Cold Dissection Technique Research Articles

Current status and reflection on minimal access breast surgery

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

A comparative study of BiZact™ tonsillectomy versus cold steel dissection technique in adults: Analysis of operating time, intraoperative blood loss, postoperative bleeding rate and pain.

To analyse operating time, intraoperative blood loss, postoperative bleeding rate and pain when using the relatively new BiZact™ tonsillectomy device compared to the commonly used cold steel dissection technique with bipolar cautery in adults. Retrospective case control study. Parameters analysed for significant association with technique were operating time, intraoperative blood loss, wound pain on postoperative days 1-4 and rate of post-tonsillectomy bleeding (PTB). Monocentric study at a department of otolaryngology and head and neck surgery at a tertiary centre in Germany. A total of 183 patients who underwent a bilateral tonsillectomy with either the BiZact™ tonsillectomy device or the cold dissection technique with bipolar cautery for haemostasis. Operating time, intraoperative blood loss, postoperative pain on the first to fourth postoperative day (numeric rating scale: 0-10) (PTB, primary bleeding ≤24 h, secondary bleeding >24 h postoperative; Stammberger scale). The BiZact™ tonsillectomy device leads to a significant shorter operating time with less intraoperative blood loss compared to cold steel dissection with bipolar haemostasis. No benefits with regards to PTB or postoperative pain could be observed. The use of the BiZact™ device provides major benefits in clinical routine and stands up to conventional tonsillectomy techniques.

Coblation tonsillectomy versus conventional tonsillectomy

Objectives: The objective of this study was to compare the effectiveness of conventional tonsillectomy versus coblation tonsillectomy with respect to duration of surgery, amount of intraoperative bleeding, recovery time, and post-surgical pain. Material and Methods: Sixty patients were divided into two groups. One group underwent conventional tonsillectomy while coblation tonsillectomy was performed in the second group. Duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain were measured. All patients were followed for 24 months. Results: Comparing the coblation tonsillectomy group to the cold steel dissection tonsillectomy group, the mean duration of surgery was 6.92 versus 18 min, the amount of intraoperative bleeding was 2.75 versus 39.88 mL, and the difference on the post-operative pain scale between the two groups was statistically significant (P < 0.005). There was no recurrence of tonsillitis episodes in either of the two groups during the 2-year follow-up period. Conclusion: After adequate training, the coblation technique is beneficial to both the surgeon and the patient, including the possibility to excise tissue and coagulate bleeding vessels with the same device. Post-operative morbidity and complications are lower as compared to the conventional cold dissection technique.

Comparison of Post-Operative Outcomes of Blunt Dissection and Electrocautery Technique in Tonsillectomy; A Randomized Controlled Trail

Introduction: Tonsillectomy is most common procedure performed in ENT Practice. Various surgical techniques are used in this procedure, including blunt dissection, electrocautery, cryosurgery, ultrasonic removal, laser removal, monopolar and bipolar dissection. After tonsillectomy, morbidities associated are pain, fever and hemorrhage. Objective: In our study we compared the bipolar electrocautery dissection with cold steel dissection method. We compared compare post tonsillectomy morbidities in terms of, pain, fever, post-operative hemorrhage. Methodology: This study was a randomized controlled trial. All 100 patients scheduled for elective tonsillectomy was randomized to tonsillectomy with the hot technique (group-A) or the cold dissection technique (group-B). The randomization was performed by the use of a random number generator (Excel). Chi-square test/Fisher’s exact test was applied to compare hemorrhage and fever. Independent sample t-test was applied to compare pain in both study groups. Results: The mean age of patients in cold dissection was 23.26 ± 9.317 whereas in hot dissection group the mean age of the patients was 25.20 ± 8.013. At first day of procedure mild post-operative pain in 28 (28.0%) patients, moderate pain in 39(39.0%) patients and severe pain in 33(33.0%) patients was seen. In cold dissection group 19(38.0%) patients had mild, 26 (52.0%) had moderate and 5(10.0%) had severe postoperative pain while in hot dissection group 9(18.0%) patients developed mild, 13(26.0%) developed moderate and 28(56.0%) developed severe postoperative operative pain at day 1. Practical Implications: It will help in early and prompt management of patients of tonsils undergoing tonsillectomy with minimal invasion. Conclusion: In our study, the cold dissection was observed to be better in terms of low pain however; in terms of hemorrhage the hot dissection was found to be better. MeSH Words: Tonsillectomy, electrocautery, cold steel dissection, bleeding, pain, blood transfusion

