|
1
|
Samara P, Athanasopoulos M, Athanasopoulos I. Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery. Microorganisms 2023; 11:1624. [PMID: 37512798 PMCID: PMC10383913 DOI: 10.3390/microorganisms11071624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.
Collapse
Affiliation(s)
- Pinelopi Samara
- Children's Oncology Unit "Marianna V. Vardinoyannis-ELPIDA", Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | | | | |
Collapse
|
|
2
|
TUNA YALÇINOZAN E. The effect of ultrasonic surgery tool in the treatment of tonsillolithiasis. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.873557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
|
3
|
Chen AWG, Chen MK. Comparison of Post-Tonsillectomy Hemorrhage between Monopolar and Plasma Blade Techniques. J Clin Med 2021; 10:jcm10102051. [PMID: 34064672 PMCID: PMC8151987 DOI: 10.3390/jcm10102051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
Abstract
The plasma blade is an innovative device that was recently introduced for performing tonsillectomy. While one of the benefits of the plasma blade is limited thermal damage, the effects of plasma blades on postoperative hemorrhage have not been thoroughly investigated. Patients who underwent tonsillectomy in our institution between January 2013 and September 2018 were retrospectively enrolled in the study. A total of 1214 patients were enrolled in the study, with 759 participants who underwent monopolar tonsillectomy and 455 participants who underwent plasma blade tonsillectomy. In total, 14 bleeding events occurred in the monopolar group, and 10 events occurred in the plasma blade group. The odds ratio for postoperative bleeding in the plasma blade group was 1.20 (95% CI 0.52 to 2.72). After adjusting for potential confounders, the adjusted odds ratio was 1.34 (95% CI 0.58 to 3.07). In conclusion, there is no significant difference in post-tonsillectomy hemorrhage rates between the traditional monopolar technique and plasma blade technique. Plasma blade tonsillectomy can be considered as safe as traditional monopolar tonsillectomy.
Collapse
Affiliation(s)
| | - Mu-Kuan Chen
- Correspondence: ; Tel.: +886-4-7238595 (ext. 4966)
| |
Collapse
|
|
4
|
Kwek WMJ, Chua SMCA, Xu SH, Tan THL, Huang XY, Loh I, Lee TS. Randomized controlled study comparing tonsillectomy safety and patient satisfaction outcomes between HARMONIC ACE® + shears and monopolar diathermy in an adult population - A pilot study. Am J Otolaryngol 2020; 41:102568. [PMID: 32574895 DOI: 10.1016/j.amjoto.2020.102568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Various types of the harmonic scalpel blades have been used for tonsillectomy since the early 2000s with varying successes. The HARMONIC ACE® + 23 cm shears is a relatively new blade which has not been studied in an adult population yet. METHODOLOGY A randomized controlled pilot study was performed comparing the HARMONIC ACE® + 23 cm shears (HS) and monopolar electrocautery (EC) tonsillectomy in 20 patients. Intraoperative blood loss, pain control, return to normal diet and activity as well as patient satisfaction outcomes were compared between these two arms. RESULTS The operative time was comparable. Compared to the EC arm, there was less intraoperative bleeding, lower risks of delayed haemorrhage and readmission in the HS arm. Post-operative pain scores and use of analgesia were similar. There was earlier return to normal diet and activity in the HS arm compared to the EC arm. More patients in the HS arm recommended using HARMONIC ACE® + 23 cm shears compared to those in the EC arm. This is a non-inferiority study which suggests that the HARMONIC ACE® + 23 cm shears is comparable to monopolar electrocautery in terms of efficacy and post-operative complication rates with better patient satisfaction outcomes. The main weakness of the study is a small study population. CONCLUSION This is the first reported study comparing the use of the HARMONIC ACE® + 23 cm shears with monopolar cautery in tonsillectomy. A prospective adequately powered study validated by objective outcome measures would be useful to verify the findings from this pilot study.
Collapse
|
|
5
|
Ding XX, Zhao LQ, Cui XG, Yin Y, Yang HA. Clinical observation of soft palate-pharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome in children. World J Clin Cases 2020; 8:679-688. [PMID: 32149052 PMCID: PMC7052550 DOI: 10.12998/wjcc.v8.i4.679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/21/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Childhood obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical disease that can cause serious complications if not treated in time. The preferred treatment for OSAHS in children is surgery.
AIM To observe the effects of soft palate-pharyngoplasty on postoperative outcome, pharyngeal formation, and possible complications.
METHODS A total of 150 children with snoring, hernia, and mouth breathing were selected. A polysomnography test was performed to confirm the diagnosis of OSAHS. The children were randomly divided into experimental and control groups. The experimental group underwent adenoidectomy, tonsillectomy, and soft palate-pharyngoplasty. The control group underwent adenoidectomy and tonsillectomy. The t-test and chi-square test were used to compare conditions such as postoperative fever, postoperative hemorrhage, and pharyngeal reflux. Postoperative efficacy and complications were interrogated and observed in the form of outpatient follow-up and telephone follow-up at 6 mo and 1 year after surgery. The curative effects were divided into two groups: Cure (snoring, snoring symptoms disappeared) and non-cure.
RESULTS The effective rate of the experimental group was significantly higher than that of the control group, but the difference was not statistically significant (P > 0.05). The incidence of postoperative bleeding was lower in the experimental group. There was no postoperative pharyngeal reflux in either group. In the experimental group, the incidence of hyperthermia (body temperature exceeded 38.5 °C) was lower than that in the control group. The difference in postoperative swallowing pain scores between the experimental and control groups was significant.
CONCLUSION Soft palate-pharyngoplasty can more effectively enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium. Compared with surgery alone, it can better treat OSAHS in children, improve the curative effect, reduce the risk of perioperative bleeding, close the surgical cavity, reduce the risk of postoperative infection, reduce the proportion of postoperative fever, and accelerate healing. Although this process takes more time, it is simple, safe, and effective.
