Cold Steel Tonsillectomy Research Articles

Thulium laser versus cold steel tonsillectomy: a prospective pilot study in adult patients

BackgroundThe aim of this pilot study was to compare the operation time, intraoperative and postoperative bleeding, postoperative pain, and wound healing of the thulium RevoLix laser tonsillectomy method over the more commonly practiced cold steel tonsillectomy.MethodsA prospective, single-blinded randomized pilot trial was conducted. Twenty-four adult patients with a mean age of 28.7 years with chronic recurrent tonsillitis were observed and underwent tonsillectomy. The patients were randomly assigned to have one tonsil removed with a thulium RevoLix laser 200, and the conventional cold steel tonsillectomy method was used for the other side.ResultsThe tonsillectomy time from incision to hemostasis was 12.08 ± 0.77 (SE) min with the laser method and 10.92 ± 1.31(SE) min with the cold dissection method, with no statistically significant difference (P < 0.121). Intraoperative blood loss in the cold dissection method was 10.92 ± 1.31 ml, and 2.04 ± 1.62 ml was observed during laser treatment (P < 0.000, t = 8.363). In the cold steel tonsillectomy group, the pain score was significantly higher than that in the laser tonsillectomy group on the 7th and 12th postoperative days.ConclusionThe use of the thulium RevoLix 200 laser for tonsillectomy in the present pilot study of 24 patients showed significantly better outcomes than those in conventional cold dissection methods in terms of intraoperative bleeding and postoperative pain; however, there was no statistically significant difference in other parameters, such as operational time and late postoperative bleeding. A large full-scale prospective study is needed to increase the generalizability and reliability of the results.Clinical trial registrationISRCTN16280803, registered on 25 March 2020, https://www.isrctn.com/ISRCTN16280803.

Wired Snare and Negus Artery Ligation for Securing Lower Pole Tonsillar Removal during Cold Steel Tonsillectomy: A Comparative Study

Background: Tonsillectomy is one of the most commonly practised surgeries in general and otolaryngology. Bleeding tonsillar lower pole, primarily pain and tonsillar remnant are common complications of this operation.&#x0D; &#x0D; Objectives: To assess and compare the effectiveness of wired snare removal of the inferior tonsillar pole with negus artery ligaturisation technique regarding bleeding, pain, operative time, and the tonsillar remnant in cold dissection tonsillectomy.&#x0D; &#x0D; Patients and Methods: This hospital-based, prospective, comparative study was conducted on 200 patients (400 tonsils) that underwent a tonsillectomy in Sulaimani Teaching Hospital and Shorsh Teaching Hospital from April 2021 to February 2022. On one side, the tonsil's inferior pole was removed by silk using negus artery ligaturisation, while the other lower pole tonsil of the same patient was crushed by wired eves snare. Patients followed up on the 4th, 7th day, and 8th weeks postoperative for bleeding, pain, fever, and tonsillar remnant.&#x0D; &#x0D; Results: Most patients were aged 5-10 years (48.5%) and males (56%). The mean±SD of surgical time for wired snaring was significantly (p=0.000) shorter (6.04±0.47 minutes) than that of artery ligation (7.0±1.55 minutes). The tonsillar remnant occurred mainly with ligation, while bleeding more commonly occurred on the snare side (p=0.048).&#x0D; &#x0D; Conclusions: Lower tonsillar pole negus ligation removal was associated with less bleeding and pain. However, it is more time-consuming operatively, with more tonsillar remnant occurrence than wired snare removal of the lower pole.

