Cautery Technique Research Articles

Effectiveness of Intralesional Cautery in Treatment of Vascular Malformations

Objective: to evaluate effectiveness of intralesional cautery in treatment of vascular malformations
 Methodology: Descriptive case series study was conducted at Pak Italian Modern Burn Center /plastic surgery department, Nishtar Medical University Multan during a period from January 2020 to December 2020. A total of 20 patients were enrolled with vascular malformation involving head and neck region.The average follow-up period was 06 months after completion of a multisession treatment. Advanced diagnostic technology, mostly noninvasive, was used on all 20 patients with vascularmalformation.
 Results: Majority of our study cases i.e. 18 (90%) reported with the venous vascular malformation followed by Arteriovenous malformation 02 (10%). Overall regression was better in venous malformations shown in six weeks and it was observed in 18 (90%) of the study cases.Arteriovenous malformations showed less regression with procedure and took three to four sessions (as compared to VM which took two sessions). Color matching was comparable to that of normal site in 18 (90%) of our study cases mostly seen in slow flow venous malformation, while Arteriovenous malformation showed less improvement 02 (10%) of our study cases. Normal healing was noted in 19 (95%) of our study cases while one (05%) oral vascular malformation case got burn wound near oral commissure.
 Conclusion: Intralesional cautery technique for vascular malformation particularly venous one is a reliable, safe and versatile technique. It provides a good aesthetic outcome in terms of color matching, regression and scarring. It results in restoration of normal form and function in critically challenging areas like head and neck and pinna.

Comparing recurrence between cautery techniques in pediatric epistaxis

ObjectiveTo compare the risk of recurrent epistaxis between children treated with silver nitrate (SN) in the office or electrocautery (EC) in the operating room (OR). MethodsPatients aged 2–18 diagnosed with epistaxis (ICD R04.0) in 2018 and treated with SN or EC were retrospectively reviewed. Epistaxis laterality, history of nasal trauma, and personal or family history of a bleeding disorder were recorded. Patients with prior cautery or epistaxis secondary to a procedure were excluded. Recurrence was defined as initial encounter after cautery with documented epistaxis. Patients were followed up into 2022 to track onset of recurrence. Time to recurrence between SN and EC was compared with hazard curves with predictors for recurrence analyzed via Cox's proportional hazard regression. ResultsAmong 291 patients cauterized for epistaxis, 62 % (n = 181) received SN compared to 38 % (n = 110) who underwent EC. There was significantly higher risk of recurrence when treated with SN compared to EC (Hazard ratio 2.45, 95 % CI: 1.57–3.82, P < 0.0001). Median time to recurrence was not statistically different between techniques (6.39 months (SN) (IQR: 2.33, 14.82) vs. 4.11 months (EC) (IQR: 1.18, 20.86), P = 0.4154). Complication rates were low for both groups (1.16 % (SN) vs. 0 % (EC), P > 0.05). ConclusionAmong patients with epistaxis, risk of recurrence is significantly higher in those cauterized with SN compared to EC. Time to recurrence is not significantly different between cautery techniques.

Development and Application of a Novel and Efficient Skills Assessment Tool: A Pilot Initiative to Measure Vasectomy Competency on a Smartphone

