Cold Dissection Tonsillectomy Research Articles

The effects of thermal welding tonsillectomy on postoperative pain

This study aims to compare the effects of the thermal welding tonsillectomy and conventional cold dissection tonsillectomy on the postoperative pain. Between November 2009 and May 2011, 60 pediatric patients (38 boys, 22 girls; mean age 8.4 years; range 5 to 15 years) who underwent tonsillectomy due to chronic tonsillitis or obstructive sleep apnea were included. Tonsillectomy with thermal welding was performed on 30 patients and conventional cold dissection tonsillectomy was performed on the 30 patients. Postoperative pain was assessed by visual analog scale. Postoperative first day pain score was accepted as 10 and the patients were asked to score between 0-10 for other nine days. Student t-test was used for the statistical evaluation of pain scores in the first five days, while Mann-Whitney-U test was used for the other days. In the first five day evaluation, the mean pain score was 35.83 for cold dissection tonsillectomy and 31.90 for thermal welding tonsillectomy. The mean pain value for the last five days was 15.6 for cold dissection tonsillectomy and 10.33 for thermal welding tonsillectomy. The mean pain scores of cold dissection tonsillectomy were statistically significantly higher, compared to thermal welding tonsillectomy for first five day, last five day and total 10 days (p<0.05). We consider that thermal welding tonsillectomy results in lower postoperative pain, compared to the conventional cold dissection tonsillectomy.

Killian Nazal Spekülüm Yardımıyla Lokal Tonsillektomi

Objective: To describe Killian nasal speculum-assisted tonsillectomy under local anesthesia in detail and to question the experience of our patients with this surgical procedure. Material and Methods: Group 1 included patients that underwent Killian nasal speculum-assisted tonsillectomy under local anesthesia (n=44) and Group 2 those who underwent classical cold dissection tonsillectomy under general anesthesia (n=28). Results: Among the patients in Group 1, 59.1% (26/44) reported mild, 27.3% (12/44) moderate, and 13.6% (6/44) excessive levels of anxiety preoperatively. All patients in Group 1 reported that they felt safe during surgery; 84.1% (37/44) reported that the surgery was easier than they had anticipated, whereas 15.9% (7/44) reported it was more difficult than anticipated. Duration of surgery in Groups 1 and 2 was 22.7 ± 7.0 minutes and 63.7 ± 16.3 minutes, respectively (p<0.001), and the median volume of intraoperative bleeding was 5 mL (range, 1-90 mL) and 180 mL (range, 40-400 mL), respectively (p < 0.001). No intraoperative complication developed in either group and the amount of postoperative bleeding did not show a significant difference between the groups. Conclusion: In selected adult patients, Killian nasal speculum-assisted tonsillectomy under local anesthesia is a time saving procedure, which produces less intra-operative blood loss compared to cold dissection tonsillectomy under general anesthesia.

English

Various hemostatic agents and techniques have been used to reduce intraoperative and postoperative hemorrhage in tonsillectomy. This study aims to compare the effect of using adrenaline and normal saline in maintaining hemostasis during cold dissection tonsillectomy. This is a prospective randomized single-blind study spanning fifty seven months in a private hospital setting in Jos, Plateau State, Nigeria. Thirty seven patients aged between 2 and 31 years had tonsillectomy consisting of 22 (59.5%) males and 15 (40.5%) females. The mean age of patients was 15.6 years (SD= ± 8.97). Recurrent tonsillitis (45.9%) was the commonest indication for surgery and obstructive sleep apnea was the commonest associated indication in 12 (32.4%) patients. In 12 (32.4%) patients, there was no associated indication for surgery. The mean time required to achieve hemostasis with the use of adrenaline soaked gauze compress was 3.84 min. (SD= ± 0.92) and with the normal saline soaked gauze compress was 4.15 min. (SD=± 0.81) with a difference of 0.31 min. There was no incidence of primary, reactionary or secondary hemorrhage. The local application of adrenaline as a topical hemostatic agent during tonsillectomies is effective in reducing intraoperative and postoperative hemorrhage and invariably reducing operative time with no significant side effects or complications. Key words: Tonsillectomy, hemostasis, Nigeria.