A novel electrosurgical divider: performance in a self-controlled tonsillectomy study

PurposeTonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid tonsillectomies and might reduce postoperative pain, but comparative studies to assess performance are warranted.MethodsThis randomized self-controlled clinical trial was conducted from October 2019 to October 2020 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Vienna. Forty-eight patients underwent a tonsillectomy with the device on one side and using cold-steel with localized bipolar cauterization on the other side (control). Main outcomes were the time for tonsil removal (per side) and the time to stop bleeding (per side). Secondary measurements were postoperative pain, assessed once on day 0 and five times on days 1, 3, 5, 7, and 10. Postoperative bleeding episodes and consequences were recorded.ResultsDevice tonsillectomies were performed significantly faster than controls; the mean surgical time difference was 209 s (p < 0.001, 95% CI 129; 288). Intraoperative blood loss was significantly lower on the device side (all p < 0.05). Postoperative measurements of pain and bleeding were similar for both sides. Two return-to-theatre secondary bleeding events were recorded for the control side.ConclusionThe novel electrosurgical temperature-controlled divider reduced the tonsillectomy surgical time and intraoperative blood loss, with no apparent negative effects on postoperative pain or bleeding, compared to a cold-steel tonsillectomy with localized bipolar cauterization. In time-restricted settings, the device could be beneficial, particularly after familiarization with device handling.Trial registrationClinicalTrials.gov Identifier: NCT03793816.

COBLATION TONSILLECTOMY, IS IT SUPERIOR TO COLD STEEL METHOD?

Coblation tonsillectomy is a new technique that was started in 1975, it involves passing a radiofrequency bipolar electrical current through a medium of normal saline, resulting in a plasma field of highly ionized particles which in turn break down intercellular bonds and thus melt tissue at around 40º to 70ºC (in comparison with electrocautery which cuts tissues at 400ºC)The aim of this study is to evaluate the benefit of coblation tonsillectomy over conventional (cold steel) tonsillectomy, comparing tonsillectomy duration, blood loss during the surgery, and the postoperative pain. This prospective randomised single-blinded clinical trial was done on 90 patients. Patients were divided into 2 equal groups; Group A: Underwent coblation tonsillectomy, and Group B who underwent cold steel tonsillectomy. The study was performed in Al-Musawy Private Hospital, Basrah Teaching Hospital, and Al-shifaa hospital, Basrah, Iraq. All surgeries were done by the three authors in the period between February 2018 to August 2020. The intraoperative bleeding, duration of surgery, and postoperative pain were evaluated and compared for both groups. The age range of the studied patients was 4–32 years, 52 were males and 38 were females. The average duration of tonsillectomy procedure was 31.8 minutes in coblation tonsillectomy (Group A), while the average duration in the cold steel tonsillectomy (Group B) was 25.8 minutes. The average operative blood loss in cold steel tonsillectomy was 31.5 ml while that incoblation was 3.2 ml. Average postoperative pain in coblation group was (20.7± 6.15), while in cold steel group was (27.5±7.27).In conclusion, coblation tonsillectomy is effective and beneficial in decreasing the volume of intraoperative blood loss but not for postoperative pain in comparison with conventional method, in addition that it take more time to be completed.Key words: coblation, cold steel, tonsillectomy.

To evaluate the role of Feracrylum (1%) as hemostatic agent in Tonsillectomy.