To develop and evaluate a mobile phone-based skills assessment tool that measures procedural competency of urology residents learning to perform a common, non-robotic urology procedure as a means of tracking current skillset and improvement over time. The assessment tool was a Qualtrics survey accessed via a smartphone link that breaks down a vasectomy into 6 critical steps. Level of competency was measured on a scale of '1-novice' to '5-expert.' Nine residents from Post graduate year (PGY)-1 to PGY-5 were evaluated by one instructor after completing a vasectomy (86 single-side cases recorded over a 6-month period). We compared individual trainees to each other, analyzed performance (improvement) over time, and evaluated competency against cohort and program averages. As an example, a single resident ('Resident 2,' N = 11 cases) was compared to cohort (PGY, M = 7.5/resident) and program (all residents, M = 7.4/resident). Results indicate similar skillfulness across Step 1 (puncturing and isolation of vas and hand positioning; P > 0.1), but marginally lower competency on Step 2 (opening of vasal sheath to expose/isolate vas; vs. cohort: P = 0.076, vs. residents: P = 0.082). Significantly lower competency on Steps 3-6 (all P < 0.04) suggests targeted teaching could improve cautery technique, fascial interposition, hemostasis, and positioning of stumps. Our mobile-based skills assessment is a low cost, novel, and efficient assessment that would support current Accreditation Council for Graduate Medical Education (ACGME) goals to increase competency-based residency training. This tool is easily created and accessed, provides real-time feedback to learners, and can be used for individual and group assessment at a single timepoint or longitudinally.

S2901 Afferent Limb Syndrome Treated With Non-Cautery-Enhanced Lumen Apposing Metal Stent: An Alternate Approach

Introduction: Afferent limb syndrome (ALS) is a known complication after gastrojejunostomies from mechanical obstruction of the afferent limb (AL). Recently endoscopic ultrasound (EUS) guided gastroenterostomy placement has provided an alternate to surgical correction. However this approach is not always technically possible. We describe a case successfully treated with endoluminal non-cautery enhanced lumen apposing metal stent (LAMS) placement. Case Description/Methods: A 63 year old woman with a history of ileocolonic Crohns disease (diagnosed at age 25), status post multiple surgeries including ileocolic resections and Billroth II gastrectomy, was referred with persistent abdominal pain. She was recently diagnosed with acute pancreatitis with CT concerning for dilated afferent jejunal limb, a luminal stricture near the biliary anastomosis and dilated intra and extra hepatic bile ducts (Figure a). She underwent two deep enteroscopies revealing a stricture in the AL from intra-abdominal adhesion. This was dilated with minimal improvement in symptoms and imaging. After multi-disciplinary discussion it was decided to attempt EUS guided drainage of the AL to promote drainage of pancreatico- biliary secretions. During the procedure a significant amount of food residue was identified in the gastric remnant. The dilated afferent limb was visualized endosonographically adjacent to the posterior stomach at an acute angle. Considering large amount of food in the stomach, difficult angulation to deploy the AXIOS stent and concern for food entering the already obstructed limb after stent deployment it was decided to reconsider this approach. The AL was then explored with a therapeutic upper endoscope with stenosis at 10 cm from the anastomosis. A wire was passed through the stenosis under fluoroscopy. It was decided to place a stent using the 15 x 10 mm LAMS stent system considering short (< 1 cm) stricture. Using non cautery technique both flanges were deployed successfully across the stricture under fluoroscopic and endoscopic guidance with decompression of the AL (Figure b,c). 1 month follow up imaging demonstrated continued decompression of the AL. Discussion: EUS guided gastrojejunostomy has been increasingly used for ALS. However it can be challenging in situations where a good window cannot be identified. In such settings using a traditional luminal route to reach the stenosis and placing a non-cautery enhanced LAMS can provide a viable alternative.Figure 1.: (a) Dilated afferent limb with stricture (arrows), (b) post non-cautery enhanced LAMS deployment, (c) Fluoroscopy image post LAMS deployment