The Outcomes of 4 Different Techniques of Tonsillectomy

Objective: Compare 4 different techniques of tonsillectomy reagarding operative time, intra-operative blood loss, and pain scores. Method: A total of 160 patients were randomly assigned to the cold dissection tonsillectomy (CDT), bipolar elecrocautery tonsillectomy (BPT), Harmonic Scalpel tonsillectomy (HST), and Thermal Welding tonsillectomy (TWT) groups. Patients underwent tonsillectomy where intraoperative blood loss and time were evaluated. Patients where then followed for pain analysis. Results: Operative time varied from 6 to 31 minutes, and mean operative time was 13.76 ± 5.28 minutes. Operative time in the HST group was significantly shorter than in the CDT and TWT groups (p = 0.001). Highest intraoperative bleeding was observed in the CDT group (68.6 ± 35.3 ml) and was significantly higher than in the HST (9.4 ± 3.1ml) and BPT groups (13.4 ± 3.8 ml) ( P = .001, resp P = .022). Pain scores in the HST group were much lower than in the CDT and BPT groups ( P = .022, resp P = .001). Pain scores between other groups did not show any statistically significant difference ( P &gt; .05). Conclusion: The 4 techniques compared all show different attributes useful during surgery, but considering long learning curves and high prices we believe that cold dissection tonsillectomy still has the upper hand.

Effects of cooling the pharyngeal mucosa after bipolar scissors tonsillectomy on postoperative pain

Conclusion: Bipolar scissors tonsillectomy followed by cooling down the pharyngeal mucosa has advantages in terms of postoperative pain and intraoperative blood loss compared with cold dissection. Objectives: The purpose of this study was to compare the postoperative pain between bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa and a traditional cold dissection. Methods: A total of 189 patients aged more than 16 years were operated due to habitual tonsillitis, obstructive sleep apnea syndrome, and IgA nephropathy. Of these, 79 patients were operated using bipolar scissors followed by cooling the pharyngeal mucosa with 4°C saline for 10 min just after the removal of tonsils. The other 110 patients underwent cold dissection tonsillectomy. Outcome measures were intraoperative blood loss, operative time, postoperative pain evaluated on a visual analog scale, and postoperative secondary hemorrhage. Results: Significantly lower levels of intraoperative blood loss and less postoperative pain were obtained in bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa compared with cold dissection. Postoperative hemorrhage needing hemostatic surgery occurred in 2 of 79 patients who underwent bipolar scissors tonsillectomy with cooling, while it occurred in 1 of 110 patients after cold dissection. However, the difference was not statistically significant.

Intrapersonal Randomized Controlled Trial Comparing Bipolar Scissors and Conventional Cold Tonsillectomy

ABSTRACTObjectiveTo evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy in the same patients, utilizing one technique on either side.Study designRandomized controlled trial.SettingsThe ENT day care unit of the Karolinska University Hospital at Danderyd Hospital, Stockholm.PatientsA total of 50 patients of which 49 were eligible (M/F 20/29), mean age 14.3 (4-41) years and included in the study. Thirty-one patients were operated due to upper airway obstruction and 18 for chronic tonsillitis. Outcome measures: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain and (4) complication rates, including postoperative primary and secondary hemorrhage.MethodsModern cold technique; cold scissors, Henke tonsil elevator, bipolar diathermia. Hot technique; bipolar scissors (Ethicon, set on 20 W), bipolar diathermia if needed. Each side was completed separately. Blood loss and total operative time on each side were registered. Pain was evaluated daily on a visual analog scale, VAS (0-100 mm) in patients from 10 years of age.ResultsMean operative time for the conventional cold technique was 11.6 SD ± 8.5 (range 1.0-55 mins) and for the hot technique 3.1 SD ± 3.1 min (range 0.5-8.5 mins) (Wilcoxon-test, p &lt; 0.001). The corresponding median values were 3 and 1.9 mins, respectively. The mean blood loss was 43.2 SD ± 41.7 ml (range 7-225 ml)vs3.0 SD ± 4.7 ml (range 0-25 ml) (Wilcoxon-test p &lt; 0.001). The corresponding median values were 30 and 1 ml respectively. No primary or secondary postoperative hemorrhages requiring surgical intervention occurred. There was no difference in pain.ConclusionTonsillectomy with bipolar scissors was almost four times faster and the blood loss significantly less than on the side operated with the conventional cold technique, whereas no difference in morbidity was found.

Bipolar radiofrequency tonsillotomy compared with traditional cold dissection tonsillectomy in adults with recurrent tonsillitis

Objective To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis. Study Design A randomized clinical trial. Setting A tertiary referral university hospital. Subjects and Methods Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes. Results Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively ( P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months. Conclusion Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis.