To Compare the Outcomes of Bipolar Electro Cautery Tonsillectomy Vs Cold Steel Dissection Pediatric Tonsillectomy in Terms of Mean-Operative Time and Intra-Operative Blood Loss

Background: One of the most popular surgical operations performed using a variety of techniques is a tonsillectomy. The two that are used the most frequently are the traditional cold dissection technique (CDT) and electrocautery, the latter of which is carried out using the monopolar and bipolar electrocautery procedures (BET).All techniques used during tonsillectomy are intended to lessen perioperative bleeding, the intensity of felt pain, and postoperative morbidities. Aim: To compare the outcomes of the bipolar electro cautery tonsillectomy versus cold steel dissection pediatric tonsillectomy in terms of mean-operative time and intra-operative blood loss. Setting: ENT department of Sir Ganga Ram Hospital, F.J. Medical University Lahore from 11-03-2022 to 10-09-2022 Study design: Randomized Controlled Trial Study type: Quantitative study type Methods: The sample size of 110 (55 in group A 55 in group B) was estimated by using 95% confidence level, 90% power of test with an anticipated mean loss of blood during surgery of tonsillectomy i.e. 7.38±2.81m1 with bipolar electro cautery dissection and 11.73±2.86 ml with cold steel dissection. Results: One hundred and ten patients were included as per calculated sample size with the mean age of 8.96±2.42 years. The lowest age limit of children was 5 years while the maximum age limit of children was 13 years. In group A, the mean age of children was 8.80±2.46 years. In group B, the mean age of children was 9.13±2.38 years. The difference was observed as insignificant i.e. p--value = 0.481. Of 110 patients, 67(60.91%) patients were male whereas in group B 29(52.7%) were males. Similarly in group A 17(30.9%) were females and 26(47.3%) were females. The difference was observed as insignificant i.e. p--value = 0.079.In group A, the mean operative time was 19.76±4.47 minutes. Conclusion: This study concluded that bipolar electro cautery tonsillectomy showed significantly better outcome as compared to cold steel dissection pediatric tonsillectomy. Keywords: Cold dissection tonsillectomy, Electrocautery tonsillectomy, Mean operative time, Intra operative blood loss.

Photobiomodulation for Lowering Pain after Tonsillectomy: Low Efficacy and a Possible Unexpected Adverse Effect.

Background: Tonsillectomy is one of the most common surgical procedures performed in children as a treatment for obstructive sleep apnea due to tonsil hypertrophy or highly recurrent tonsillitis. Odynophagia, associated with food refusal for the first few days, is a common post-operative complaint. Available drugs for pain management, while efficacious, present some drawbacks, and a novel strategy would be welcome. Photobiomodulation (PBMT), in this context, can represent a possible choice, together with pharmacological therapy. The aim of this study was to evaluate PBMT effects compared to standard pain therapy on nociceptive sensation at different time points and administration of painkiller. Methods: A registered, controlled, randomized, double-blind clinical trial was performed. Twenty-two patients were recruited and divided into laser-treated (T) or untreated (UT) groups, based on random assignment. In T group, immediately after tonsillectomy, performed with cold dissection technique, laser light was applied to the surgery site (using a Cube 4 from Eltech K-Laser s.r.l., Treviso, Italy), and then hemostasis was performed using bismuth subgallate paste. In C group, the same procedure was performed, except that laser light was switched off. The primary outcome was the difference in pain scores between subject receiving photobiomodulation (PBMT) and subjects receiving standard care after 24 h; the secondary outcomes were pain scores at awakening and at 48 h together with distress (delirium) at awakening. Results: Two patients from the T group experienced a post-surgery bleeding, and one of them required revision of the hemostasis under general anesthesia. A preliminary analysis of pain sensation reported by the patients or caregivers did not show differences between treated and untreated subjects. Conclusion: These data suggest that PBMT could increase post-surgical bleeding.