Monopolar versus bipolar cautery in tonsillectomy: A comparative study

Introduction: Tonsillectomy is the most commonly performed surgeries in otolaryngology. Despite the evolution in surgical and anaesthetic techniques, pain and bleeding are still the most important surgical complications. This study was done to compare the pain and bleeding following tonsillectomy using monopolar and bipolar cautery techniques in our population. Methods: It was a prospective, longitudinal study done over a period of one year at Gandaki Medical College, Pokhara, Nepal. Total 45 patients who underwent tonsillectomy by either monopolar or bipolar cautery were included in the study and assessed for postoperative pain and haemorhage. The data was entered in Microsoft Excel and further analysis done by statistical package for the social sciences 16.0. The association of variables was be tested by Chi square test and p-value of less than 0.05 was considered significant. Confidence interval was be kept at 95%. Results: Out of the 45 patients who underwent tonsillectomy, 35.5% were males and 64.5% were females. The age of patients varied from 16 to 60 years. Mean age of the patients was 27.5 years. Fourty percent of the total patients underwent tonsillectomy by monopolar cautery whereas 60% patients were operated by bipolar cautery. No statistically significant difference was found between the two groups regarding age, sex ratio, postoperative pain and bleeding. Conclusions: Both monopolar and bipolar cautery are equally effective methods of tonsillectomy in terms of postoperative pain and haemorrhage.

Retrospective Concomitant Nonrandomized Comparison of “Touch” Cautery Versus Athermal Dissection of the Prostatic Vascular Pedicles and Neurovascular Bundles During Robot-assisted Radical Prostatectomy

BackgroundDuring robotic-assisted radical prostatectomy (RARP), the use of electrocautery near the neurovascular bundles (NVBs) frequently results in thermal injury to the cavernous nerves. The cut and “touch” monopolar cautery technique has been suggested to reduce desiccating thermal injury caused by bipolar energy when vessels are sealed. ObjectiveTo compare potency outcomes between an athermal technique (AT) and touch cautery (TC) to transect the prostatic vascular pedicles (PVPs) and dissect the NVBs. Design, setting, and participantsA retrospective concomitant nonrandomized study of AT versus TC was performed in 733 men. A total of 323 undergoing AT had “thin” pedicles, easily suitable for suture ligation. TC was based on “thick” pedicles (n = 230) difficult to suture ligate. Men were excluded for an International Index of Erectile Function (IIEF-5) score of <15 or adjuvant therapies (n = 180). Surgical procedureSingle-surgeon RARP. MeasurementsPatient-reported outcomes with erectile function (EF) recovery defined as two affirmative answers to erections sufficient for intercourse (ESI; “are erections firm enough for penetration?” and “are the erections satisfactory?”), IIEF-5 scores 15–25, and a novel percent fullness score comparing pre- versus postoperative erection fullness. Logistic regression models assessed the correlation between cautery technique, covariates, and EF recovery. Results and limitationsIn an unadjusted analysis, preoperative IIEF-5, age, body mass index (BMI), and prostate weight were significant predictors of potency recovery. Follow-up was similar (AT 52.7 mo vs TC 54.6 mo, p = 0.534). In logistic regression, preoperative IIEF-5, age, and BMI were significant predictors of EF recovery, defined as IIEF-5 scores 15–25, ESI, and percent fullness >75%. Results were similar when IIEF-5 and percent fullness were assessed continuously. ConclusionsDuring transection of the PVPs and dissection of the NVBs, TC did not impact EF recovery significantly, compared with an AT. Patient summaryElectrocautery can be applied safely, with similar outcomes to those of an athermal technique.

Comparison of bipolar cautery dissection and harmonic scalpel tonsillectomy in terms of postoperative bleeding and pain in children

Aim: To compare postoperative bleeding and pain in children after tonsillectomy with bipolar diathermy versus tonsillectomy with harmonic scalpel tonsillectomy.Materias and Methods: Group A, 25 patients were treated by tonsillectomy with bipolar diathermy and group B, 25 patients underwent tonsillectomy with harmonic scalpel. Results: Postoperative bleeding occurred in one patient in each group. The mean pain postoperative first day was 8.51±1.31 in the bipolar tonsillectomy group (BTG) and 6.02±0.84 in the harmonic scalpel group (HSG), 3th day 6.84±1.42 in the BTG and 4.98±1.03 in the HSG and at the postoperative 5th day were examined, it was 5.39±0.73 in the BTG and 3.95±0.74 in the HSG and this differences were significant statistically (p&amp;lt;0.05).Conclusion: Harmonic scalpel tonsillectomy technique is significantly less painful in postoperative early period compared to bipolar cautery technique.