Bipolar diathermy versus cold dissection in paediatric tonsillectomy

To compare bipolar diathermy with cold dissection in paediatric tonsillectomy. One hundred and fifty children were randomized equally into bipolar diathermy tonsillectomy (BDT) and cold dissection tonsillectomy (CDT). Operative time, operative blood loss, postoperative pain, diet intake, activity level and complications were compared in the 2 groups. The 2 groups were comparable in age and sex distribution. Operative time and blood loss was significantly less in the diathermy group. No significant difference in the postoperative pain except on the 3rd day in which the cold dissection group showed significantly lower pain score. Mean percentage of diet was significantly higher in the diathermy group on the 1st day. No significant difference between the 2 groups in terms of postoperative activity and complications. BDT is a safe technique of tonsillectomy. There is significant less operative time and blood loss with similar morbidity compared to CDT, so it can be used safely in children.

COMPARISON BETWEEN TONSILLECTOMY WITH THERMAL WELDING AND THE CONVENTIONAL ‘COLD’ TONSILLECTOMY TECHNIQUE

The aim of this study was the evaluation of length of the procedure, anaesthesia, the amount of the intraoperative fluid required, total blood loss and postoperative pain of the 'thermal welding system tonsillectomy (TWS)' compared with the conventional 'cold dissection tonsillectomy'. Fifty patients aged between 3 and 28 years were included in this prospective controlled study. Extracapsular tonsillectomy with TWS was carried out on 25 patients and conventional 'cold' extracapsular dissection complete tonsillectomy was carried out on the other 25 patients. Haemostasis was achieved with packing and 3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Intraoperatively, the duration of the procedure, anaesthesia, the amount of the required intraoperative fluid, the total blood loss and the number of sutures were documented for each patient. In the hospital, the postoperative amount of intravenous fluids, oral intake (timing of onset and amount), the duration and the total dose of analgesics were recorded. Daily assessment included the type of diet, the level of appetite, the total number of analgesics, the presence of fever, the time required to return to normal activity and the pain score (twice daily). Pain was measured by means of Faces Pain Scale and Visual Analogue Scale. There was a statistically and clinically significant difference in the operating time in the intraoperative blood loss in favour of the conventional tonsillectomy group (P > 0.05). Although there was no statistically significant difference between the two groups for the postoperative evening pain scores (P > 0.05), there was a statistically significant difference for the morning pain scores (P < 0.05) in the first 2 days postoperatively (P > 0.05) and in the level of appetite in the first postoperative day (P > 0.05). The other outcome measures did not show any statistically significant difference. When we compared TWS with the conventional 'cold' dissection tonsillectomy, we found that TWS tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain. It was a useful method for tonsillectomy.

Harmonic Scalpel Tonsillectomy Using the Curved Shears Instrument versus Cold Dissection Tonsillectomy: A Retrospective Study

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. 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). 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). 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.

Evaluation of hemostatic and analgetic effects of platelet rich plasma in tonsillectomy

The author designed a study to assess hemostatic and analgetic effects of platelet rich plasma in tonsillectomy. The study was carried out on 85 patients with recurrent tonsillitis, who underwent cold dissection tonsillectomy under general anastasia. PRP in membrane form was introduced only in one randomly chosen tonssilar niche, while the other served as control. In postoperative period nine cases of tonsillar hemoragia were registered, all from control niches. Postoperative pain was evaluated by ten-grade visual-analog scales for each side separately. Pain scores reached statistical significance. There appears to be advantage to the use of PRP in tonsillectomy, but further investigations are necessary.

Argon plasma coagulation versus cold dissection tonsillectomy in adults: a clinical prospective randomized study

Argon plasma coagulation (APC) is a new surgical procedure based on a conductive plasma of ionized argon between an activating electrode and a tissue surface. It is a good alternative for tonsillectomy because of its effective hemostasis and limited penetration depth of the coagulation beam. The aim of this prospective, randomized trial was to evaluate operative time, intraoperative bleeding, and postoperative morbidity of the "hot" APC tonsillectomy as with regard to with a traditional "cold" dissection tonsillectomy in adults. Two hundred twenty six adult patients (age, >18 years) were randomized into 2 groups: TA (tonsillectomy with APC, n = 113) and TB (conventional tonsillectomy, n = 113). The outcome measures were (1) operative time; (2) intraoperative blood loss; (3) postoperative pain (evaluated using a Visual Analogue Scale with a range score 0-10 on postoperative days 1, 3, 5, 8, and 15); and (4) postoperative primary and secondary hemorrhage. Statistical analysis was carried out using the Student t test. In the TA group, the mean duration of operative time and the intraoperative blood loss were significantly reduced (P < .001). There was no statistically significant difference between 2 groups in the intensity of postoperative pain and the incidence of postoperative hemorrhage (P > .05). Tonsillectomy with APC is a safe technique and offers an innovative procedure as with regard to the conventional cold dissection. It significantly reduces the operative time and the intraoperative blood loss without increasing the postoperative morbidity.

