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Falz H, von Lücken HJ, Münscher A, Möckelmann N. A comparative study of BiZact™ tonsillectomy versus cold steel dissection technique in adults: Analysis of operating time, intraoperative blood loss, postoperative bleeding rate and pain. Clin Otolaryngol 2024; 49:299-305. [PMID: 38169104 DOI: 10.1111/coa.14140] [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: 03/16/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To analyse operating time, intraoperative blood loss, postoperative bleeding rate and pain when using the relatively new BiZact™ tonsillectomy device compared to the commonly used cold steel dissection technique with bipolar cautery in adults. DESIGN Retrospective case control study. Parameters analysed for significant association with technique were operating time, intraoperative blood loss, wound pain on postoperative days 1-4 and rate of post-tonsillectomy bleeding (PTB). SETTING Monocentric study at a department of otolaryngology and head and neck surgery at a tertiary centre in Germany. PARTICIPANTS A total of 183 patients who underwent a bilateral tonsillectomy with either the BiZact™ tonsillectomy device or the cold dissection technique with bipolar cautery for haemostasis. MAIN OUTCOME MEASURES Operating time, intraoperative blood loss, postoperative pain on the first to fourth postoperative day (numeric rating scale: 0-10) (PTB, primary bleeding ≤24 h, secondary bleeding >24 h postoperative; Stammberger scale). RESULTS AND CONCLUSION The BiZact™ tonsillectomy device leads to a significant shorter operating time with less intraoperative blood loss compared to cold steel dissection with bipolar haemostasis. No benefits with regards to PTB or postoperative pain could be observed. The use of the BiZact™ device provides major benefits in clinical routine and stands up to conventional tonsillectomy techniques.
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Affiliation(s)
- Hendrik Falz
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Hans-Jürgen von Lücken
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Adrian Münscher
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
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Mao B, Woods CM, Athanasiadis T, MacFarlane P, Boase S, Joshi H, Wood J, Ooi EH. BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series. Clin Otolaryngol 2023. [PMID: 37129013 DOI: 10.1111/coa.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. SETTING Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. DATA COLLECTED patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH. RESULTS One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001). CONCLUSIONS BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.
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Affiliation(s)
- Boyuan Mao
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Theodore Athanasiadis
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Patricia MacFarlane
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - Samuel Boase
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Himani Joshi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - John Wood
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
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An observational pragmatic quality-of-life study on paediatric tonsillectomy and waiting for surgery. Eur Arch Otorhinolaryngol 2023; 280:885-890. [PMID: 36136151 PMCID: PMC9849282 DOI: 10.1007/s00405-022-07659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/12/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate parental perceptions of the effects of tonsillectomy on their child's quality of life while awaiting and following surgery in an Australian public health system. METHODS An observational pragmatic study was undertaken at a tertiary Australian hospital. Parents of paediatric patients (2-16 years of age) listed for tonsillectomy completed a validated quality-of-life questionnaire (T-14 Paediatric Throat Disorders Outcome Test) at the initial consultation, on day of surgery, 6 weeks post-operatively and 6 months post-operatively. T-14 scores were compared using the Related-Samples Wilcoxon Signed Rank Test. RESULTS Parents of 167 children participated in this study. There was a median wait time of 174 days (IQR 108-347) from the initial consultation until the day of surgery, with no significant change in median T-14 scores (35 [IQR 22-42] vs 36 [IQR 22-42]; n = 63; p > 0.05). There was a significant decrease from pre-operative T-14 scores to 6 weeks post-operatively (33.5 [IQR 22-42] vs 2 [IQR 0-5]; n = 160; p < 0.001), and this was sustained with a minor improvement at 6 months post-operatively (6 weeks 2 [IQR 0-5] vs 6 months 0 [IQR 0-2]; n = 148; p < 0.001). CONCLUSIONS Paediatric tonsillectomy improves quality of life with a sustained benefit in the long term. There is no improvement to the patient's quality of life while awaiting tonsillectomy, thus patient welfare can be improved through reducing waiting times for surgery.