Collapse
Affiliation(s)
- Xiao-Xu Ding
- Department of Otolaryngology Head and Neck Surgery, Department of The Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Lan-Qing Zhao
- Department of Otolaryngology Head and Neck Surgery, Department of The Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiang-Guo Cui
- Department of Otolaryngology Head and Neck Surgery, Department of The Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yang Yin
- Department of Otolaryngology Head and Neck Surgery, Department of The Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Huai-An Yang
- Department of Otolaryngology Head and Neck Surgery, Department of The Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
|
6
|
Lee KC, Bent JP, Dolitsky JN, Hinchcliffe AM, Mansfield EL, White AK, Younis R. Surgical Advances in Tonsillectomy: Report of a Roundtable Discussion. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130408303s02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
|
7
|
Comparison of Complications in Parotid Surgery With Harmonic Scalpel Versus Cold Instruments. J Craniofac Surg 2017; 28:e342-e344. [DOI: 10.1097/scs.0000000000003581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
|
8
|
Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg 2017; 156:442-455. [PMID: 28094660 PMCID: PMC5639328 DOI: 10.1177/0194599816683915] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 01/21/2023]
Abstract
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
Collapse
Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Chris Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Nila Sathe
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Siva Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center
| |
Collapse
|
|
9
|
Fritz DK, Matthews TW, Chandarana SP, Nakoneshny SC, Dort JC. Harmonic scalpel impact on blood loss and operating time in major head and neck surgery: a randomized clinical trial. J Otolaryngol Head Neck Surg 2016; 45:58. [PMID: 27821144 PMCID: PMC5100249 DOI: 10.1186/s40463-016-0173-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background Long operating time and high blood loss contribute to post-surgical morbidity. Therefore, strategies to reduce these factors should to be tested using robust methods. The purpose of this study was to evaluate the impact of using the harmonic scalpel on operating time and blood loss in patients undergoing resection for advanced oral cancer (OSCC). Methods Thirty-six adult head and neck cancer patients with advanced OSCC requiring primary tumor resection with uni- or bi- lateral selective neck dissection from July 2012 to September 2014 were randomized to either the control group (traditional surgery) or the experimental group (harmonic surgery). Patients older than 18 years who were able to provide informed consent were eligible. Primary outcomes of interest were: intraoperative blood loss (mL) and operative time (minutes) for the ablative part of the surgery. Results Mean blood loss in the experimental group was 260 mL versus 403 mL in the control group (p = 0.08). Mean operative time was 140 min in the experimental group and 159 min in the control group (p = 0.2). Conclusions In this randomized controlled trial, use of the harmonic scalpel did not effect intraoperative blood loss or OR time in patients undergoing surgery for advanced OSCC. Trial registration ClinicalTrials.gov, NCT02017834.
Collapse
Affiliation(s)
- Dieter K Fritz
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Cumming School of Medicine, University of Calgary, HRIC 2A02, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - T Wayne Matthews
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Cumming School of Medicine, University of Calgary, HRIC 2A02, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shamir P Chandarana
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Cumming School of Medicine, University of Calgary, HRIC 2A02, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joseph C Dort
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Cumming School of Medicine, University of Calgary, HRIC 2A02, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada. .,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| |
Collapse
|
|
10
|
Blankenship DR, Gourin CG, Porubsky EA, Porubsky ES, Klippert FN, Whitaker EG, Terris DJ. Harmonic Scalpel versus Cold Knife Dissection in Superficial Parotidectomy. Otolaryngol Head Neck Surg 2016; 131:397-400. [PMID: 15467607 DOI: 10.1016/j.otohns.2004.03.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES: Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques. STUDY DESIGN AND SETTING: The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy. RESULTS: Forty-two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 ± 42.6 min vs. 195.5 ± 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 ± 25.8 mL vs. 60.0 ± 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 ± 33.8 mL vs. 48.0 ± 22.9 mL, respectively, P > 0.05) or facial nerve function. CONCLUSION: Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques. SIGNIFICANCE: A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.
Collapse
Affiliation(s)
- D Russ Blankenship
- Department of Otolarygology-Head and Neck Surgery, Medical College of Georgia, Augusta 30912, USA
| | | | | | | | | | | | | |
Collapse
|
|
11
|
Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-Tonsillectomy Morbidity and Quality of Life in Pediatric Patients with Obstructive Tonsils and Adenoid: Microdebrider vs Electrocautery. Otolaryngol Head Neck Surg 2016; 134:114-20. [PMID: 16399190 DOI: 10.1016/j.otohns.2005.10.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: To prospectively compare outcomes in children over age 2 with obstructive adenotonsillar hypertrophy when tonsillectomy is performed utilizing an intracapsular microdebrider technique versus low-wattage electrocautery technique. STUDY DESIGN AND SETTING: Prospective, single-blind, randomized controlled trial at a tertiary care children's hospital. RESULTS: Among the 300 children, those treated with the microdebrider resumed normal activity faster, with a median recovery of 2.5 days, and stopped taking pain medication sooner, with the median time to the last dose of 4 days. The microdebrider group were 3 times more likely to no longer need pain medications at 3 days postoperatively and 2.5 times less likely to be still needing pain medication 7 days postoperatively. They were twice as likely to be at a normal activity level by 3 days postoperatively and were less likely to still not have attained normal activity and normal diet after 7 days. There was no difference between groups in median days to return to normal diet (3.0 to 3.5 days). At 1-month follow-up, children in the microdebrider group were 5 times more likely to have residual tonsil tissue. CONCLUSIONS: Intracapsular tonsillectomy in children with obstructive adenotonsillar hypertrophy results in improved peri-operative outcomes. Residual tonsil tissue is more common with use of the microdebrider; however, the incidence of future obstruction or infection is unknown. EBM rating: A-1b
Collapse
Affiliation(s)
- Craig S Derkay
- Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Ste. 510, Norfolk, VA 23507-1914, USA.
| | | | | | | |
Collapse
|
|
12
|
Glade RS, Pearson SE, Zalzal GH, Choi SS. Coblation Adenotonsillectomy: An Improvement Over Electrocautery Technique? Otolaryngol Head Neck Surg 2016; 134:852-5. [PMID: 16647547 DOI: 10.1016/j.otohns.2005.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES: To compare postoperative complication rates of coblation and electrocautery adenotonsillectomies. STUDY DESIGN: Retrospective chart review. RESULTS: From January 2000 to June 2004, 1997 pediatric patients underwent adenotonsillectomy. 745 coblation, and 1252 electrocautery tonsillectomies were performed. Primary bleed, secondary bleed, and dehydration were seen in 3, 35, and 23 coblation, and 9, 41, and 64 electrocautery tonsillectomies, respectively. Data analysis revealed no significant difference in primary and secondary hemorrhage rate, but a higher dehydration rate in the electrocautery group ( P = 0.0423). A total of 602 coblation, 763 curette/cautery, and 632 electrocautery adenoidectomies were performed. Neck pain was seen in 0, 17, and 3 patients, respectively. Data analysis showed a higher incidence of neck pain with the curette/cautery technique compared with coblator and cautery techniques ( P = 0.0006 and P = 0.0119, respectively). CONCLUSIONS: Coblation tonsillectomy had similar rates of primary and secondary hemorrhage when compared with electrocautery tonsillectomy but a lower incidence of postoperative dehydration. Coblation adenoidectomy caused less postoperative neck pain than curette/cautery adenoidectomy without significant advantage over cautery adenoidectomy. EBM rating: B-3b
Collapse
Affiliation(s)
- Robert S Glade
- Division of Otolaryngology, George Washington University Medical Center, Washington, DC 20010, USA
| | | | | | | |
Collapse
|
|
13
|
Oremule B, Johnson M, Sanderson L, Lutz J, Dodd J, Hans P. Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2015; 79:2166-9. [PMID: 26590004 DOI: 10.1016/j.ijporl.2015.09.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen. METHODS A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups. RESULTS More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups. CONCLUSION This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery.