Thermal Welding versus Cold Dissection Tonsillectomy: A Prospective, Randomized, Single-Blind Study in Adult Patients

We performed a single-blind, prospective, randomized, controlled clinical study to compare the rates of postoperative morbidity in adults undergoing thermal welding tonsillectomy versus cold dissection tonsillectomy. Thirty-two adults with recurrent tonsillitis who were scheduled for elective tonsillectomy were randomized to either thermal welding or cold dissection tonsillectomy groups. The main outcome measures included intraoperative blood loss, intensity of postoperative pain expressed on a 10-cm visual analog scale (with 0 representing no pain and 10 representing the worst possible pain), day of cessation of significant pain (ie, a pain score of at least 7), and presence of postoperative hemorrhage estimated on a 3-point scale (with 0 representing no bleeding, 1 representing minor bleeding, and 2 representing major bleeding). Additional outcome measures included total analgesic requirements, last day of receipt of analgesics, presence of nausea and/or vomiting, and wound healing after 10 days of surgery. The rate of intraoperative blood loss was significantly lower in the thermal welding group (p < .0001). Patients who had thermal welding tonsillectomy also showed a general trend toward lower pain scores, and this difference was statistically significant from the first to the fourth postoperative days (p < .05). Cessation of significant pain also occurred 3 days earlier in this group (p < .05). No significant difference was observed regarding pain medication, nausea and/or vomiting, postoperative hemorrhage, or wound healing. Thermal welding tonsillectomy is a relatively safe and reliable method with significantly less postoperative morbidity than cold dissection tonsillectomy.

Bipolar Radiofrequency Dissection Tonsillectomy: A Prospective Randomized Trial

To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

Estimating the Volume of Blood Loss and Using Diathermy in the Cold Dissection Tonsillectomy Group

The LaryngoscopeVolume 115, Issue 10 p. 1898-1898 Letters to the Editor Estimating the Volume of Blood Loss and Using Diathermy in the Cold Dissection Tonsillectomy Group First published: 03 January 2009 https://doi.org/10.1097/01.mlg.0000176752.19369.8bRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume115, Issue10October 2005Pages 1898-1898 RelatedInformation

Bipolar electrodissection tonsillectomy in children

The purpose of this study was to compare bipolar electrodissection tonsillectomy with traditional cold dissection tonsillectomy in the pediatric population. Forty children with recurrent tonsillitis and/or obstructive symptoms were included in the study. The study population was randomly divided into two groups, and the two techniques were compared with regard to operative time, intraoperative and postoperative bleeding and postoperative pain. There were 23 children in the bipolar electrodissection tonsillectomy group (mean age, 8.1 years; range, 5-12 years), and 17 children in the cold dissection tonsillectomy group (mean age, 6.7 years; range, 5-12 years). The average operative times were 15.2+/-8.5 min for bipolar electrodissection tonsillectomy and 29.06+/-13.5 min for cold dissection tonsillectomy (P < 0.05). The blood loss in bipolar electrodissection tonsillectomy and cold dissection tonsillectomy was 5.0+/-4.2 ml and 32.1+/-11.3 ml, respectively (P < 0.05). Postoperative hemorrhage was not observed. Bipolar electrodissection tonsillectomy was less painful the first 30 min postoperatively (P < 0.05). Bipolar electrodissection tonsillectomy in children is a useful technique, with results comparable to traditional cold dissection tonsillectomy.

A double‐blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post‐ operative symptoms

The aim of this study was to compare postoperative symptoms following coblation tonsillectomy with those experienced following a traditional cold dissection. A prospective randomized controlled trial. Secondary otorhinolaryngology care. Ninety-two adult patients with recurrent tonsillitis meriting tonsillectomy were recruited and randomly allocated into either coblation or cold dissection tonsillectomy groups. Primary outcomes were post-operative pain, otalgia, swallowing and analgesia use at 6-8 hours, 1, 3, 7 and 14 days post-operative. Secondary outcomes were post-operative day returned to eating and returned to normal activities/work. No significant differences between the two groups (P >or= 0.1) were found in any of the above primary outcomes, apart from swallowing at 6-8 hrs post-operatively where the cold dissection group had less pain. This group also returned earlier to normal eating (P = 0.03). The power of the study was sufficient to show a difference in the visual analogue scores of 2 between groups. The use of coblation to perform tonsillectomy does not confer any symptomatic benefits to the patient over conventional cold dissection tonsillectomy.