Evaluating nasal cautery techniques in epistaxis.

Silver nitrate cautery and bipolar electrocautery are commonly used in the treatment of epistaxis. Currently, there are no recommendations on optimum contact times or power for nasal cautery. ENT consultant practice in the UK has not previously been evaluated. This study examined the burn depth associated with silver nitrate (75 per cent concentration) cautery and bipolar electrocautery on porcine septum samples, using varying contact times and power. ENT consultants completed a survey evaluating their practice. ENT consultant practice of nasal cautery was shown to vary widely. Silver nitrate cautery with a contact time of less than 30 seconds does not cause a full thickness burn. The findings lend some support to bilateral cauterisation with silver nitrate. Bipolar electrocautery should be set at lower than 10 W and with a contact time of less than 4 seconds to reduce the risk of complications associated with a full thickness burn.

1655 Removal of a 6CM Appendiceal Orifice Polyp With Snare Cautery Polypectomy

INTRODUCTION: Appendiceal orifice (AO) polyps are uncommon. They are usually removed surgically due to technical difficulties and high risk of perforation with endoscopic intervention. In the following case we present a patient with a 6 cm AO polyp removed successfully with snare cautery technique during colonoscopy. CASE DESCRIPTION/METHODS: A 66-year-old man presented to our clinic for colorectal cancer screening. During colonoscopy, careful inspection of the AO revealed a subtle bulge. A submucosal injection of the AO using Eleview revealed a 6cm cauliflower-like lesion. The AO polyp was then removed with snare cautery polypectomy technique without any complications. The edges were approximated with endoscopic mechanical clips. Biopsy results showed tubular adenoma without dysplasia. DISCUSSION: The majority of AO polyps are removed surgically due to potential complications, especially perforation. Currently, there are no guidelines that discuss management of these polyps due to lack of available data. A retrospective study involving 131 patients from multiple tertiary centers showed that polyps more than 20 mm in size undergoing endoscopic resection had significantly higher rates of perforation. Another retrospective study of 691 patients found that AO polyps greater than 5 mm in size were more likely to require surgery. Additionally, it has been reported that AO polyps encompassing more than 75% circumference have low resection rates. To our knowledge, this case is one of the largest endoscopic removal of an AO polyp encompassing the majority of the AO circumference without complications. Although traditionally AO polyps are removed surgically, our case suggests an alternative, less invasive and effective method of removing these difficult polyps. In order to validate our claim, documentation of more cases would be required.

Comparison of Endonasal DCR Surgery Using Cautery and Surgical Blade Technique in Cases of Chronic Dacryocystitis.

Dacryocystitis is defined as inflammation of lacrimal sac. This can be congenital or acquired. Congenital dacryocystitis is commonly chronic while acquired dacryocystitis is acute and chronic both. Endonasal DCR surgery is the most commonly used treatment in chronic DCR but recent use of cautery technique in endonasal DCR surgery rather than traditional surgical blade technique has emerged with promising results with good success rate and fewer complications.

Surgical techniques for the treatment of conjunctivochalasis: paste-pinch-cut conjunctivoplasty versus thermal cautery conjunctivoplasty

