Harmonic Scalpel Tonsillectomy Research Articles

A comparison of the harmonic scalpel, coblation, bipolar, and cold knife tonsillectomy methods in adult patients

Background/Aim: Tonsillectomy is one of the widely performed surgical procedures by otolaryngologists. Today, many new surgical instruments are used in tonsil surgery to reduce postoperative morbidity. This study aimed to compare intraoperative blood loss, operating time, postoperative pain, and bleeding between harmonic scalpel tonsillectomy, coblation tonsillectomy, bipolar tonsillectomy, and cold dissection tonsillectomy in adult patients. Methods: This prospective cohort study population comprised 96 adult patients aged 18-60 years (mean age: 34.9 (10.7) years) who were operated on for chronic tonsillitis. The amount of bleeding and the operation time were calculated intraoperatively. Postoperative pain level was evaluated using a Visual Analogue Scale (VAS) at the sixth postoperative hour and on postoperative days 1, 2, 3, and 7. Results: In the harmonic scalpel group, the mean volume of intraoperative bleeding (2.7 (1.5) ml) and the mean operation time (8.8 (3.0) min) were significantly lower compared to the other groups (P

A Comparative Study of Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy Under Microscope- Our Experience.

Tonsillectomy is one of the most common proceduresin routine otolaryngology.Given that the pediatric demographic is usually in question, ENT surgeons are resorting to newer modalities that minimize the dreaded complication of intra-operative and post-operative hemorrhage and have shorter operative time. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3-4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3-4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. In our study Mean operation time, mean blood loss, Analogue score for post-operative pain at 24hrs and 7th postoperative day respectively and Healing of wound on 14th post-operative day were significantly lower in cases of tonsillectomy with harmonic scalpel than cold dissection method tonsillectomy. The novel technique of tonsillectomy harmonic scalpel is proven to be better with regard to lesser operative time, blood loss and lesser post-operative morbidity.

Comparison of three tonsillectomy techniques in children.

Tonsillectomy is still one of the most common surgical procedures worldwide performed by otorhinolaryngologists. This single-blind randomized study aimed to compare cold dissection tonsillectomy, coblation tonsillectomy, and harmonic scalpel tonsillectomy in pediatric patients in respect of intraoperative blood loss, operating time, and postoperative pain and bleeding. This single-blind randomized clinical trial evaluated 82 pediatric patients aged 3-16years (mean age: 7.23 ± 3.26years) applied with tonsillectomy between April 2017 and March 2020. Harmonic scalpel tonsillectomy was applied to 33 (40.2%) patients, the cold knife technique to 25 (30.5%), and coblation tonsillectomy to 24 (29.3%). There was no statistically significant difference between the three techniques in respect of postoperative pain levels and post-tonsillectomy bleeding rates. The intraoperative bleeding rate and mean operating time were determined to be significantly lower in the harmonic scalpel group (p < 0.05). Harmonic scalpel tonsillectomy is associated with a shorter operating time and lower intraoperative bleeding rates and similar postoperative pain score and postoperative bleeding rates compared with coblation tonsillectomy and cold dissection tonsillectomy. Harmonic scalpel tonsillectomy is a fast, safe, and effective method for tonsillectomy in children.

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

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

Harmonic Scalpel Versus Coblation Tonsillectomy A Comparative Study.

Tonsillectomy is an age old procedure in ENT practice. Though traditional dissection method is gold standard, we surgeons are trying different techniques like electrocautery, coblation, harmonic scalpel (HS) mainly to improve surgical convenience, to decrease operative time, post operative pain, intra and post operative bleeding and fast return to normal life. In this particular study we are comparing coblation and HS as surgical tool in tonsillectomy. It is a prospective double-blind randomized controlled trial where information was compared between two groups of coblation and HS tonsillectomy. A total number of 128 patients were compared over operation time, intra-operative blood loss, postoperative pain, time needed to regain the normal diet and activity and postoperative haemorrhage. We found statistically significant differences in operation time (p < 0.001) and intra operative blood loss (p < 0.001). Secondary haemorrhage rate was far better in HS (1.5%) group compared to coblation (7.8%). Whereas postoperative pain, time needed to go back to the normal diet and activity were better in HS group but the difference is not significant. This study revealed a significantly less operative time and intra-operative and post operative blood loss in harmonic scalpel tonsillectomy in comparison with coblation method. These findings addressed HS tonsillectomy as an advanced method.