Cold dissection versus bipolar cauterizing tonsillectomy for bacteriemia

Objective The purpose of this study is to compare transient bacteriemia ratios between cold dissection tonsillectomy and bipolar cauterizing tonsillectomy, and also to analyze the bacteria detected with superficial/central tonsillar cultures. Methods A total of 86 patients that were grouped as 46 patients of cold dissection tonsillectomy and 40 patients of bipolar cauterizing tonsillectomy were included in this study. Preoperative surface swab cultures, intraoperative central swab cultures of tonsils, and preoperative and postoperative blood culture samples were obtained. Antibiotic sensitivity tests were determined. Fischer exact χ 2 test was performed to compare the results of postoperative bacteriemia of both techniques statistically. Results Postoperative bacteriemia was detected in 6 (13%) patients of cold dissection tonsillectomy group. In 5 (83.3%) of the 6 postoperative bacteriemia patients of cold dissection tonsillectomy group, isolated microorganism was confirmed both in the blood cultures and in the central swab cultures of tonsils, and resistance to penicillin was established. No patient of bipolar cauterizing tonsillectomy group appeared with postoperative bacteriemia. There was a statistically significant difference ( P = .028) for postoperative bacteriemia between cold dissection tonsillectomy group and bipolar cauterizing tonsillectomy group. Conclusion We recommend bipolar cauterizing tonsillectomy for high-risk patients.

Harmonic Scalpel versus Conventional Tonsillectomy: A Double-Blind Clinical Trial

We conducted a prospective, double-blind clinical trial to evaluate the differences in operating time, intraoperative blood loss, postoperative pain at 3 hours and 1 week, and delayed (>24 hr) bleeding associated with ultrasonic harmonic scalpel tonsillectomy and conventional tonsillectomy. The study was carried out on 28 patients with recurrent tonsillitis and/or adenotonsillar hypertrophy who underwent harmonic scalpel tonsillectomy on one side and cold dissection tonsillectomy with suction electrocautery hemostasis on the other. The harmonic scalpel was associated with significantly less intraoperative blood loss (mean: 6.2 vs. 58.8 ml; p < 0.0001) and less early (3 hr) postoperative pain as determined by scores on a 10-point visual analog scale (mean: 3.5 vs. 4.4; p = 0.0042); although the difference in early pain scores is statistically significant, it is probably not clinically significant. Pain scores at 1 week were nearly identical (mean: 2.7 vs. 2.6; p = 0.9246). The length of operating time was similar (mean: 10.9 vs. 7.7 min; p = 0.0022). An unanticipated finding was the fact that delayed bleeding, which occurred in 3 patients (10.7%), occurred only on the harmonic scalpel side. We conclude that the only clearly demonstrable advantage that the harmonic scalpel had over cold dissection was that it caused less intraoperative blood loss.

Tonsillectomy: cold dissection versus bipolar electrodissection

Objectives: to compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection. Material and methods: prospective study including children (3> age <14) undergoing tonsillectomy in ORL Department of the main hospital in Azores, Portugal, from September 2000 to March 2001. Patients alternately selected to cold dissection tonsillectomy group (CDT) or bipolar electrodissection tonsillectomy group (BET). Duration of surgery; amount of blood loss; duration of hospitalization; aspect of tonsillar fossa on 10th post-operative day and intensity of pain after surgery were recorded and compared. Results: Sixty tonsillectomies were performed. Blood loss and duration of surgery were significantly decreased in BET group ( P<0.001), but the healing process, directly assessed by the aspect of tonsillar fossa on the 10th day was markedly delayed. The intensity of pain was slightly higher in the BET group compared with the CDT group, and no difference on duration of hospitalization was found between the two groups. Two post-operative hemorrhages occurred (one in each group), and no major complications were registered. Conclusions: BET reduces the duration of surgery and amount of blood loss when compared with cold dissection, but post-operative morbidity is increased. We believe the best patient indication for this method are small children where total circulating blood volume is reduced and patients with bleeding disorders.