Collapse
Affiliation(s)
- B Oremule
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK.
| | - M Johnson
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - L Sanderson
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - J Lutz
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - J Dodd
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| | - P Hans
- Blackpool Teaching Hospitals NHS Trust, Blackpool, UK
| |
Collapse
|
|
14
|
Cunningham LC, Chio EG. Comparison of outcomes and cost in patients undergoing tonsillectomy with electrocautery and thermal welding. Am J Otolaryngol 2015; 36:20-3. [PMID: 25304999 DOI: 10.1016/j.amjoto.2014.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the morbidity and efficacy of thermal tissue welder instrument for tonsillectomy and compare it with monopolar electrocautery. MATERIALS AND METHODS IRB approval was obtained at the Wexner Medical Center at Ohio State University for a prospective, randomized, single-blinded, controlled clinical study of 48 healthy adult volunteers undergoing tonsillectomy for chronic tonsillitis and tonsil hypertrophy. Subjects were randomized to the TW or EC group. Post-operative pain, pain medication use, return to normal oral intake, return to normal activity, and bleeding were measured on the post-operative log. We recorded operative time, operating room time, and blood loss. All procedures were performed by one surgeon to eliminate variations in time and experience. Operative and patient data were analyzed using a Student T-test and evaluated by cost analysis. RESULTS There was a statically significant increase in operative time with the TW taking an average of 4min longer per procedure, p<0.001. However, when total anesthesia time was compared, this did not translate into a statistically significant increase in total operating room time and therefore did not translate into additional cost. The remaining categories were not significantly different between the two groups. In 3/23 TW cases, suction cautery was required for hemostasis. Two patients had 3 occurrences of secondary bleeding in the electrocautery group and none in the tissue welder group. TW cost increase per case was $167 per instrument but averaged $700 per case. CONCLUSIONS While the tissue welder remains a viable option for the adult tonsillectomy procedure, it has not demonstrated in our study the necessary parameters intraoperatively, postoperatively, or via cost analysis to become the choice instrument at our institution. We cannot ignore the increase in cost that may be seen for short and routine procedures without an added benefit to the patient in terms of outcome or safety. A larger study is needed to determine if secondary bleeding rates are lower with this instrument.
Collapse
|
|
15
|
Elsobky S, Ahmad N, Qureshi M, Izzath W, Sadiq H. Paediatric day case tonsillectomy: a safe, feasible and an economical way to treat patients – Yorkhill experience. Scott Med J 2014; 59:5-8. [DOI: 10.1177/0036933013518140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Day case surgery is widely encouraged as it has many benefits. In this study, we evaluate the feasibility of paediatric tonsillectomies as day case surgery procedures in a tertiary paediatric centre. Methods The outcome of paediatric tonsillectomy performed as day case procedures was studied for four months. We recorded complication rates in comparison to the standard in-patient practice. Results 23 paediatric patients were included in this study. The age of the patients ranged from four to 11 years, with mean age of 6.5. No patients suffered post-operative complications within the first 24 h. Two patients were re-admitted due to a post-operative complication (8.6%) and one patient for a non-operative cause (4.3%) beyond the initial 24 h. Conclusion Paediatric Day Case Paediatric Tonsillectomy is a safe, feasible and an economical way to manage patients. It should be practised as a day case where appropriate and when criteria are met.
Collapse
Affiliation(s)
- S Elsobky
- Research Associate & Junior Doctor, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - N Ahmad
- Junior Doctor, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - M Qureshi
- Medical Student, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - W Izzath
- Junior Doctor, Royal Hospital for Sick Children, UK
| | - H Sadiq
- Consultant Doctor, Royal Hospital for Sick Children, UK
| |
Collapse
|
|
16
|
Pajić-Penavić I, Danić D, Mrzljak-Vučinić N, Matić I, Vuković-Arar Z, Dikanović M. Postoperative quality of life after two different methods of tonsillectomy. Wien Klin Wochenschr 2013; 125:524-8. [PMID: 23934185 DOI: 10.1007/s00508-013-0411-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Tonsillectomy is a very painful procedure. Pain may be severe, and patients are often unable to perform in school or eat regular food for a number of days after the surgery. The aim of this study was to compare the quality of life after undergoing two different surgical techniques of tonsillectomy, harmonic scalpel and classic tonsillectomy with bipolar cauterization. DESIGN AND SETTING Prospective randomized double-blind, clinical trial study conducted in the ENT Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia. PATIENTS AND METHODS Data were collected, according to the type of operation, on pain persistence and intensity and returning to normal eating with tonsillectomy patients during the first seven postoperative days. Group A consisted of 50 children submitted to classic tonsillectomy with bipolar cauterization, while group B included 50 children operated on using the harmonic scalpel. Data on pain intensity were obtained using pain measuring scales adjusted to children's age (Faces scales, visual analog scale). The first day of normal oral food intake was recorded. RESULTS The analysis of variance revealed that the grade of pain significantly differs by a surgical technique employed, and that it significantly varied over the first seven postoperative days. The pain was more severe after undergoing the harmonic scalpel technique and children started to eat later compared with the classic tonsillectomy. CONCLUSION The classic tonsillectomy method with bipolar cauterization is the method of choice due to lower postoperative pain levels and sooner normal eating. The quality of life is better after undergoing the classic tonsillectomy method.
Collapse
Affiliation(s)
- Ivana Pajić-Penavić
- Department of ENT, Head and Neck Surgery, General Hospital Dr. Josip Benčević, Andrije Štampara 42, 35000, Slavonski Brod, Croatia,
| | | | | | | | | | | |
Collapse
|
|
17
|
Dean A, Alamillos F, Centella I, García-Álvarez S. Neck dissection with the harmonic scalpel in patients with squamous cell carcinoma of the oral cavity. J Craniomaxillofac Surg 2013; 42:84-7. [PMID: 23680491 DOI: 10.1016/j.jcms.2013.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Our purpose was to evaluate the use of the Harmonic scalpel in neck dissections. MATERIAL AND METHODS We conducted a randomized prospective intervention study to compare the Harmonic scalpel (32 patients) with the conventional technique (31 patients). RESULTS Operative time was lowered by 64 min (p < 0.001) and 7.5 min (p = 0.367); blood lost during surgery was lowered by 80.5 ml (p < 0.001) and 76.6 ml (p < 0.001); the length of time the drains were kept in place was lowered by 1.3 days (p < 0.001) and 1.5 days (p < 0.01); and the volume of drainage was lower by 228.7 ml (p < 0.001) and 187.6 ml (p < 0.01) in selective and comprehensive neck dissections respectively in patients treated with the Harmonic scalpel. CONCLUSIONS The Harmonic scalpel shortens operative time in selective dissections. It reduces blood loss during surgery; time drains are kept in place and the amount of drainage in comprehensive and selective neck dissections.
