Does Harmonic Scalpel Tonsillectomy Have Better Postoperative Outcomes Than Cold Dissection Technique in Adults? Results of A Randomized Double-Masked Study

Abstract

Objective: To compare postoperative pain, intraoperative blood loss, operating time, time needed to return to a normal diet, and activity between harmonic scalpel and cold dissection tonsillectomies. Material and Methods: In this prospective, double-blind study, eligible patients aged 18 and above (n=88) were randomized to receive either harmonic scalpel tonsillectomy (n=44) or cold steel tonsillectomy (n=44). Pain was assessed using the visual analogue scale (VAS) on days 1, 4 and 7, respectively. Intraoperative bleeding was measured by intra-suction blood and the weight of tonsil swabs. Results: On postoperative day one, the mean pain score in the harmonic scalpel group was 4.6±1.4 (range, 2-7), and in the cold steel group, it was 7.2±1.7(range, 4-10): (p-value<0.001). The mean pain score on the 7th postoperative day in the harmonic scalpel group was 2.3±1 (range, 1-4), and in the cold steel group, it was (2.6±1.3, range 1-6) (p-value=0.145). The mean intraoperative bleeding in Group 1 was 8±1.9 (range, 5-12 cubic centimeter (cc)), and in Group 2 was 66.3±8.1 (range, 58-90 cc): (p-value<0.001). The mean duration of surgery in Group 1 was 14.5±3.5 (range, 11-28 minutes) and in Group 2 was 27.4±4.4 (range, 22-38 minutes) (p-value<0.001). The mean time taken to return to resume daily activities in the case of harmonic scalpel was 7.6± 0.8 days, whereas in cases of the cold steel method it was 8.8±0.9 days (independent t-test, p-value=0.050). Conclusion: Harmonic scalpel tonsillectomy has less postoperative pain compared to the cold dissection technique. Additionally, there is less intraoperative blood loss and a reduced incidence of delayed haemorrhage.