Tonsillectomy is a common procedure performed globally. It is associated with morbidities like hemorrhage and pain. Various methods are employed to reduce them. The present study is aimed to evaluate the role of Feracrylum (1%) in traditional cold steel tonsillectomy and to measure the outcomes in terms of intra-operative bleed, intra-operative time and post operative pain and recovery. A prospective study was conducted in Department of ENT, ESI Medical College, Kalburgi Karnataka, India, for a period of two years between January 2019 to December 2020 In this study, a total of 60 patients were involved and divided them into two groups after fulfilling the inclusion and exclusion criteria. Thirty patients each undergoing tonsillectomy with the use of Feracrylum considered as Group I and without the use of Feracrylum in the tonsillar fossae considered as Group II. The study has been approved by Ethics committee and informed consent was obtained from all the study subjects. The amount of blood loss is calculated. Post operative pain based on VAS (Visual Analogue Scale) is assessed in both the groups. Assessment of recovery in days is estimated in both groups by reduced pain, gaining normal activity and normal food intake. In this study, intra-operative time in group I was 19.83 ± 3.93min and in group II 27.16 ± 3.35min (P < 0.001). The intra-operative blood loss in group I was 26.67 ± 4.81ml and in group II 44.70 ± 7.59ml (P < 0.001). Patients recovered from pain, resumed normal activity and food intake within 2-3days in Group I and in contrast it took about 3-5days on an average in group II. In this study, majority of the patients experienced mild pain in Group I when Feracrylum was used during hemostasis. In our study, the time taken by the patients to recover from pain, resume their normal activity and also with regard to normal food intake was rapid. On an average of 2-3days was seen in Group I. Group II patients required 3-5days to recover from pain and resuming normal activity and food intake. The P value of < 0.001 was highly significant. Our study has stressed that use of Feracrylum in cold steel tonsillectomy is relatively safe. Its use is associated with a significant decrease in surgical time and blood loss. Rapid recovery makes it favourable to be used in cold steel tonsillectomy.

Secondary Heamorrhage After Cold Steel Tonsillectomy: An Audit Performed in Shalamar Hospital

Introduction: Tonsillectomy is a common surgical procedure in which post tonsillectomy heamorrhage remains the most serious complication. The cold steel dissection method is the oldest and safest method used to perform tonsillectomies. Aims &amp; Objectives: This study was done to see the frequency of posttonsillectomy heamorrhage with cold steel dissection method. It was a clinical audit performed retrospectively to compare our results with International standards. Place and duration of study: Our clinical audit was conducted at Otolaryngology department in Shalamar Hospital, Lahore, Pakistan. This study was conducted in a period of 6 months. Material &amp; Methods: The charts of patients (n=344) that underwent tonsillectomy at Shalamar Hospital from January 2016 till December 2019 were retrospectively viewed, in a cross-sectional, pilot study, using convenience sampling technique. All the tonsillectomy procedures were performed using the cold steel dissection method. Frequencies were recorded and chi-square test was applied. Results: The complication of secondary heamorrhage occurred in 7 patients and the frequency was calculated as 2%. A significant difference (P=0.01) of age was found in patients suffering from secondary heamorrhage. The incidence was lower in patients below 18 years of age (0.7%) as compared to patients above 18 years of age (7.14%). The rate of heamorrhage was found to be slightly higher in males than in females (2.6% and 1.31% respectively). Conclusion: We conclude that the rate of secondary heamorrhage in our institution is up to the rate reported in literature. Different hot techniques for tonsillectomy should also be performed in clinical settings and compared with the standard cold steel dissection tonsillectomy.

Comparison of Bipolar Diathermy Tonsillectomy Versus Cold Steel Dissection Tonsillectomy

Objective: To compare mean Primary Blood loss and mean time taken to complete the procedure between conventional cold steel tonsillectomy versus bipolar diathermy tonsillectomy. Study Design: Randomized Control Trial. Settings: Department of ENT Unit-I, Allied hospital, Faisalabad. Duration: 6-month duration from: May 2019 to October 2019. Methodology: After taking approval from hospital ethical committee, patients coming through the OPD who fulfilled the selection criteria were enrolled and informed consent was obtained. All the basic demographic information of each patient (Name, age, sex, address and contact) was also noted. Using computer generated random number tables patients were randomized in two groups. In Group-A patient underwent conventional cold steel tonsillectomy and in Group-B underwent diathermy tonsillectomy. All procedures were done by single surgical team to avoid the bias. From the start of the procedure till completion of tonsillectomy, the primary blood loss and time to complete the procedure was calculated. Results: Mean age was 14.83+5.84 years in Group-A and 15.63+5.59 years in Group-B, 62.86%(n=22) in Group-A and 57.14%(n=20) in Group-B were male whereas 37.14%(n=13) in Group-A and 42.86%(n=15) in Group-B were females. Comparison between conventional cold steel tonsillectomy versus bipolar diathermy tonsillectomy shows that 24.57+1.42ml in Group-A and 11.17+1.67ml blood loss in Group-B, p value was 0.001. Mean operative time (minutes) was recorded as 24.94+2.26 minutes in Group-A and 13.09+1.66 minutes in Group-B, p value was 0.0001. Conclusion: We concluded that mean Primary Blood loss and mean time taken to complete the procedure were significantly lower in bipolar diathermy tonsillectomy when compared to conventional cold steel tonsillectomy