Collapse
Affiliation(s)
- Alicia Dean
- Department of Oral and Maxillofacial Surgery (Head: A. Dean), "Reina Sofía" University Hospital, Córdoba, Spain.
| | - Francisco Alamillos
- Department of Oral and Maxillofacial Surgery (Head: A. Dean), "Reina Sofía" University Hospital, Córdoba, Spain
| | - Inmaculada Centella
- Department of Oral and Maxillofacial Surgery (Head: A. Dean), "Reina Sofía" University Hospital, Córdoba, Spain
| | - Sandra García-Álvarez
- Department of Oral and Maxillofacial Surgery (Head: A. Dean), "Reina Sofía" University Hospital, Córdoba, Spain
| |
Collapse
|
|
18
|
Paramasivan VK, Arumugam SV, Kameswaran M. Randomised comparative study of adenotonsillectomy by conventional and coblation method for children with obstructive sleep apnoea. Int J Pediatr Otorhinolaryngol 2012; 76:816-21. [PMID: 22429513 DOI: 10.1016/j.ijporl.2012.02.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Adenotonsillectomy is one of the most common surgical procedures throughout the world for children in otolaryngology. One of the current indications for adenotonsillectomy is adenotonsillar hypertrophy causing Obstructive Sleep Apnoea (OSA). The choice of surgical tools and technique affects the outcome and morbidity due to adenotonsillectomy. AIM OF THE STUDY To assess the efficacy and safety of coblation adenotonsillectomy as compared to dissection method. To evaluate the morbidity and to study complications associated with each procedure. MATERIALS AND METHODS This prospective and comparative study of dissection and coblation method of adenotonsillectomy was conducted in our institute, Madras ENT Research Foundation, Chennai over a period of 6 months. 50 cases of children with OSA age group between 5 and 12 years were randomly selected for each group and studied. Duration of surgical procedure, blood loss, post operative pain, post operative reactionary and secondary bleeding was noted and compared. OBSERVATION AND RESULTS Operative time was more in dissection method compared to coblation technique. Blunt dissection tonsillectomy was associated with greater blood loss than coblation tonsillectomy. Post operative pain was more in dissection method and it was less in coblation technique. Post operative bleeding in both the techniques were found to be minimal. CONCLUSION We conclude that the use of coblation for adenotonsillectomy may have several advantages over standard methods for the treatment of children with Obstructive Sleep Apnoea. It is highly efficacious, practical and safe with less morbidity and less complications.
Collapse
Affiliation(s)
- Vijaya Krishnan Paramasivan
- Madras ENT Research Foundation, No.1 1st Cross Street, Off. 2nd Main Road, Raja Annamalaipuram, Chennai Tamil Nadu, India.
| | | | | |
Collapse
|
|
19
|
Kemal O. Harmonic scalpel versus bipolar tonsillectomy: a double-blind clinical trial. Eur Arch Otorhinolaryngol 2011; 269:1533-6. [PMID: 22159967 DOI: 10.1007/s00405-011-1872-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/29/2011] [Indexed: 11/28/2022]
Abstract
This is a double bind clinical trial which evaluated harmonic scalpel versus bipolar diathermy tonsillectomy The study was conducted at Diyarbakir government hospital, Diyarbakir, Turkey. The study population comprised 144 patients, aged 4-18 years (mean 9 years ± 4.12 SD). All patients underwent tonsillectomy with or without adenoidectomy. The indications for tonsillectomy were obstructive sleep apnea (84 patients [58.3%]) and chronic tonsillitis (60 patients [41.7%]). All 144 patients were randomly divided into two groups: bipolar dissection (81 patients [56.2%] with mean age 8.98 years ± 4.22) and harmonic scalpel (63 patients [43.8%] with mean age 9 years ± 4.02). BD group showed statistically significantly less intraoperative bleeding (< 0.05). There was no statistically significant difference on postoperative day 1 but a statistically significant difference was determined on postoperative days 4, 7 and 14. There was no statistically significant difference between the two techniques with regard to immediate and delayed bleeding. The mean operative time was the same in both the groups. Bipolar dissection group showed statistically significant less intraoperative bleeding than harmonic scalpel group. An analysis of postoperative pain scores showed that the harmonic scalpel group pain scores are lower than the bipolar dissection group on all recorded days, and no statistically significant complications was seen in both groups. The results of this study indicate that the HS technique is associated with lower pain scores with the same complication rates as the BD technique.
Collapse
Affiliation(s)
- Ozgur Kemal
- Samsun Gazi Government Hospital, Yesilere mah. Akca cad. Mimoza Evleri C Blok 75/41 Atakum, Samsun, Turkey.
| |
Collapse
|
|
20
|
Rubino LJ, Konstantakos EK, Stills HF, Dudley ES, Grunden BK, Malaviya P. Healing of Iatrogenic Skeletal Muscle Wounds Is Affected by Incision Device. Surg Innov 2010; 17:85-91. [PMID: 20504782 DOI: 10.1177/1553350610364531] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Orthopedic joint procedures frequently require extensive dissection of skeletal muscles resulting in tissue injury, formation of scar tissue, pain, and potentially, functional impairment. The authors hypothesized that using a low-temperature ultrasonic cutting and coagulating device (Harmonic Blade, Ethicon Endo-Surgery, Cincinnati, OH) would result in reduction in tissue trauma in terms of reducing acute and chronic inflammation during healing. Bilateral longitudinal incisions were made into the tibialis cranialis muscles of rabbits with either a Harmonic Blade or a standard monopolar electrosurgical scalpel. At 3, 7, and 21 days postoperatively, necropsy and histological evaluations indicated a significant attenuation of acute inflammation ( P = .011) for the Harmonic incisions compared with electrosurgery. No significant differences were observed for chronic inflammation, necrosis, or fibrosis. Use of a Harmonic scalpel during dissection of skeletal muscle in orthopedic surgery may result in reduced influx of neutrophils, reducing acute inflammation, and potentially aid in reducing postoperative pain and functional impairment.