Harmonic scalpel versus other techniques for tonsillectomy: a systematic review and meta-analysis

Background: The objective of this review was to compare treatment effects of harmonic scalpel tonsillectomy versus alternative techniques on postoperative pain. Secondary outcomes included delayed bleeding and intraoperative blood loss. Methods: Medline, Embase, and Central were searched for randomized controlled trials where harmonic tonsillectomy was compared to any alternative technique for participants of any age undergoing tonsillectomy. The primary outcome was pain scores using validated pain scores on day 1, day 4, and day 7 postoperatively. Data for postoperative pain scores were synthesized using random effects model and presented as standard mean difference (SMD). All outcomes were presented with 95% confidence intervals (CI). Subgroup analyses were performed based on hot or cold techniques. Results: Eleven trials were identified in this review. Five trials (637 patients) contained data that permitted meta-analysis for postoperative pain. Harmonic scalpel tonsillectomy was associated with less postoperative pain compared to other hot techniques on day 1, 4, and 7 (P Conclusions: The harmonic scalpel technique may cause less pain in the postoperative period compared to other techniques, but the difference is small. The harmonic scalpel does demonstrate evidence for superiority compared to blunt dissection, with a 56% reduction in delayed haemorrhage.

A randomised double blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy

A randomised double blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy

A Comparison between Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy.

Introduction: This study aimed to compare operation time, intraoperative bleeding and postoperative pain between cold dissection tonsillectomy and harmonic scalpel tonsillectomy. Materials and Methods: In this single-blinded clinical trial, 32 patients aged 14–48 were enrolled. Each patient randomly underwent tonsillectomy using the harmonic scalpel on one side and cold dissection on the other side. Operation time and bleeding volume were measured during surgery. The pain intensity level on each side was recorded on the first and seventh postoperative days. Results: The mean volume of intraoperative bleeding was 9.59 ml on the harmonic side and 74.38 ml on the cold dissection side; which represents a significantly lower amount on the harmonic side (P<0.001). The mean time of tonsillectomy was 427.63±196.32 s for the harmonic side and 711 271.88 s for the cold dissection side (P<0.001). The mean pain intensity level on the first postoperative day was 3.88 on the harmonic side and 6.19 on the cold dissection site (P<0.001). Conclusion: Mean operation time, volume of bleeding and pain intensity level on the first postoperative day were all statistically lower on the harmonic side.

Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study

ObjectiveTo compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection).MethodsSixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded.ResultsNo statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication.ConclusionUsage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

Comparison of Outpatient Harmonic Scalpel Tonsillectomy and Traditional Tonsillectomy in Sleep Disordered Breathing

ABSTRACTIn this prospective study of 43 patients, 20 patients were operated by the outpatient harmonic scalpel tonsillectomy. The outpatient harmonic scalpel technique was performed by local injection with 2% Xylocaine with 1:80,000 adrenaline solution around palatine tonsils and using harmonic scalpel for dissecting tissue at superior pole until inferior pole of tonsil. Harmonic scalpel will cut and stop bleeding simultaneously and then, using plain catgut 3-0 ligation at the inferior pole of tonsil stops bleeding from tonsil branch of facial artery. All of the patients were followed up for 1 and 3 weeks postoperatively; 19 of 20 (95%) patients who were operated by the outpatient harmonic scalpel tonsillectomy felt satisfied and in one case, the patients wound healing delayed for 3 weeks. All patients were discharged on the day of admission with no major complication. Twenty-three patients were operated by the traditional tonsillectomy as an inpatient. Twenty of 23 (87%) patients were satisfied and in three cases, the patients had delayed wound healing for 3 weeks. The results of the study conclude that the outpatient harmonic scalpel tonsillectomy is satisfactory and medical treatment cost also is cheaper than the traditional tonsillectomy for the majority of patients.How to cite this articleChanvimalueng W. Comparison of Outpatient Harmonic Scalpel Tonsillectomy and Traditional Tonsillectomy in Sleep Disordered Breathing. Int J Otorhinolaryngol Clin 2016;8(1):18-21