ObjectiveThe aim of this study was to evaluate the outcomes of paste-pinch-cut conjunctivoplasty and cautery conjunctivoplasty for the treatment of symptomatic conjunctivochalasis. DesignThis was a prospective cohort study. ParticipantsSixteen patients (32 eyes) with bilateral conjunctivochalasis that was symptomatic after medical therapy were enrolled in the study. MethodsThis was a single-centre, contralateral eye, prospective study. Paste-pinch-cut conjunctivoplasty was performed in the left eye, and thermal cautery conjunctivoplasty was performed in the right eye. The outcomes of each procedure were compared preoperatively and at the 1-month follow-up by using the Canadian Dry Eye Assessment (CDEA) scoring system, standard conjunctivochalasis grading, and corneal staining. Intraoperative discomfort and immediate postoperative discomfort were assessed by using a 10-point scale. ResultsThe mean age of patients was 72.4 ± 8.67 years. Conjunctival redundancy was absent in 14 of 16 patients postoperatively. The mean CDEA score improved after both procedures (7.1 ± 2.8 preoperatively versus 4.5 ± 0.78 at the 1-month follow-up for cautery conjunctivoplasty, 7.4 ± 2.5 versus 4.9 ± 3.1 for paste-pinch-cut conjunctivoplasty). This improvement was statistically significant in the cautery conjunctivoplasty group (p = 0.012). Mean intraoperative discomfort was 2.6 ± 2.1 with the use of paste-pinch-cut conjunctivoplasty and 3.5 ± 3.2 with the use of cautery conjunctivoplasty; however, the difference was not statistically significant. No intraoperative or postoperative complications were observed with either technique. ConclusionsPaste-pinch-cut and thermal cautery conjunctivoplasty are both safe and effective surgical treatments for the repair of conjunctivochalasis, with patients reporting greater improvement in symptoms after the cautery technique.

Comparison of spinal accessory dysfunction following neck dissection with harmonic scalpel and electrocautery – A randomized study

IntroductionHarmonic scalpel is being increasingly used in neck dissection as alternative to conventional electro-cautery for achieving haemostasis. Use of harmonic scalpel has been shown to significantly reduce intra operative blood loss and intra operative time in neck dissection. But how safe is it with regards to nerve injury (spinal accessory nerve and other nerves) during neck dissection. We intended to study the spinal accessory nerve injury during neck dissection by both harmonic scalpel and electro cautery technique and compared postoperative recovery of shoulder function after neck dissection. Methods40 patients undergoing selective neck dissection for primary oral malignancy were enrolled in this study. The Harmonic scalpel (HS) group consisted of 20 patients, and the electo cautery technique (ET) group had 20 patients. The following variables were examined: shoulder pain by visual analog scoring and shoulder function by means of degree of abduction and graded was grade I-0–90°; grade II-90–135°; grade III-135–180°. They assessment was done at the time of discharge, 1month and 3month and six month after surgery. ResultsThough shoulder pain was almost similar at 1st week and 1month, however at 2nd and 6th month shoulder pain was found to be significantly lesser in harmonic scalpel group as compared to electro cautery. At 1week more no of patients had restricted shoulder mobility in HS as compared to EC group. But at 6months the shoulder function was found to be significantly better in HS group as compared to EC group (p value<0.05). ConclusionSpinal accessory nerve function recovery after selective neck dissection is better in HS group as compared to the electro cautery group.

Prospective comparison of ligation and bipolar cautery technique in non-scalpel vasectomy.

ABSTRACTObjectives:There is no trial comparing bipolar cautery and ligation for occlusion of vas in non-scalpel vasectomy. This study aimed to compare the effectiveness of these vasectomy occlusion techniques.Materials and Methods:Between January 2002-June 2009, patients were allocated in alternate order. We recruited 100 cases in cautery group and 100 cases in ligation group. Non-scalpel approach was performed during vasectomy and fascial interposition was performed in all cases. First semen analysis was done 3 months after vasectomy. Vasectomy success was defined as azoospermia or non-motile sperm lower than 100.000/mL.Results:Four patients from the cautery group were switched to the ligation group due to technical problem of cautery device. Thus, data of 96 patients as cautery group and 104 patients as ligation group were evaluated. After vasectomy, semen analyses were obtained from 59 of 96 (61.5%) patients in cautery group and to 66 of 104 (63.5%) patients in ligation group. There was no statistical significant difference between the two groups in terms of the success of vasectomy (p=0.863).Conclusion:Although bipolar cautery technique is safe, effective and feasible in non-scalpel vasectomy, it has no superiority to ligation. There was no statistically significant difference in terms of the success and complications between the two groups.