Comparison of Postoperative Pain and Appetite in Pediatric Patients Undergoing Monopolar Tonsillotomy and Cold Steel Tonsillectomy.

Objectives Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. In Lebanon, very few studies were done tackling this issue and assessing its sequelae on the pediatric population. Methods A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. An estimated number of children included were 50: 25 patients underwent PT and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results Patients in the PT group and in the TT group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Assessing the appetite using the visual analogue scale favored PT over TT. Comparisons revealed that most PT patients returned to their normal eating habits starting at day 4 while this was applicable in the TT group at day 10. Postoperative pain improved from day 1 to day 10 in both surgical groups. Conclusion In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT. The patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery.

Argon plasma coagulation versus cold steel tonsillectomy: a comparison of safety and efficacy

Background: Various tonsillectomy techniques have been introduced as alternatives to cold steel (CS) dissection. The aim of this study was to compare safety and efficacy of Argon plasma coagulation (APC) with CS tonsillectomy, by evaluating: (I) operative time; (II) intraoperative haemorrhage; (III) postoperative pain and (IV) postoperative haemorrhage. Methods: This study was a retrospective analysis of a 5-year prospectively collected database. Five hundred patients who underwent elective tonsillectomies performed by a single surgeon were included in this study (age range 1–57, male/female ratio =0.68, APC group n=232, CS group n=268). Results: APC group had shorter operative time than CS [12.33 min, standard deviation (SD) 0.284 vs. 20.68 min, SD 0.16, P&lt;0.001], and less intraoperative haemorrhage (P&lt;0.001). Intraoperative haemorrhage was described by a grading system: the majority of APC group in grade 1a bleeding (equivalent to 0–2 mL) and majority of CS in grade 2 bleeding (equivalent to 14–65 mL). Pain scores were lower in CS group by only 0.45 on a 10-point scale (P=0.04) and pain profiles over a 2-week postoperative period were similar. There was less secondary postoperative haemorrhage in APC group compared to CS, which was not statistically significant (3.88% vs. 5.22%, P=0.16). Primary haemorrhage did not occur in either group. Conclusions: APC appears to be a safe and efficacious technique for paediatric and adult tonsillectomy. It offers shorter operative time, reduced intraoperative haemorrhage and same postoperative pain experience. Rates of secondary haemorrhage require further evaluation with higher powered studies.

Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK.

This study aimed to estimate the cost-effectiveness of Coblation compared with cold steel tonsillectomy in adult and paediatric patients in the UK. Decision analysis was undertaken by combining published clinical outcomes with resource utilisation estimates derived from a panel of clinicians. Using a cold steel procedure instead of Coblation is expected to generate an incremental cost of more than £2000 for each additional avoided haemorrhage, and the probability of cold steel being cost-effective was approximately 0.50. Therefore, the cost-effectiveness of the two techniques was comparable. When the published clinical outcomes were replaced with clinicians' estimates of current practice, Coblation was found to improve outcome for less cost, and the probability of Coblation being cost-effective was at least 0.70. A best-case scenario suggests Coblation affords the National Health Service a cost-effective intervention for tonsillectomy in adult and paediatric patients compared with cold steel procedures. A worst-case scenario suggests Coblation affords the National Health Service an equivalent cost-effective intervention for adult and paediatric patients.