Harmonic Scalpel versus Conventional Technique of Tonsillectomy- A Prospective Study

Tonsillectomy is the one of the most commonly performed surgical procedure in the department of otorhinolaryngology. There are different methods of tonsillectomy techniques used today with the aim of providing more comfort and less morbidity to patients. Postoperative bleeding and Pain are the most common complications. This study evaluated the Operative time, Intraoperative blood loss, Postoperative pain ,Hospital stay and Cost effectiveness of tonsillectomy performed by Harmonic scalpel as compared to Conventional dissection technique. This is a prospective randomized study where in fifty patients were divided into two groups of equal number. In one group, the tonsillectomy was performed by Harmonic scalpel and in the other group by Conventional dissection technique. Amount of blood loss is significantly reduced in the harmonic group. Total postoperative pain and operative time slightly higher for harmonic scalpel group. There is no significant difference in hospital stay and post operative complications. Harmonic scalpel tonsillectomy has shown to be useful, safe, easy and reliable method of performing tonsillectomy.

Postoperative quality of life after two different methods of tonsillectomy

Tonsillectomy is a very painful procedure. Pain may be severe, and patients are often unable to perform in school or eat regular food for a number of days after the surgery. The aim of this study was to compare the quality of life after undergoing two different surgical techniques of tonsillectomy, harmonic scalpel and classic tonsillectomy with bipolar cauterization. Prospective randomized double-blind, clinical trial study conducted in the ENT Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia. Data were collected, according to the type of operation, on pain persistence and intensity and returning to normal eating with tonsillectomy patients during the first seven postoperative days. Group A consisted of 50 children submitted to classic tonsillectomy with bipolar cauterization, while group B included 50 children operated on using the harmonic scalpel. Data on pain intensity were obtained using pain measuring scales adjusted to children's age (Faces scales, visual analog scale). The first day of normal oral food intake was recorded. The analysis of variance revealed that the grade of pain significantly differs by a surgical technique employed, and that it significantly varied over the first seven postoperative days. The pain was more severe after undergoing the harmonic scalpel technique and children started to eat later compared with the classic tonsillectomy. The classic tonsillectomy method with bipolar cauterization is the method of choice due to lower postoperative pain levels and sooner normal eating. The quality of life is better after undergoing the classic tonsillectomy method.

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.

Evaluating postoperative pain in monopolar cautery versus harmonic scalpel tonsillectomy

Objectives To compare postoperative pain between monopolar cautery tonsillectomy and harmonic scalpel tonsillectomy (HST). Study Design Randomized controlled trial using paired organs. Setting Community hospital with academic affiliation. Subjects One hundred and fourteen consecutive patients six years of age or older undergoing tonsillectomy for indications of hypertrophy or recurrent infection. Methods For each subject, monopolar cautery tonsillectomy was performed by four senior surgeons on one side and HST was performed on the other side. Allocation of technique to side was randomized and revealed to the surgeon at the start of the operation. Validated visual analog pain scales were used to quantify pain at rest and with swallowing for each side and were completed daily for 14 days. All subjects were prescribed weight-equivalent doses of analgesics. Secondary outcome measures included postoperative complications (hemorrhage and readmission). Results Pairwise comparisons of pain scores revealed no significant difference between monopolar cautery tonsillectomy and HST ( P < 0.05). Conclusions Subjects undergoing monopolar cautery tonsillectomy do not experience increased postoperative pain in comparison to HST.

Harmonic Scalpel Tonsillectomy versus Monopolar Diathermy Tonsillectomy: A Prospective Study

For tonsillectomy, the ultrasonic harmonic scalpel has been purported to cause less tissue injury and postoperative morbidity while providing adequate levels of hemostasis. We undertook a prospective study to compare outcomes in 162 patients who had undergone harmonic scalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy over a 33-month period. We found that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.0001). There was no clinically significant difference between the groups with respect to (1) the amount of operating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, and primary or secondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.