Collapse
|
|
21
|
Cushing SL, Smith O, Chiodo A, Elmasri W, Munro-Peck P. Evaluating Postoperative Pain in Monopolar Cautery Versus Harmonic Scalpel Tonsillectomy. Otolaryngol Head Neck Surg 2009; 141:710-5.e1. [DOI: 10.1016/j.otohns.2009.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/25/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES: To compare postoperative pain between monopolar cautery tonsillectomy and harmonic scalpel tonsillectomy (HST). STUDY DESIGN: Randomized controlled trial using paired organs. SETTING: Community hospital with academic affiliation. SUBJECTS: One hundred and fourteen consecutive patients six years of age or older undergoing tonsillectomy for indications of hypertrophy or recurrent infection. METHODS: For each subject, monopolar cautery tonsillectomy was performed by four senior surgeons on one side and HST was performed on the other side. Allocation of technique to side was randomized and revealed to the surgeon at the start of the operation. Validated visual analog pain scales were used to quantify pain at rest and with swallowing for each side and were completed daily for 14 days. All subjects were prescribed weight-equivalent doses of analgesics. Secondary outcome measures included postoperative complications (hemorrhage and readmission). RESULTS: Pairwise comparisons of pain scores revealed no significant difference between monopolar cautery tonsillectomy and HST ( P < 0.05). CONCLUSIONS: Subjects undergoing monopolar cautery tonsillectomy do not experience increased postoperative pain in comparison to HST.
Collapse
Affiliation(s)
- Sharon L. Cushing
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Oakley Smith
- Department of Otolaryngology–Head and Neck Surgery, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Albino Chiodo
- Department of Otolaryngology–Head and Neck Surgery, Toronto East General Hospital, Toronto, Ontario, Canada
| | - William Elmasri
- Department of Otolaryngology–Head and Neck Surgery, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Pam Munro-Peck
- Department of Otolaryngology–Head and Neck Surgery, Toronto East General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
|
22
|
Making sense out of the tonsillectomy literature. Int J Pediatr Otorhinolaryngol 2009; 73:1499-506. [PMID: 19346010 DOI: 10.1016/j.ijporl.2009.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/10/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons. OBJECTIVES To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children. To propose the use of specific study parameters that could optimize clinical decision-making and future research. METHODS Detailed review of the methodologies and findings in articles which compared one or more tonsillectomy techniques in clinical trials of children, ages 1-23 years from 1987 through 2007. RESULTS The Medline search revealed 255 papers of which 89 studies were suitable for inclusion in our review. In these 89 studies (found in 87 papers), 9 dissection techniques, 3 planes of dissection, 8 methods of hemostasis, and 41 different outcome measures were reported. Forty-four (49%) were described as randomized, 63 (71%) prospective, 25 retrospective (28%), 1 case report, 1 matched pair, and 9 case series papers. Sixteen (18%) trials were non-blind, 23 (26%) were single blind, 17 (19%) were double blind, and 7 (8%) were not stated. Seventy-five (84%) were comparative and 14 (16%) non-comparative. Eight (9%) studies reported power analyses. Twelve (13%) had no follow-up; 67 (75%) of the studies performed had short-term follow-up in the peri-operative period; 10 (11%) had follow-up for greater than 1 year. Eleven (12%) mentioned outcomes related to the effectiveness of the procedure itself in relieving symptoms for which the surgery was done. CONCLUSIONS Tonsillectomy technique research is of obvious interest to the otolaryngologist. We found deficits in: the precise reporting of surgical techniques, adequate study design and useful outcome measures, all of which make the literature less useful than it could be. Guidelines for study design parameters which could lead to more valuable information for the clinician are suggested.
Collapse
|
|
23
|
Pons Y, Gauthier J, Clément P, Conessa C. Ultrasonic partial glossectomy. HEAD & NECK ONCOLOGY 2009; 1:21. [PMID: 19552821 PMCID: PMC2710330 DOI: 10.1186/1758-3284-1-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 06/24/2009] [Indexed: 11/18/2022]
Abstract
Introduction Partial glossectomy is the main treatment for tongue carcinoma. The resection of the tongue, which is a very vascularised tissue, requires a good hemostasis. The advantage of the harmonic scalpel is in combining sectioning and hemostasis in one single instrument, allowing a bloodless dissection of soft tissue. The aim of this prospective study was to evaluate the benefits and risks when using a harmonic scalpel in partial glossectomy. Subjects and Methods In this prospective study conducted in a university hospital from march 2004 to Decemeber 2008, eighteen consecutive patients underwent a partial glossectomy with the use of harmonic scalpel. Results were compared with previous surgical procedures performed between September 2000 and February 2004 by monopolar hemostasis by our team (n = 12) when the harmonic scalpel was not available. Results All 18 patients underwent partial glossectomy with the harmonic scalpel as the only instrument of section and hemostasis. The median blood loss was of 0 mL. The median operative time was 29 minutes (16 minutes less than partial glossectomies performed with conventional hemostasis. P < .001). No operative complications occurred. Two post-operative bleedings (5 days and 7 days after the glossectomy) occurred necessitating a new surgery to ligate the lingual artery. The margins of the resection were acceptable and no recurrence appeared. Conclusion The harmonic scalpel makes it fast and easy to perform a partial glossectomy with no bleeding. Ligation of the lingual artery (when it is visualized during the dissection) should be performed because of the frequency (more than 10% in our series) and because of the potential gravity of a lingual post-operative bleeding.
Collapse
Affiliation(s)
- Yoann Pons
- Head and Neck Surgery Department, Val of Grace's Academic Military Hospital, Paris, France.
| | | | | | | |
Collapse
|
|
24
|
A prospective observational study of 363 cases operated with three different harmonic scalpels. Eur Arch Otorhinolaryngol 2009; 266:1965-70. [PMID: 19308436 DOI: 10.1007/s00405-009-0954-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 02/26/2009] [Indexed: 10/21/2022]
Abstract
The objective of this study is to evaluate the efficacy of the Harmonic ACE, Harmonic FOCUS and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE and Harmonic FOCUS scalpel reduced the time of thyroid and parotid surgery by 20-25%. The use of Harmonic ACE reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE and Harmonic FOCUS devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.