Comparision of Coblation and Cold Dissection Techniques outcome among Tonsillectomy patients at Birat Medical College and Teaching Hospital

Tonsillectomy is the most commonly performed surgery. Cold dissection tonsillectomy remains as the gold standard for tonsil removal, although it may increase risk for complication. Coblation tonsillectomy is a new technique .There are studies comparing these two method of surgery and have shown coblation technique to cause less postoperative pain, less intra operative time along with less intra and postoperative blood loss. In contrary few studies have shown it to be ineffective in reducing postoperative bleeding. Hence more studies are still required. Thus the objective of the present study was to compare coblation and cold dissection techniques outcome among tonsillectomy patients at Birat Medical College and Teaching Hospital. The study intended to determine and compare the intraoperative time, intra operative blood loss and postoperative pain in coblation and cold dissection tonsillectomy. This is a hospital based cross sectional comparative study. Eighty six patients underwent tonsillectomy during the study period of one year (15th Feb 2020 to 14th Feb 2021) in the department of ENT HNS, Birat Medical College and Teaching Hospital. Among 86 patients, 43 underwent cold dissection and 43 coblation tonsillectomy. Method of surgery was based on odd and even serial number of the patients during presentation. This study showed that intra operative time, intraoperative blood loss and post operative pain score was 16.77±2.7mins, 36.51±128ml and 6.28 respectively in coblation method and 37.84±3.1 mins, 101.4±12.7ml and 7.88 respectively in cold dissection method. Hence coblation method is a safer and effective method of tonsillectomy compared to cold dissection which ultimately leads to less post operative analgesics demands and early recovery.

Coblation cryptolysis for treatment of tonsillar stones: a randomized clinical study

BackgroundTonsillectomy is usually indicated in patients with tonsillar stones. It is thought coblation cryptolysis avoids the hazards related to monopolar bipolar diathermy and the regular cold surgical technique. This study compared the peri-operative outcomes in patients with tonsillar stones submitted to coblation cryptolysis, monopolar bipolar dissection, and cold dissection techniques. This randomized study included 105 patients with tonsillar stones. The included patients comprised three groups: GI (n = 35) was subjected to cold dissection, GII (n = 35) was subjected to monopolar bipolar diathermy tonsillectomy, and GIII (n = 35) was subjected to coblation cryptolysis. Outcome parameters included operative time, intraoperative bleeding, consumption of postoperative analgesia, and time to normal food intake.ResultsGIII patients experienced significantly shorter operative time, less intraoperative bleeding, less consumption of postoperative analgesics, and less time to normal diet when compared with the other two groups.ConclusionCoblation cryptolysis is a safe and effective technique in the management of tonsillar stones. It appears to be superior to other surgical interventions.

A Comparative Study of Coblation versus Dissection Tonsillectomy

Objectives: To compare the efficacy of coblation tonsillectomy and dissection tonsillectomy regarding the duration of surgery, amount of intraoperative bleeding, postoperative pain, recovery time and complications.
 Methods: 50 patients aged 5-30 years with chronic tonsillitis who underwent tonsillectomy operation were randomly divided into two groups. One group underwent coblation tonsillectomy while other group with dissection tonsillectomy. Chronic tonsillitis patients with adenoid hypertrophy and Otitis media with effusion were excluded by diagnostic nasal endoscopy, imaging and audiometry. All patient were examined regularly after surgery for 10 days to assess the postoperative morbidity and efficacy of both coblation and dissection methods. Duration of surgery, amount of intraoperative bleeding, recovery time, postoperative pain& requirement of analgesics, time required to regain normal diet & activityand complication were assessed.
 Result: Comparing the coblation tonsillectomy to cold dissection group the mean duration of surgery was 9.7 versus 18.4 minutes, the amount of intra operative bleeding 10.62 versus 28.72 milliliter. The difference on the postoperative pain scale, requirement of analgesics, condition of the tonsillar fossa, time required to regain normal diet & activity between two groups were statistically significant.
 Conclusion: In our study patient underwent coblation tonsillectomy providing a near bloodless field, minimum operating time, less postoperative pain, quicker return to normal diet, normal activity and less use of analgesics than patients underwent dissection tonsillectomy. Postoperative morbidity and complications were lower as compared to conventional cold dissection technique.
 Bangladesh J Otorhinolaryngol; October 2020; 26(2): 121-127