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.

Tonsillektomia z zastosowaniem skalpela harmonicznego – doświadczenie własne i przegląd literatury

The harmonic scalpel has been used in tonsil surgery for several years. The comparison of harmonic scalpel tonsillectomy with other tonsillectomy techniques has been the subject of many studies. The research results proved to be contradictory, particularly concerning postoperative complications and complaints. Most authors observed reduced intraoperative bleeding during harmonic scalpel tonsillectomy. Analysis of harmonic scalpel tonsillectomy results and review of literature. Material and methods. The harmonic scalpel was used for 71 tonsillectomies in the Department of Otolaryngology UJ CM between 2002-2007. The surgical procedure and postoperative results were analyzed retrospectively and compared with other tonsillectomy techniques. The harmonic scalpel provided sufficient intraoperative hemostasis in 67% of cases. 33% of patients required electrocautery, vessel ligation in the operation field or suturing of the marginal tissue to control bleeding. Postoperative hemorrhage requiring surgical intervention occurred in 3 patients. No other severe postoperative complications were observed in either group. Harmonic scalpel tonsillectomy is an effective and safe alternative technique in tonsil surgery. In some cases however other hemostasis techniques may be necessary to control intense bleeding.

Comparison of LigaSure vessel sealing system, harmonic scalpel, and cold knife tonsillectomy

We sought to compare LigaSure Vessel Sealing System tonsillectomy (LT), Harmonic Scalpel tonsillectomy (HST), and cold knife tonsillectomy (CKT). We conducted a prospective study on 161 adult patients undergoing tonsillectomy. Subjects were randomized to LT, HST, or CKT groups, and intraoperative bleeding, operative time, postoperative pain, and complication rates were assessed. The LT, HST, and CKT groups consisted of 50, 43, and 37 individuals, respectively. Intraoperative bleeding was significantly lower in the LT group, whereas bleeding in the HST group was significantly lower than that in the CKT group. Operative time and postoperative pain were significantly lower in the LT and HST groups. One primary hemorrhage occurred in the HST group, and one occurred in he CKT group. Secondary hemorrhage occurred in one, two, and one patients in the LT, HST, and CKT groups, respectively. LT and HST have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with CKT, both were associated with less intraoperative blood loss and pain.

A prospective randomised single blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy

To compare the differences in pain, analgesic use and bleeding in children after tonsillectomy using either a harmonic scalpel or a bipolar diathermy surgical technique. Children 6-15 years presenting for tonsillectomy were randomised to either a harmonic scalpel or bipolar diathermy surgical technique. Post-operative pain scores (VAS, 0-10) were recorded within 30 min of surgery and again at the 4h hospital discharge. A subsequent telephone interview daily for 7 days and then every second day until day 13 was used to monitor pain scores, analgesic use and tonsil bed bleeding. There were 204 children studied. The response rate over the first 7 days was 93% for the children in the harmonic scalpel group and 87% for the bipolar group. Children experienced moderate post-operative pain for the first 6 days, after which pain declined from 4-7 to reach a score of 1-2 by day 11. Children undergoing harmonic scalpel tonsillectomy (n=103) reported higher mean pain scores than those who underwent bipolar diathermy (n=101) for current pain (4.7 versus 4.2, p=0.002), worst pain of the day (6.9 versus 6.2, p<0.001) and pain on swallowing (5.9 versus 5.2, p<0.001) over the first 6 post-operative days. Analgesic use (acetaminophen, ibuprofen) was similar in both groups. Hospital readmission for bleeding in children who underwent harmonic scalpel was similar to those who underwent bipolar diathermy tonsillectomy (9% versus 11%) as was bleeding requiring surgical re-exploration (4% versus 2%). Tonsillectomy was associated with considerable pain for the first 6 post-operative days. Children undergoing harmonic scalpel tonsillectomy had a slight increase in pain compared to the bipolar diathermy group during this time. Both methods of tonsillectomy are effective and safe.

Tonsillectomy

Tonsillectomy