Collapse
|
|
25
|
Kurzyński M, Szaleniec J, Składzień J. [Harmonic scalpel tonsillectomy--personal experience and review of literature]. Otolaryngol Pol 2008; 62:561-6. [PMID: 19004258 DOI: 10.1016/s0030-6657(08)70315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The harmonic scalpel has been used in tonsil surgery for several years. The comparison of harmonic scalpel tonsillectomy with other tonsillectomy techniques has been the subject of many studies. The research results proved to be contradictory, particularly concerning postoperative complications and complaints. Most authors observed reduced intraoperative bleeding during harmonic scalpel tonsillectomy. OBJECTIVE Analysis of harmonic scalpel tonsillectomy results and review of literature. Material and methods. The harmonic scalpel was used for 71 tonsillectomies in the Department of Otolaryngology UJ CM between 2002-2007. The surgical procedure and postoperative results were analyzed retrospectively and compared with other tonsillectomy techniques. RESULTS The harmonic scalpel provided sufficient intraoperative hemostasis in 67% of cases. 33% of patients required electrocautery, vessel ligation in the operation field or suturing of the marginal tissue to control bleeding. Postoperative hemorrhage requiring surgical intervention occurred in 3 patients. No other severe postoperative complications were observed in either group. CONCLUSIONS Harmonic scalpel tonsillectomy is an effective and safe alternative technique in tonsil surgery. In some cases however other hemostasis techniques may be necessary to control intense bleeding.
Collapse
|
|
26
|
Roth JA, Pincock T, Sacks R, Forer M, Boustred N, Johnston W, Bailey M. Harmonic Scalpel Tonsillectomy versus Monopolar Diathermy Tonsillectomy: A Prospective Study. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For tonsillectomy, the ultrasonic harmonic scalpel has been purported to cause less tissue injury and postoperative morbidity while providing adequate levels of hemostasis. We undertook a prospective study to compare outcomes in 162 patients who had undergone harmonic scalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy over a 33-month period. We found that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.0001). There was no clinically significant difference between the groups with respect to (1) the amount of operating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, and primary or secondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.
Collapse
Affiliation(s)
- Jason A. Roth
- From the Department of Otorhinolaryngology, Royal Prince Alfred Hospital, New South Wales (NSW), Australia
| | - Tobias Pincock
- From the Department of Otorhinolaryngology, Royal Prince Alfred Hospital, New South Wales (NSW), Australia
| | - Raymond Sacks
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - Martin Forer
- Department of Otorhinolaryngology, Royal North Shore Hospital, NSW
| | - Neil Boustred
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - William Johnston
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University/The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
|
27
|
Michel RG, Weinstock BI, Tsau K. Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.
Collapse
Affiliation(s)
- Randall G. Michel
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Bernard I. Weinstock
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Kang Tsau
- Department of Anesthesiology, Lompoc (Calif.) District Hospital
| |
Collapse
|
|
28
|
Gilbey P, Gadban H, Letichevsky V, Talmon Y. Harmonic Scalpel Tonsillectomy Using the Curved Shears Instrument versus Cold Dissection Tonsillectomy: A Retrospective Study. Ann Otol Rhinol Laryngol 2008; 117:46-50. [DOI: 10.1177/000348940811700110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We compared operating time, intraoperative blood loss, and rate of postoperative bleeding in harmonic scalpel (HS) tonsillectomy using the curved shears instrument to those in cold dissection (CD) tonsillectomy. Methods: The charts of 560 patients who underwent tonsillectomy were retrospectively reviewed. Three hundred nineteen patients underwent CD tonsillectomy between the years 1998 and 1999, and 241 patients underwent HS tonsillectomy using the curved shears instrument between the years 2001 and 2005. For the purpose of evaluation of postoperative bleeding rates, the groups were further stratified by age (11 years of age or less versus 12 years of age or more). Results: For the HS group, the mean operating time was shorter (7 minutes versus 17.57 minutes) and the intraoperative blood loss was lower (0 mL versus 42.12 mL). These differences were statistically significant (p < .05). There was no significant difference in the overall postoperative bleeding rates between the two groups. The postoperative bleeding rate in the HS patients 11 years of age or younger was lower than that in the equivalent age group in the CD group (0.56% versus 2%, respectively), although this difference did not reach statistical significance. The postoperative bleeding rate in the HS patients 12 years of age or older was significantly higher than that in the equivalent age group in the CD group (7.93% versus 1%, respectively; p < .05). Conclusions: Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.
Collapse
|
|
29
|
Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy Techniques and Pain: A Review of Randomized Controlled Trials and Call for Standardization. ACTA ACUST UNITED AC 2007; 69:364-70. [DOI: 10.1159/000108369] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
|
30
|
Leaper M, Mahadevan M, Vokes D, Sandow D, Anderson BJ, West T. A prospective randomised single blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy. Int J Pediatr Otorhinolaryngol 2006; 70:1389-96. [PMID: 16551480 DOI: 10.1016/j.ijporl.2006.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 02/06/2006] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the differences in pain, analgesic use and bleeding in children after tonsillectomy using either a harmonic scalpel or a bipolar diathermy surgical technique. METHODS Children 6-15 years presenting for tonsillectomy were randomised to either a harmonic scalpel or bipolar diathermy surgical technique. Post-operative pain scores (VAS, 0-10) were recorded within 30 min of surgery and again at the 4h hospital discharge. A subsequent telephone interview daily for 7 days and then every second day until day 13 was used to monitor pain scores, analgesic use and tonsil bed bleeding. RESULTS There were 204 children studied. The response rate over the first 7 days was 93% for the children in the harmonic scalpel group and 87% for the bipolar group. Children experienced moderate post-operative pain for the first 6 days, after which pain declined from 4-7 to reach a score of 1-2 by day 11. Children undergoing harmonic scalpel tonsillectomy (n=103) reported higher mean pain scores than those who underwent bipolar diathermy (n=101) for current pain (4.7 versus 4.2, p=0.002), worst pain of the day (6.9 versus 6.2, p<0.001) and pain on swallowing (5.9 versus 5.2, p<0.001) over the first 6 post-operative days. Analgesic use (acetaminophen, ibuprofen) was similar in both groups. Hospital readmission for bleeding in children who underwent harmonic scalpel was similar to those who underwent bipolar diathermy tonsillectomy (9% versus 11%) as was bleeding requiring surgical re-exploration (4% versus 2%). CONCLUSIONS Tonsillectomy was associated with considerable pain for the first 6 post-operative days. Children undergoing harmonic scalpel tonsillectomy had a slight increase in pain compared to the bipolar diathermy group during this time. Both methods of tonsillectomy are effective and safe.