Comparison between dissection method and coblation technique in tonsillectomy

<p class="abstract"><strong>Background:</strong> The objective of the present study was to compare the dissection method and coblation technique in tonsillectomy in patients of chronic tonsillitis.</p><p class="abstract"><strong>Methods:</strong> This is prospective study in which 40 patients of chronic tonsillitis in age group of 5-12 years were selected in this study. Patients were blinded with regards to technique used to remove tonsils. 20 patients underwent tonsillectomy by cold dissection method and 20 with coblation method. In both techniques, duration of surgery and amount of blood loss were recorded and compared. </p><p class="abstract"><strong>Results:</strong> In our study, the mean operative time from giving incision to achieving complete haemostasis for dissection method was 42.9 minutes and that for coblation technique was 34 minutes. The amount of blood lost on an average by dissection method was 51.8 ml, and by coblation technique was 22.3 ml. This difference was found to be statistically significant. Pain was evaluated by visual analogue scale. The data recorded from two groups was put to statistical analysis and ‘p’ value was calculated using independent t-test. The mean pain score for coblation technique averaged over 10 days was 2.72 and was 4.84 for dissection technique.</p><p class="abstract"><strong>Conclusions:</strong> We can conclude that coblation tonsillectomy is an easy to learn safe procedure with significant advantages in terms improving the quality of post-operative recovery compared to that following the cold dissection technique. But cost effectiveness of dissection method outweighs benefits of coblation at present in Indian scenario.</p>

THE EFFECTIVENESS OF LOWER POLE LIGATION IN TONSILLECTOMY

OBJECTIVE: Hemorrhage following tonsillectomy has always been a serious problem. Recently several techniques, devices and materials have been developed to reduce the intra-operative and post-operative blood loss but still no optimal methods have emerged. In this study we assessed the effectiveness of lower pole ligation in tonsillectomy ensuring the hemostasis and preventing the post-operative hemorrhage in early and late stages.
 MATERIALS AND METHODS: This was a hospital based retrospective study performed in the department of ENT, Aziz Fatima Hospital (Medical College) and Faisal Hospital Faisalabad from May 2014 to June 2017. During this period 310 patients underwent tonsillectomy using COLD DISSECTION TECHNIQUE. Inferior pole was ligated by Negus artery forceps as close to its junction with the lingual tonsils ensuring no tissue remnants are left and knot applied by Negus ligature carrier with Black Silk #1. Bipolar diathermy was used for tonsillar bed hemostasis. Follow-up was continued for the next 4 weeks.
 RESULTS: Out of 310 patients undergoing the procedure only 2 presented with reactionary hemorrhage. One of them presented after 3 hours and the cause of bleeding was appreciated as slipping of the knot from the lower pole which was shifted to OT and ligated again using the Silk # 1. Second patient presented after 2 hours with mild reactionary hemorrhage and the site was not from the lower pole, but diffuse oozing from the tonsillar bed which was conservatively dealt by cold sponging and ice cold gargles. Out of 310 only 1 patient presented after 3 weeks with secondary hemorrhage which was treated by broad spectrum antibiotics.
 CONCLUSION: The use of lower pole ligation in tonsillectomy affords efficient and practical hemostasis. The procedure is inexpensive and requires no special and refined equipment. The anterior and posterior tonsillar pillars remained intact thus the functional anatomy was preserved.

Comparison of postoperative morbidity between conventional cold dissection and bipolar electrocautery tonsillectomy: which technique is better?

IntroductionTonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques. ObjectiveThis study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery. MethodsThis prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant. ResultsIn this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p<0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24hours after the operation was significantly higher (p<0.001). Other variables showed no significant differences between the two groups. ConclusionBased on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients.

Cold Dissection Tonsillectomy and Radiofrequency Tonsil Ablation: A Prospective Comparative Study

Background: Over the last few years, various techniques have been proposed for performing tonsillectomy in an attempt to lower the morbidity of this surgery. However, controversy still exists regarding the optimal technique involving the least postoperative morbidity. More recently, temperature-controlled radiofrequency has been introduced as a much more effective and safe device for tonsil reduction. Objective: To compare the effectiveness of conventional tonsillectomy versus radiofrequency tonsil ablation with respect to duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain. Materials and Methods: 60 patients were randomly divided into two groups. One group underwent conventional cold ablation tonsillectomy while radiofrequency tonsillectomy was performed in the second group. Duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain (using the Wong-Baker FACES Pain Rating Scale®) were measured. All patients were followed for 24 months. Results: Comparing the radiofrequency tonsillectomy group to the cold dissection tonsillectomy group, the mean duration of surgery was 6.92 versus 18 min, the amount of intraoperative bleeding was 2.75 versus 39.88 mL, and the difference on the postoperative pain scale between the two groups was statistically significant (p < 0.005). There was no recurrence of tonsillitis episodes in either of the 2 groups during the 2-year follow-up period. Conclusion: After adequate training, the radiofrequency technique is beneficial to both the surgeon and the patient, including the possibility to excise tissue and coagulate bleeding vessels with the same device. Postoperative morbidity and complications are lower as compared to the conventional cold dissection technique.