Tonsillectomy-Comparative Study of Various Techniques and Changing Trend.

Tonsillectomy is a major surgical procedure in terms of volume in the general otolaryngological practice. It is a 3000-year-old surgical operation, referred in Hindu medicine. There has been a conceptual change in the indications and surgical technique in the last 40years. A comparative study between the various methods of tonsillectomy was done. The study was carried out in the single institutional set up by the same surgeon but using different techniques. The study aimed at comparing the intra-operative factors (blood loss, time taken for surgery), postoperative results (pain, bleeding, dehydration, time taken for complete healing), and other complications like vomiting and hospitalization time between different groups of surgical methods. This study was done in 2500 patients undergoing tonsillectomy with or without adenoid removal in a period of 35years (1979-2013). The majority of the patients (approximately 41%) in the first half of this period underwent cold steel tonsillectomy whereas 39% underwent microdebrider assisted tonsillectomy. Microdebrider assisted tonsil surgery was done as day care procedure in 90%. In 21% of the patients, other methods viz coblation, radio frequency and laser were used. Microdebrider intracapsular tonsillectomy is associated with lower mortality and morbidity as compared to cold steel, coblation, electrodissection, laser and radio frequency.

Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study.

Background Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad). Methods In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. Results 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007). Conclusion Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.

Complications after tonsillectomy in paediatric patients

s / International Journal of Surgery 12 (2014) S13eS117 S44 1360: COMPLICATIONS AFTER TONSILLECTOMY IN PAEDIATRIC PATIENTS Sheneen Meghji, Sparsh Prasher, Nitesh Patel, Paolo Livi, Amr Salem. Whipps Cross University Hospital, London, London, UK. Introduction: What is the true complication rate of paediatric tonsillectomies? Themost common complications are: Primary haemorrhage 1-2%, secondary haemorrhage 2-5%, pain, nausea, and dehydration. Methods: Retrospective review of paediatric tonsillectomies performed between June 2013 and December 2013 at Whipps Cross Hospital. Data was collected by electronic records and telephone survey. Results: 110 paediatric tonsillectomies were carried out on 65 males and 45 females, average age being 6 years 7 months old. 90% had bipolar dissection and 10% had cold-steel tonsillectomy. 100% of patients received paracetamol, 98% had ibuprofen, 69% had difflam, 62% had antibiotics and 18% had codeine prescribed on discharged. 90/110 responded to the telephone survey. 31/90 (34%) sought further advice in the post-operative period; 17/31 came to A&E (3 were not admitted 13 were admitted for medical management and 1 returned to theatre), 11/31 visited their GP and 3/31 called for advice. The main complaint was bleeding 35%, pain 35%, infection 19%, nausea 6% and stridor 3%. Conclusions: A third of patient’s sought advice post-operatively. A new protocol for tonsillectomy has been implemented which includes standardised peri-operative techniques, post-operative prescriptions and patient information leaflet on discharge. A re-audit will be undertaken, assessing the effectiveness of these changes. 1371: LOW PRIORITY PROCEDURES IN ENT Kapil Rajwani, Mike O'Connell. Brighton and Sussex University Hospitals,

Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children.We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight.

Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method

Tonsillectomy, a common paediatric otolaryngology procedure, has undergone several evolutionary trends in the surgical techniques aimed at minimizing complications and improving patients' satisfaction. Despite the technological advancements in this respect, search for an ideal method is still ongoing, and some authorities are reverting back to the conventional methods. We wish to introduce the "Vasoconstrictive hydrolytic cold dissection" (VHCD) method. The VHCD method was described, and the outcome measures in one hundred and thirty-five patients who had the procedures were presented in . Data entrance was done with SPSS 14. A total 135 patients comprising of 107 children aged 1-12 years and 28 adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15 minutes and 5 mls for children and 12 mins and 10 mls for adults/adolescents, respectively. There was a single case (0.7%) of post-tonsillar bleed (reactionary haemorrhage). The rest (99.3%) recorded nil haemorrhage within and beyond first 2 weeks post-surgery. Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however, those practicing CSM will benefit from VHCD. We hereby recommend this simple, cost-effective modification of the cold steel tonsillectomy, which appears to have made dissection easier and also minimizes haemorrhage, a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A randomized control trial is required for further evaluation of this method.

