrequency Myringotomy with the Topical Use of Mitomycin C: An Experimental Study

OBJECTIVE

To assess the use of radiofrequency myringotomy in combination with mitomycin C as an alternative myringotomy technique on rabbits.

STUDY DESIGN

Experimental animal research protocol.

SETTING

University of Crete, School of Medicine, Medical Experimental Education and Research Center.

METHODS

Radiofrequency myringotomies were performed under general anesthesia on both ears of 20 rabbits. Mitomycin C (0.3 mg/ml) pledgets were applied in the right ears (study group) and saline pledgets in the left ears (control group). Animals were monitored using otomicroscopy weekly until myringotomy closure. Kaplan-Meier survival techniques were used to compare myringotomy patency time between the two sides.

INTERVENTION

Radiofrequency myringotomy under general anesthesia on both ears of 20 rabbits.

MAIN OUTCOME MEASURE

Myringotomy patency time.

RESULTS

The mean patency time of the study group was 5.45 weeks (95% confidence interval, 5.185-5.715 weeks). The mean patency rate for the control side was 1.60 weeks (95% confidence interval, 1.38-1.82 weeks). The Breslow (generalized Wilcoxon) test showed the study group to have significantly longer patency of radiofrequency myringotomy than the control group (p<0.0001).

CONCLUSION

The patency period of radiofrequency myringotomy was not long enough to be proposed as an alternative to the insertion of ventilation tubes, although mitomycin C had a significant adjunct effect in prolonging the patency rate of radiofrequency myringotomy on rabbits.