Collapse
Affiliation(s)
- Matthew Leaper
- Department of Paediatric Otolaryngology, Auckland Children's Hospital, Park Road, Auckland, New Zealand.
| | | | | | | | | | | |
Collapse
|
|
31
|
Schmidt R, Richter M, Gleichsner F, Geiger P, Puhl W, Cakir B. Posterior atlantoaxial three-point fixation: comparison of intraoperative performance between open and percutaneous techniques. Arch Orthop Trauma Surg 2006; 126:150-6. [PMID: 16479396 DOI: 10.1007/s00402-005-0046-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atlantoaxial instabilities, which require surgical fixation follow a variety of clinical disorders. Different surgical procedures are used for stabilization of the atlantoaxial complex, mainly posterior wiring techniques and transarticular screw fixation. Nowadays, often a combination of transarticular screws and a posterior one-point fixation is used to achieve a three-point fixation, with superior biomechanical stability and good clinical results. Different modifications were developed to improve this technique. In 1995, a percutaneous approach for atlantoaxial stabilization was introduced. In clinical studies, the technique showed a tendency towards better outcome. Beside the outcome, the intraoperative performance is of special interest for minimal invasive approaches. We therefore compared the operation time, screw angulation and blood loss, between the open and percutaneous posterior atlantoaxial techniques. MATERIALS AND METHODS Two groups, each consisting of 17 patients, with either open (group 1) or percutaneous (group 2) atlantoxial stabilization, were compared. The operation time was retrospectively acquired from the patient's charts. The data for blood loss was provided by our anaesthesiological department, separated for intraoperative, postoperative and total blood loss. Screw angulation was measured on the postoperative x-ray by an orthopaedic surgeon. RESULTS The percutaneous group showed an average intraoperative blood loss of 239.7 ml, compared to 929.4 ml for the open group (p< or =0.001). The analogue values for the postoperative blood loss were 142.9 ml and 379.4 ml for group 2 and group 1, respectively (p=0.008). Consecutively, the total blood loss showed also a statistically significant difference (p< or =0.001). The operation time was significantly different (p< or =0.001), with average values of 175.3 min (group 1) and 110.6 min (group 2). Screw angulation showed a trend towards a steeper angulation in the percutaneous group with an average angle of 56.8 degrees , compared to 53.9 degrees (group 1), although this was not statistically significant (p=0.053). CONCLUSION The percutaneous technique for atlantoaxial stabilization with a three-point fixation has clear intraoperative benefits, with shorter operation time and reduced blood loss. A trend towards steeper screw angulation was found and shows at least equal feasibility for transarticular screw placement with the percutaneous technique, compared to the standard open approach.
Collapse
Affiliation(s)
- René Schmidt
- Department of Orthopedics and SCI, Orthopädische Klinik mit Querschnittgelähmtenzentrum, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
|
32
|
Oko MO, Ganly I, Loughran S, Clement WA, Young D, Geddes NK. A prospective randomized single-blind trial comparing ultrasonic scalpel tonsillectomy with tonsillectomy by blunt dissection in a pediatric age group. Otolaryngol Head Neck Surg 2006; 133:579-84. [PMID: 16213933 DOI: 10.1016/j.otohns.2005.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if there was a difference in postoperative pain and dietary intake when comparing ultrasonic scalpel (US) with blunt dissection tonsillectomy (BD) in children. STUDY DESIGN AND SETTING A prospective single-blind randomized controlled trial comparing US and BD tonsillectomy in children aged between 5 and 13 years who undergo tonsillectomy for recurrent acute tonsillitis in a specialized pediatric hospital. RESULTS One hundred and twenty-two children were enrolled. Ninety-three (76%) patients completed dietary and pain scales. Pain was significantly greater in the US group on postoperative days 1 and 3 (P = 0.0466, P = 0.0084) and overall (P = 0.0003). Dietary intake scores were significantly better in the US group on days 1, 5, 7, and 9, however, these scores were inconsistent with dietary intake scores declining in both groups throughout the study. Blood loss was statistically significantly greater in the BD group (33.1 ml vs 3.0 ml, P < 0.0001). There were no significant differences for all other observed outcomes. CONCLUSIONS US tonsillectomy causes significantly more pain overall and on postoperative days 1 and 3 when compared to BD tonsillectomy. US tonsillectomy causes less intraoperative blood loss, the clinical significance of which is questionable. SIGNIFICANCE US tonsillectomy appears to cause more postoperative pain than BD tonsillectomy in children aged 5 to 13 years undergoing tonsillectomy for recurrent acute tonsillitis.
Collapse
Affiliation(s)
- Michael O Oko
- Department of Otolaryngology, Royal Hospital for Sick Children, Yorkhill, UK
| | | | | | | | | | | |
Collapse
|
|
33
|
Parsons SP, Cordes SR, Comer B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006; 134:106-13. [PMID: 16399189 DOI: 10.1016/j.otohns.2005.09.027] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare postoperative tonsillectomy pain between 3 commonly used surgical devices: the Harmonic Ultrasonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), the Coblator (ArthroCare Corp, Sunnyvale, CA), and electrocautery. STUDY DESIGN AND SETTING A prospective, randomized trial. One hundred thirty-four patients were randomly assigned to receive a tonsillectomy with 1 of 3 surgical devices. All patients were asked to fill out a postoperative diary. RESULTS Statistically significant differences in pain scores were revealed between the Coblator and electrocautery (P = 0.02) and between the Coblator and the Ultrasonic Scalpel (P = 0.003), with the Coblator having lower pain scores. Electrocautery and the Ultrasonic Scalpel did not differ significantly from each other. The Coblation method showed a strong trend toward quicker return to normal diet. CONCLUSION Patients undergoing tonsillectomy with the Coblator device reported less pain over a 10-day period than patients undergoing tonsillectomy with electrocautery or the Ultrasonic Scalpel. Pain after tonsillectomy remains a major issue for our patients. The choice of surgical instrument appears to be one way to reduce this pain. EBM RATING A-1b.
Collapse
Affiliation(s)
- Stephen P Parsons
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 699 West Drive, Indianapolis, IN 46202, USA.
| | | | | |
Collapse
|
|
34
|
|
|
35
|
Sharma A, Muna S, Fahmy FF. The ultrasonically activated scalpel versus bipolar diathermy for tonsillectomy: a prospective randomized trial. Clin Otolaryngol 2005; 30:284; author reply 284-5. [PMID: 16111431 DOI: 10.1111/j.1365-2273.2005.01009.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
36
|
Abstract
The bipolar scissors, coblator, harmonic scalpel, and somnoplasty techniques are widely available and offer new choices for the operating arena. There are advantages and disadvantages to all four techniques. With time, these dissection methods will prove their lasting power. Otolaryngologists have already begun to expand their applications and will surely play a role in their use and development.