Postoperative Outcomes in Cold Dissection Versus Bipolar Electrocautery Tonsillectomy: A Randomized Double-Blind Controlled Study.

Tonsillectomy is one of the oldest and most common procedures worldwide. This surgery is performed by different methods include cold dissection technique (CDT) and bipolar electrocautery technique (BET). Assessment and comparison of postoperative outcomes in cold dissection and bipolar electrocautery is the aim of present study. This randomized controlled clinical trial study was conducted as double-blind on 534 patients. The enrolled patients underwent tonsillectomy in Vali-e-Asr Hospital of Birjand city from Oct. 2013-Oct. 2015. Al patients systematically allocated into two groups treated with cold dissection or bipolar electrocautery methods. Intensity of throat pain scores, Otalgia, analgesic consumption, resume normal diet, body temperature and also wound healing on 10th day after operation were measured and compared between the two groups. The gathered data were analyzed by SPSS software (Ver-22) and using necessary tests. The differences between studied groups less than 0.5 (p<0.05) considered significant statically. 51.7 and 50.6% in the CDT and the BET groups were male respectively. In comparison between the groups the mean of pain scores 4 and 24h after operation in the BET group were higher significantly (p<0.001). Otalgia only 4h after surgery was higher significantly in the BET group (p=0.008). All the other studied parameters were significantly more desirable in the CDT group (p<0.001). According to the findings of present study it seems that the CDT is safer and more favorable than the BET in tonsillectomy.

Surgical technique and post-tonsillectomy hemorrhage: a single institution's retrospective study.

Post-tonsillectomy hemorrhage is one of the most common complications of tonsillectomy. The rate varies with different methods. We retrospectively analyzed patients who underwent tonsillectomy in a period of two years. Two surgical methods, cold dissection and microscopically assisted bipolar tonsillectomy, were compared. 1007 patients were included in the study. Postoperative hemorrhage occurred in 116 patients (11.5%). By the cold dissection method, postoperative bleeding was noted in 86 patients (10.9%), while by the microscopic bipolar method in 30 patients (13.9%). A surgical hemostasis was required in 47 patients (5.9%) and 17 patients (7.9%), respectively. Concerning the time of occurrence of the first postoperative bleeding episode, we found that it occurred mainly on day 6 by the cold dissection technique (median=6, mean=5.84, SD=3.30), whereas by the bipolar technique the first episode occurred on day 5 (median=5, mean=5.27, SD=2.85). However, a statistical analysis did not show a significant difference. In conclusion, our study did not show a significant difference concerning the prevalence or the postoperative day of occurrence of the first bleeding episode after tonsillectomy when comparing the two methods, but recommendations concerning the duration of the in-hospital stay could be made. Each institution should perform its own individualized statistics concerning the occurrence of postoperative bleeding and should use a standardized documentation protocol. Level of evidence 3b.

Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia

IntroductionTonsillectomy is a common surgical procedure done by otolaryngologists. Tonsillectomy is a relatively simple procedure. The concept of implementing it as a day case operation has become increasingly popular. Material and MethodsThis is a cross sectional study done in Alahsa city, eastern province, Saudi Arabia during the period from January 2014 to March 2015,This study reported the postoperative hemorrhage after Bipolar diathermy and Cold dissection surgical techniques to evaluate the incidence of the hemorrhage and to identify the possible risk factors associated with its occurrence. ResultsPostoperative bleeding occurred in 45 (3.6%) out of 1232 patients. Post-tonsillectomy hemorrhage according to operation technique was significantly higher among patients who underwent bipolar diathermy than cold dissection technique (p<0.05). ConclusionBleeding after operation by bipolar diathermy technique was occurring more frequently within the first five days. Hemoglobin level was significantly decreased in post-tonsillectomy hemorrhage.

