Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage.

Abstract

To compare the tonsillectomy operations performed with bipolar radiofrequency clamp (BRC), plasma blade (PB), and cold dissection (CD) techniques in terms of postoperative pain and collateral tissue damage. This is a prospective randomized comparative cohort study conducted in a tertiary hospital. A total of 50 patients who underwent tonsillectomy in our institution met the inclusion criteria. Based on the tonsillectomy technique, patients were randomly divided into 3 groups as BRC (CURIS®) (n:20), PB (PEAK Surgical) (n:20), and CD (n:10). The patients were given a visual analog scale (VAS) for pain evaluation on the 1st postoperative day (3rd h) and on the 3rd and 6th days after discharge. The deepest and the most superficial necrosis depths were examined under the light microscope (Olympus BX53, Japan) by the same single blinded pathologist. The age of the patients included in the study ranged from 5 to 45years. The mean age was 14.5years. Twenty-four of the patients were female, 26 were male. Mean 3rd h and 3rd day VAS scores for pain in the BRC group were significantly higher than the other two groups (p < 0.001). Although PB group had higher VAS scores compared with CD group, the difference was not significant (p > 0.05). The deepest necrosis depths (dND) in patients who were operated with BRC was significantly greater compared to patients operated with PB (p < 0.01), whereas no significant difference was observed between the techniques regarding the most superficial necrosis depth (msND) (p > 0.05). For patients operated with CD technique, only ischemic fields were observed. Both BRC and PB techniques seem to not provide significant advantage compared with conventional CD technique in terms of postoperative pain. Necrosis depths in tonsillectomy specimens due to thermal damage positively correlate with the postoperative pain level.