Collapse
Affiliation(s)
- Thomas Carroll
- Department of Otolaryngology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B 205, Denver, CO 80262, USA.
| | | | | |
Collapse
|
|
37
|
Sheahan P, Miller I, Colreavy M, Sheahan JN, McShane D, Curran A. Response to Sharma. Clin Otolaryngol 2005. [DOI: 10.1111/j.1365-2273.2005.01010.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
|
38
|
Jackson LL, Gourin CG, Thomas DS, Porubsky ES, Klippert FN, Terris DJ. Use of the Harmonic Scalpel in Superficial and Total Parotidectomy for Benign and Malignant Disease. Laryngoscope 2005; 115:1070-3. [PMID: 15933523 DOI: 10.1097/01.mlg.0000163336.37077.8f] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Use of the harmonic scalpel in superficial parotidectomy for benign parotid disease has been shown to reduce surgical time as well as intraoperative blood loss. We sought to determine whether similar results could be achieved with the expanded use of the harmonic scalpel in parotidectomy for both benign and malignant disease. STUDY DESIGN Retrospective review. METHODS The medical records of all patients undergoing superficial or total parotidectomy from 1999 to 2004 were reviewed. Patients were excluded for a history of bleeding disorder, prior facial nerve weakness, or concurrent neck dissection at the time of parotidectomy. RESULTS Forty-four patients underwent harmonic scalpel parotidectomy and 41 patients underwent conventional cold knife parotidectomy (control group). Use of the harmonic scalpel was associated with a significant reduction in intraoperative blood loss (38.0 +/- 3.6 mL vs. 66.0 +/- 10.8 mL for controls, P < 0.05) and duration of drainage (31.80 +/- 2.4 h vs. 39.29 +/- 2.21 h for controls, P < 0.05). Use of the harmonic scalpel in superficial parotidectomy (n = 35) compared to controls (n = 37) was associated with a significant reduction in intraoperative blood loss (38.0 +/- 4.23 mL vs. 68.0 +/- 12.0 mL, P < 0.05) and reduced incidence of facial nerve injury (P < 0.05). In patients undergoing total parotidectomy, no significant differences were observed between the harmonic scalpel (n = 9) and control groups (n = 4) in length of surgery, intraoperative blood loss, postoperative drainage, duration of drainage, and facial nerve injury. CONCLUSIONS Use of the harmonic scalpel in the surgical treatment of parotid disease is safe and confers some advantages over conventional methods of parotid dissection.
Collapse
Affiliation(s)
- Lana L Jackson
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia 30912, USA
| | | | | | | | | | | |
Collapse
|
|
39
|
Affiliation(s)
- J P Windfuhr
- Klinik für Hals-, Nasen-, Ohren-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser-Krankenhaus St. Anna, Duisburg.
| |
Collapse
|
|
40
|
Sheahan P, Miller I, Colreavy M, Sheahan JN, McShane D, Curran A. The ultrasonically activated scalpel versus bipolar diathermy for tonsillectomy: a prospective, randomized trial. ACTA ACUST UNITED AC 2005; 29:530-4. [PMID: 15373868 DOI: 10.1111/j.1365-2273.2004.00856.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among patients undergoing tonsillectomy, the ultrasonic scalpel has been reported to lead to less intraoperative blood loss than cold dissection, and less postoperative pain and faster recovery than monopolar electrocautery. However, the ultrasonic scalpel has not been compared with bipolar diathermy. The present study was a prospective, randomized, single-blind trial, comparing these two techniques with respect to postoperative pain. Twenty-one adults underwent tonsillectomy on one side using the ultrasonic scalpel, and on the other using bipolar diathermy. Pain scores were obtained on postoperative days 1, 2, 7 and week 3. There was no difference between the two treatments at any of the time points (P = 0.6047, 0.4018, 0.6047 and 0.5000, respectively). Inability to control bleeding with the ultrasonic scalpel resulted in the rescue use of an alternative technique of haemostasis in 14 cases. We conclude that the use of the ultrasonic scalpel in adult tonsillectomy is likely to be limited by its substantial costs and difficulties with haemostasis.
Collapse
Affiliation(s)
- P Sheahan
- Department of Otolaryngology, The Adelaide and Meath Hospital, Tallaght, Ireland.
| | | | | | | | | | | |
Collapse
|
|
41
|
Abstract
BACKGROUND The aim of the study was the evaluation of the feasibility of glossectomy using an ultrasonic-activated surgical instrument. METHODS This was a prospective study of 13 consecutive patients who underwent glossectomy (12 partial and one total) for carcinoma of tongue with the use of ultrasonic scissors. RESULTS All 13 patients had glossectomy, with median blood loss of 0 mL. The glossectomies were done with an ultrasonic dissector alone. None of the glossectomies required diathermy, ligature, plication, or other methods for hemostasis. The lingual artery and veins of all 13 patients were controlled by use of the ultrasonic scissors alone. No operative complications occurred, including bleeding or wound healing problems. CONCLUSIONS The excellent combination of coagulation and the cutting effect of ultrasonic scissors has made glossectomy a simple and bloodless procedure. It is a recommended surgical technique in our surgical armamentarium.
Collapse
Affiliation(s)
- Anthony Po-Wing Yuen
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, SAR, China.
| | | |
Collapse
|
|
42
|
Weissler MC, Scharer S. What’s new in otolaryngology—head and neck surgery1 1No competing interests declared. J Am Coll Surg 2004; 199:114-23. [PMID: 15217639 DOI: 10.1016/j.jamcollsurg.2004.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 03/17/2004] [Indexed: 12/28/2022]
Affiliation(s)
- Mark C Weissler
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
|
43
|
Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg 2004; 130:666-75. [PMID: 15195050 DOI: 10.1016/j.otohns.2004.02.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES). STUDY DESIGN AND SETTING Patients aged 3 to 12 years from 3 clinical sites were randomly assigned and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45). RESULTS Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055). CONCLUSION AND SIGNIFICANCE Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.
Collapse
Affiliation(s)
- Kelly E Stoker
- Mountain West Ear, Nose, and Throat, Boutiful, UT 84010, USA.
| | | | | | | | | | | |
Collapse
|
|
44
|
Sorin A, Bent JP, April MM, Ward RF. Complications of Microdebrider-Assisted Powered Intracapsular Tonsillectomy and Adenoidectomy. Laryngoscope 2004; 114:297-300. [PMID: 14755207 DOI: 10.1097/00005537-200402000-00022] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA). STUDY DESIGN Retrospective chart review and long-term follow-up in office or by telephone interview. METHODS We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms. RESULTS All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had self-limited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission. CONCLUSIONS Microdebrider-assisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow-up may define higher complication rates.
Collapse
Affiliation(s)
- Alexander Sorin
- New York Otolaryngology Institute, 186 East 76th Street, New York, NY 10021, USA
| | | | | | | |
Collapse
|
|
45
|
Burton MJ, Doree C. Harmonic scalpel versus other surgical procedures for tonsillectomy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|