Safety and Usefulness of Warm Dissection Technique During Liver Graft Retrieval From Deceased Donors

BackgroundFor deceased-donor liver graft retrieval, the warm dissection technique of hilar dissection before perfusion had been the standard procedure in the early period of liver transplantation. Thereafter, the cold dissection technique of in situ flushing and hilar dissection after perfusion has been preferred in many transplantation centers for rapid procurement of multiple organs. This study intended to assess the safety and usefulness of the warm dissection technique used in deceased-donor liver transplantation. MethodsThis study analyzed a single surgeon's experience of the warm dissection technique for 165 cases of liver graft retrieval, regarding the prolongation of retrieval operation time, retrieval-associated graft injury, and recipient outcomes. ResultsAn additional 20 to 40 minutes was required for warm dissection. The incidence of retrieval-associated graft injury was 13 (7.9%), in which hepatic parenchymal injury was detected in 7 (capsular tear in 6 and subcapsular hematoma in 1) and vascular injury in 6 (celiac axis injury in 5 and common hepatic artery injury in 1). There was no other episode of injury at the branch artery, vena cava, portal vein, and bile duct. There was no significant difference of 1-year graft survival rates between liver grafts with and without graft injury (83% vs 83.3%, P = .73). ConclusionsWhen the vital signs of deceased donor are stable, the warm dissection technique may be helpful to decrease the cold ischemic preservation time because the risk of graft injury is acceptably low and it provides more time for recipient preparation, thus giving potential advantages for marginal liver grafts.

Post-tonsillectomy morbidities: randomised, prospective controlled clinical trial of cold dissection versus thermal welding tonsillectomy

New surgical techniques and devices have been described that decrease post-tonsillectomy morbidities. This study aimed to compare the two most popular tonsillectomy techniques. Forty children underwent tonsillectomies using both the thermal welding and cold dissection techniques. In each patient, one side was removed with thermal welding and the other was removed with cold dissection. There was a significant decrease in intra-operative blood loss, and the mean operation time was significantly lower on the thermal welding side compared with the cold dissection side. On the cold dissection side, tissue healing (i.e. the rate of complete tissue healing) was better and less pain was reported compared with the thermal welding side. However, there were no significant differences between the two techniques in terms of throat pain scores on the 1st, 3rd or 14th day post-operatively, or tissue healing scores on any of the post-operative days assessed. Cold dissection resulted in better tissue healing and lower pain scores than thermal welding, but thermal welding was associated with less intra-operative blood loss and lower mean operation time than cold dissection.

Displacement of Residual Gore‐Tex Thyroplasty Implant Presenting as a True Vocal Fold Mass

Objectives: Describe the unique presentation and management of a patient with an ipsilateral true vocal fold mass following revision thyroplasty that was identified to have migration of residual Gore-Tex thyroplasty implant into the superficial lamina propria of the anterior true vocal fold. Methods: A single case of a patient who underwent revision type I thyroplasty after an unsuccessful attempt elsewhere using a Gore-Tex implant is reported. At the time of revision surgery, it was thought that all prior implant material was extricated, and the patient underwent revision type I thyroplasty using a carved silastic Netterville Implant with arytenoid adduction. Results: After initial improvement following the revision type I thyroplasty, the patient experienced deterioration of her voice. Indirect laryngeal examination revealed fullness on the superior surface of the right true vocal fold affecting mucosal wave and glottic closure. Microdirect laryngoscopy with endoscopic evaluation revealed migration of residual implant material into the superficial lamina propria. Using microflap technique, excision of the residual Gore-Tex thyroplasty implant was successfully performed with a combination of carbon dioxide laser and cold-dissection techniques. Conclusions: This case report describes the unique presentation of a displaced, non-extruded residual Gore-Tex thyroplasty implant, which presented as new onset dysphonia and mass involving the superior surface of the true vocal fold. This case demonstrates that displaced or migrated Gore-Tex thyroplasty implant material can be successfully removed endoscopically using a modified microflap technique.

Coblation-Tonsillektomie

The introduction of coblation tonsillectomy (CTE) may contribute to reduce the postoperative morbidity in terms of pain, delayed oral intake and bleeding. A prospective pilot study was undertaken to evaluate the clinical course by inpatient observation (5 days) and telephone contact 6 months after CTE. The data from 61 patients (aged 44 months-69 years) were analyzed. The patients were grouped into those with surgical care of bleeding (A), non-surgical care of bleeding (B), and no bleeding event (C). The study was terminated early due to major bleeding complications in seven patients (A). Fifteen patients experienced minor (B) and 41 no (C) bleeding episodes. In the interview, 29 patients identified pain, lasting 16.7 (A), 11.6 (B) and 11 (C) days, as the most significant complication of surgery. The introduction of CTE was followed by a dramatic increase in major bleeding complications, including late bleeding episodes. Pain following tonsillectomy remains a problem to be solved by further techniques. We will continue to perform the cold dissection technique.