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Harmonic Scalpel Versus Coblation Tonsillectomy A Comparative Study

  • Soumik Basu
  • Anindita SenguptaEmail author
  • Arya Brata Dubey
  • Arunabha Sengupta
Original Article
  • 13 Downloads

Abstract

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.

Keywords

Tonsillectomy Harmonic Coblation 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J et al (2007) Key messages from the national prospective tonsillectomy audit. Laryngoscope. 117(4):717–724CrossRefGoogle Scholar
  2. 2.
    Pinder DK, Wilson H, Hilton MP (2011) Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 3:CD002211Google Scholar
  3. 3.
    Wiatrak BJ, Willging JP (2002) Harmonic scalpel for tonsillectomy. Laryngoscope 112(8 Pt 2 Suppl 100):14–16CrossRefGoogle Scholar
  4. 4.
    Derkay CS, Maddern BR (2002) Innovative techniques for adenotonsillar surgery in children: introduction and commentary. Laryngoscope 112(8 Pt 2 Suppl 100):2CrossRefGoogle Scholar
  5. 5.
    Plant RL (2002) Radiofrequency treatment of tonsillar hypertrophy. Laryngoscope 112(Pt 2 Suppl 100):20–22CrossRefGoogle Scholar
  6. 6.
    Lee KC, Bent JP, Dolitsky JN, Hinchcliffe AM, Mansfield EL, White AK et al (2004) Surgical advances in tonsillectomy: report of a roundtable discussion. Ear Nose Throat 83(8 Suppl 3):4–13CrossRefGoogle Scholar
  7. 7.
    Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT (2008) Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 18:593–598CrossRefGoogle Scholar
  8. 8.
    Seehofer D, Mogl M, Boas-Knoop S et al (2012) Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc 26(9):2541–2549.  https://doi.org/10.1007/s00464-012-2229-0 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lenihan J, Kovanda C, Commerano C (2004) Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. Am J Obstet Gynecol 190:1714–1722.  https://doi.org/10.1016/j.ajog.2004.02.059 CrossRefPubMedGoogle Scholar
  10. 10.
    Belloso A, Chidambaram A, Morar P, Timms MS (2003) Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 113(11):2010–2013CrossRefGoogle Scholar
  11. 11.
    Temple RH, Timms MS (2001) Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 61(3):195–198CrossRefGoogle Scholar
  12. 12.
    Polites N, Joniau S, Wabnitz D, Fassina R, Smythe C, Varley P et al (2006) Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 76(4):226–229CrossRefGoogle Scholar
  13. 13.
    Timms MS, Temple RH (2002) Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 116(6):450–452CrossRefGoogle Scholar
  14. 14.
    Burton MJ, Doree C (2007) Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 3:CD004619Google Scholar
  15. 15.
    Noon AP, Hargreaves S (2003) Increased postoperative haemorrhage seen in adult coblation tonsillectomy. J Laryngol Otol 117(9):704–706CrossRefGoogle Scholar
  16. 16.
    Back L, Paloheimo M, Ylikoski J (2001) Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study. Arch Otolaryngol Head Neck Surg 127(9):1106–1112CrossRefGoogle Scholar
  17. 17.
    Shah UK, Galinkin J, Chiavacci R, Briggs M (2002) Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Arch Otolaryngol Head Neck Surg 128(6):672–676CrossRefGoogle Scholar
  18. 18.
    Litta P, Fantinato S, Calonaci F et al (2010) A randomized controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy. Fertil Steril 94:1882–1886.  https://doi.org/10.1016/j.fertnstert.2009.08.049 CrossRefPubMedGoogle Scholar
  19. 19.
    Ivanov D, Babovic S, Selesi D, Ivanov M, Cvijanovic R (2007) Harmonic scalpel hemorrhoidectomy: a painless procedure? Med Pregl 60:421–426CrossRefGoogle Scholar
  20. 20.
    Shinhar S, Scotch BM, Benlenky W, Madgy D, Haupert M (2004) Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: an objective comparism. Ear Nose Throat J 83:712–715CrossRefGoogle Scholar
  21. 21.
    Kurzynski M, Szaleniec J (2008) Skladzien J [Harmonic scalpel tonsillectomypersonal experience and review of literature]. Otolaryngol Pol 62:561–566CrossRefGoogle Scholar
  22. 22.
    Walker RA, Syed ZA (2001) Harmonic scalpel tonsillectomy versus electrocautery tonsillectomy: a comparative pilot study. Otolaryngol Head Neck Surg 125:449–455CrossRefGoogle Scholar
  23. 23.
    Sood S, Corbridge R, Powels J, Bates G, Newbegin CJ (2001) Effectiveness of the ultrasonic harmonic scalpel for tonsillectomy. Ear Nose Throat J 80:514–516CrossRefGoogle Scholar
  24. 24.
    Akural EI, Koivunen PT, Teppo H, Alahuhta SM, Loponen HJ (2001) Posttonsillectomy pain: a prospective, randomized and double blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaethesia 56:1045–1050CrossRefGoogle Scholar
  25. 25.
    Schrey A, Pulkkinen J, Fremling C, Kinnunen I (2004) Ultrasonically activated scalpel compared with electrocautery in tonsillectomy. ORL J Otorhinolaryngol Relat Spec 66:136–140CrossRefGoogle Scholar
  26. 26.
    Gilbey P, Gadban H, Letichevsky V, Talmon Y (2008) Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study. Ann Otol Rhinol Laryngol 117:46–50CrossRefGoogle Scholar
  27. 27.
    Kamal SA, Basu S, Kapoor L, Kulandaivelu G, Talpalikar S, Papasthatis D (2006) Harmonic scalpel tonsillectomy: a prospective study. Eur Arch Otorhinolaryngol 263:449–454CrossRefGoogle Scholar
  28. 28.
    Collison PJ, Weiner R (2004) Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J 83:707–710CrossRefGoogle Scholar
  29. 29.
    Powell NB, Riley RW, Troell RJ, Blumen MB, Guilleminault C (1997) Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest 111(5):1348–1355CrossRefGoogle Scholar
  30. 30.
    Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN (2004) Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg 130(6):666–675CrossRefGoogle Scholar
  31. 31.
    Parsons SP, Cordes SR, Comer B (2006) Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 134(1):106–113CrossRefGoogle Scholar
  32. 32.
    Philpott CM, Wild DC, Mehta D, Daniel M, Banerjee AR (2005) A double-blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on postoperative symptoms. Clin Otolaryngol 30(2):143–148CrossRefGoogle Scholar
  33. 33.
    Arya A, Donne AJ, Nigam A (2003) Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain. Clin Otolaryngol Allied Sci 28(6):503–506CrossRefGoogle Scholar
  34. 34.
    Anonymous (2002) Interventional procedure overview of coblation tonsillectomy. Anonymous, LondonGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  • Soumik Basu
    • 1
  • Anindita Sengupta
    • 1
    Email author
  • Arya Brata Dubey
    • 1
  • Arunabha Sengupta
    • 1
  1. 1.Department of Ent Head Neck SurgeryInstitute of Postgraduate Medical Education ResearchKolkataIndia

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