Laparoscopic partial splenectomy by using two techniques in goats

The aim of this study is to evaluate the laparoscopic partial splenectomy, using horizontal interrupted mattress suture and electro- cautery techniques in goats. Sixteenth adult goats were divided into two main equal groups (A and B). Each group was additionally divided into two equal subgroups, according to follow up on 15th and 30th days postoperatively for histopathology examination.All operations were performed under general anesthesia. Physical and clinical examination were measured pre-operatively and 1st to 7th days postoperative. The results revealed that the two techniques of both groups were performed successfully and the operation time in group A was 86.125±20 min., which was longer than that in group B 62.375±10 min. There were significant (P&lt;0.05) differences in the physical parameters in all the experimental goats. All animals gradually returned to the normal solid food intake and activity, defecation and urination after 72hrs postoperative. Laparoscopic gross pathological changes revealed adhesions between spleen, rumen, and abdominal wall which were more severe in group A as compared with group B. Histopathology examination showed that both groups were associated with collagen and fibrous tissue formation similar to capsule surrounding the site of the incision, which was more in group B than in group A, and the latter group was infiltrated with more inflammatory cells. Also group B had more lymphocyte aggregation around the central artery, in addition to that there was thickness of capsule and mature granulation tissue, but in group A there was edema, congested red pulp and immature granulation tissue.

Évolution du marché des bistouris électriques: Du générateur à la notion de plateforme. État de l’art des applications avancées accessibles sur ces plateformes

Harmonic scalpel is being increasingly used in neck dissection as alternative to conventional electro-cautery for achieving haemostasis. Use of harmonic scalpel has been shown to significantly reduce intra operative blood loss and intra operative time in neck dissection. But how safe is it with regards to nerve injury (spinal accessory nerve and other nerves) during neck dissection. We intended to study the spinal accessory nerve injury during neck dissection by both harmonic scalpel and electro cautery technique and compared postoperative recovery of shoulder function after neck dissection.40 patients undergoing selective neck dissection for primary oral malignancy were enrolled in this study. The Harmonic scalpel (HS) group consisted of 20 patients, and the electo cautery technique (ET) group had 20 patients. The following variables were examined: shoulder pain by visual analog scoring and shoulder function by means of degree of abduction and graded was grade I-0–90°; grade II-90–135°; grade III-135–180°. They assessment was done at the time of discharge, 1 month and 3 month and six month after surgery.Though shoulder pain was almost similar at 1st week and 1 month, however at 2nd and 6th month shoulder pain was found to be significantly lesser in harmonic scalpel group as compared to electro cautery. At 1 week more no of patients had restricted shoulder mobility in HS as compared to EC group. But at 6 months the shoulder function was found to be significantly better in HS group as compared to EC group (p value < 0.05).Spinal accessory nerve function recovery after selective neck dissection is better in HS group as compared to the electro cautery group.

What is the Clinical Relevance of Filiform Polyposis?

What is the Clinical Relevance of Filiform Polyposis?

Is harmonic scalpel during laparoscopic cholecystectomy superior than clips and cautery technique?