Use of Floseal and effects on wound healing and pain in adults undergoing tonsillectomy: randomised comparison versus electrocautery

The objective of this study was to evaluate the effect of FloSeal(®) (FS, Baxter Healthcare, Deerfield, IL, USA) as a haemostatic matrix in comparison to bipolar electrocautery (EC) after tonsillectomy. Eligible patients were adults undergoing cold-knife tonsillectomy because of recurrent tonsillitis, tonsillar hypertrophy, or peritonsillar abscess (more than 3 months previously). Patients were randomly allocated, on a single-blind basis, to either FS or EC for haemostasis during tonsillectomy. Five experienced surgeons judged the handling of FS application using a five-point scale (very good, good, fair, poor, very poor). Postoperative pain scores were evaluated with a visual analogue scale for 20 days, and the duration under pain medication together with the consumption of pain medication was compared. Wound healing was documented on Days 1-5, 10, and 20. A total of 176 patients were enrolled. Overall, 76/77 (98.7%) of surgeon evaluations of FS handling were judged at least "good". FS-treated patients showed significantly improved wound healing (less thickness of wound plaques) throughout the postoperative observation period, a trend for less postoperative pain (cumulative pain intensity score; P = 0.074), and a significantly shorter duration of pain-medication use (9.5 vs. 11.6 days; P = 0.014) as well as reduced pain-medication consumption/demand (P = 0.032). No difference in the rate of postoperative haemorrhage was observed between the two treatment groups (4.9% for FS patients, 6.0% for EC patients, P = 0.76). In conclusion, this study demonstrates the easy handling of FS application in tonsillectomy. Its use instead of EC after cold-steel tonsillectomy shows beneficial effects on mucosal recovery, as assessed by a decrease in the thickness of wound coating. Furthermore, FS is associated with a significantly shortened duration of pain-medication use and overall reduction in consumption/demand.

Tonsillectomy technique as a risk factor for postoperative haemorrhage

Tonsillectomy is one of the most frequent surgical procedures. "Hot" tonsillectomy techniques (eg, diathermy and coblation) have become well established, but there is little evidence to suggest that they are better than traditional "cold steel" dissection with only packs or ties for haemostasis. We obtained data for the occurrence of complications after all tonsillectomies done since July, 2003, in England and Northern Ireland. We recorded postoperative haemorrhages and other complications, taking place within 28 days of surgery, that led to delayed discharge, return to theatre, or re-admission. By February, 2004, the audit had included 13554 patients, of whom 11796 (87%) in 252 hospitals consented to electronic submission of their tonsillectomy data. Thus, 75% of the hospitals where tonsillectomies are done submitted data for 60% of all eligible patients. Haemorrhage occurred in 389 patients (3.3%). 59 patients (0.5%) had a primary haemorrhage (during initial stay), 337 (2.9%) a secondary haemorrhage (after discharge), and seven had both. The overall haemorrhage rate was 3.1 times (95% CI 1.9-5.0) higher with bipolar diathermy tonsillectomy than with cold steel tonsillectomy without any use of diathermy (p<0.001). The corresponding relative risk for coblation tonsillectomy was 3.4 (1.9-6.2; p<0.001). When cold steel was used for dissection and diathermy only for haemostasis the relative risk was 2.2 (1.3-3.7; p=0.002). The use of techniques such as diathermy and coblation increased postoperative haemorrhage. These methods should therefore be used with appropriate caution and only after proper training.