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Dulku K, Toll E, Kwun J, van der Meer G. The learning curve of BiZact™ tonsillectomy. Int J Pediatr Otorhinolaryngol 2022; 158:111155. [PMID: 35584567 DOI: 10.1016/j.ijporl.2022.111155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the learning curve of BiZact™ tonsillectomy amongst trainees and fellows as a further technical skill. METHODS Prospective audit of consecutive BiZact™ tonsillectomies undertaken by a trainee and fellow at Starship Children's Hospital. Primary outcomes measured were operative time from gag open to gag closed, readmission and post tonsillectomy bleed rates. Secondary outcomes included need for bipolar rescue dissection, bipolar haemostasis including site and side, tonsil size (Brodsky grade 1-4) and depth (shallow or deep). Operative time was plotted against number of procedures performed and moving averages was used to investigate the learning curve. Generalised linear model was applied to examine the association between operation time and tonsil depth. RESULTS Mean operative time for the trainee and fellow was similar (07 min 34 s versus 07min and 37 s). We observed a trend of decreased operative time over number of procedures performed by the trainee but the learning curve was short. The fellow's initial time was lower than the trainee's and remained similar over time. No bipolar rescue dissection was required. Additional bipolar haemostasis was required 95% of the time, but the majority involved the superior pole only (87.5%, p = 0.0001). The overall operative time for shallow tonsils was shorter than for deep tonsils (06 min 31 s versus 08 min 09 s, p = 0.0066). A learning curve was evident for both shallow and deep tonsils for both surgeons combined but was steeper for deep. There were no primary bleeds and the secondary haemorrhage rate was 5.8% (3/51 cases) with no returns to theatre. CONCLUSION This is the first study to investigate the BiZact™ tonsillectomy learning curve. BiZact™ tonsillectomy is safe and easy to learn. We observed a clear trend of shallow tonsils being quicker to remove than deep tonsils using this technique. The secondary bleed rate of 5.8% is comparable to the previously published Starship rate of 4.7% for all tonsillectomies performed over a 10 year period. Moving averages is a useful method to assess operative learning curves during training and beyond.
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Affiliation(s)
- Kiren Dulku
- Department of Paediatric Otolaryngology, Starship Children's Health, Private Bag 92024, Auckland, 1142, New Zealand.
| | - Edward Toll
- Department of Paediatric Otolaryngology, Starship Children's Health, Private Bag 92024, Auckland, 1142, New Zealand
| | - Jin Kwun
- Department of Otolaryngology, Manukau SuperClinic, PO Box 98743, Manukau, 2241, New Zealand
| | - Graeme van der Meer
- Department of Paediatric Otolaryngology, Starship Children's Health, Private Bag 92024, Auckland, 1142, New Zealand
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Chmielik LP, Mielnik-Niedzielska G, Kasprzyk A, Niedzielski A. A review of health-related quality of life issues in children suffering from certain key otolaryngological illnesses. Front Pediatr 2022; 10:1077198. [PMID: 36714651 PMCID: PMC9875050 DOI: 10.3389/fped.2022.1077198] [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: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQoL) concept is nowadays increasingly and more broadly used for helping evaluate the effectiveness of medical treatment, superseding the earlier "quality of life" approach. The HRQoL concept likewise applies to otolaryngology and this narrative review study is focused on HRQoL outcomes in four key childhood otolaryngological diseases as reported in the literature. STUDY AIM To retrospectively evaluate the literature on measuring HRQoL in children suffering from selected otolaryngological illnesses, during treatment. MATERIALS AND METHODS Published studies/case reports were searched for in Medline, PubMed, Web of Science, Scopus and ORCID on the quality of life based on paediatric patient questionnaires, whether completed by subjects themselves or by their parents (by proxy). The following key words were used: health quality of life, otolaryngology/ENT, pediatrics/paediatrics. Studies before 1999 were omitted because hitherto, the "quality of life" had been imprecisely defined thus rendering any subsequent comparisions problematic. RESULTS HRQoL scores and well-being were found to significantly deteriorate in child patients suffering from four important otolaryngological disorders: chronic sinusitis, nasal septum deviation, adenoid hypertrophy and hearing disease. The main problems found were infection, inflammation, disruption to family life and child-parental interaction, fitness-related issues, reduced ENT patencies and apnea. CONCLUSIONS The HRQoL appears to significantly deteriorate in children suffering from otolaryngological diseases. Further such studies are needed for other ENT diseases.
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Affiliation(s)
- Lechosław Paweł Chmielik
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
| | | | - Anna Kasprzyk
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
| | - Artur Niedzielski
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
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