The standard laparoscopic cholecystectomy is usually performed using a monopolar electrocautery for dissection and clips for occlusion of the cystic duct and cystic artery. Some pitfalls are associated with the use of the monopolar cautery and clips, therefore other alternative techniques have been described. Ultrasonically activated devices have been used for dissection and cystic duct ligation during laparoscopic cholecystectomy (LC) with encouraging results, however it does not gain widespread acceptance among surgeons. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic scalpel to that peiformed by the conventional diathermy and clips. Material and methods: This prospective randomized comparative study included 30 patients (group A) in whom LC was conducted using the conventional method by clipping both the cystic duct and artery with dissection of gallbladder from liver bed by monopolar electrocautery (clips and cautery method = CCM), and 30 patients (group B) who were operated on using laparoscopic harmonic scalpel (LHS) for closure and division of cystic duct and artery and for dissection of gallbladder from liver bed. Our primary end point was the biliary complications; however other intraoperative and postoperative parameters were included: bleeding, duration of operation, postoperative pain, and other complications. Results: Demographic data was similar in both groups. The operative duration was shorter in LHS than CCM (56.3 min vs. 63.3 respectively, p < 0.01), with a significant less incidence of gallbladder peiforation (6.66% vs. 20%, p < 0.001).No postoperative bile leak was encountered in LHS, but it occurred in 3% of patients in CCM No patient developed post operative bleeding in both groups however the amount of postoperative drainage was significantly less in LHS (29 vs. 47.7, p = 0.001). Most of patients were discharged from hospital on 2nd postoperative day; however the delayed discharge was statistically higher in CCM (16.6% vs. 6.66%, p < 0.01). Conclusion: LHS is a reliable, effective and safe tool in LC. It is a good alternative to standard monopolar electrocautery dissection with clipping of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation, and less hospital stay. Abbreviations: CCM= Clip and cautery method, LC= Laparoscopic cholecystectomy, LHS= laparoscopic harmonic scalpel, HFMC= high frequency monopolar cautery, BDI= bile duct injury, CBC= complete blood picture, INR= international normalized ratio, LFT= liver function test, UIS= ultrasonography.

Principles of training in GI endoscopy

Principles of training in GI endoscopy

Suction cautery adenoidectomy (SCA): Is the additional cost justified?

Objectives Adenoidectomy is one of the oldest and most frequent ENT procedures. This study aimed to compare adenoidectomy using suction-cautery adenoidectomy (SCA) to curettage with respect to operative time, postoperative complications, and cost-effectiveness. Methods The data for this retrospective case control study were retrieved from the Medical Records Department at one of the few medical centers that perform this technique in the Kingdom of Saudi Arabia. The data for each case included the following: patient demographic features, type of procedure, time of operation, occurrence of any postoperative complications, length of hospital stay and cost of the procedure. To minimize the sources of variance in our data, all adenoidectomies were performed by the same consultant otolaryngologist, using either SCA or curettage. Result Of the 86 patients who underwent adenoidectomy in this study, SCA was performed in half of them (43) and curettage in the other half. The two groups were well matched with no significant group differences in either age or gender ( p = 0.2 and p = 0.19, respectively). There was a significant reduction in operative time ( p < 0.001) in the SCA group. There were no cases of postoperative hemorrhage after SCA, but there was one case of hemorrhage in the curette group that required a 2nd surgery to control the bleeding. Regarding cost, there were additional profits of more than 700,000 SR (US$180,000) each month with SCA as compared to curettage. Conclusions The suction cautery technique was superior at reducing operative time, increasing cost-effectiveness and decreasing the risk of postoperative complications. Therefore, we suggest suction cautery as the most appropriate method for adenoidectomy.

Tonsillectomy in children: A five‐factor analysis among three techniques—Reporting upon clinical results, anesthesia time, surgery time, bleeding, and cost

Improved technology claims better clinical results for adenotonsillectomy (T&A) in children, and promoters of each technique announce many virtues over one another, year after year. However, cost remains one variable that is not always thoroughly addressed. In this study, monopolar cautery (MPC) T&A was compared with coblation (CAT) and molecular resonance (MR) techniques in a pediatric population. Prospective analysis of 96 patients (32 for each surgical modality: MPC, MR, or CAT). Tertiary care pediatric institution. Clinical results, anesthesia and surgery time, bleeding, and cost among these three established techniques were compared. P-values of P < .05 were considered significant for all comparisons. The CAT and MPC had similar operative times (mean 19.2 and 21.1 minutes, respectively, P = NS), whereas the MR group had overall saving of 7.8 minutes in surgery (P < .05). In terms of cost of technology, the cost of the MPC and MR groups was 90.6% and 83.7% less than the CAT group, respectively. This study demonstrated that MR technique of T&A enabled the surgical team to save a significant amount of time, whereas CAT added substantial costs, compared to MR and standard cautery techniques.