Skip to main content

Advertisement

SpringerLink
Log in

Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage

  • Head & Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To compare the tonsillectomy operations performed with bipolar radiofrequency clamp (BRC), plasma blade (PB), and cold dissection (CD) techniques in terms of postoperative pain and collateral tissue damage.

Methods

This is a prospective randomized comparative cohort study conducted in a tertiary hospital. A total of 50 patients who underwent tonsillectomy in our institution met the inclusion criteria. Based on the tonsillectomy technique, patients were randomly divided into 3 groups as BRC (CURIS®) (n:20), PB (PEAK Surgical) (n:20), and CD (n:10). The patients were given a visual analog scale (VAS) for pain evaluation on the 1st postoperative day (3rd h) and on the 3rd and 6th days after discharge. The deepest and the most superficial necrosis depths were examined under the light microscope (Olympus BX53, Japan) by the same single blinded pathologist.

Results

The age of the patients included in the study ranged from 5 to 45 years. The mean age was 14.5 years. Twenty-four of the patients were female, 26 were male. Mean 3rd h and 3rd day VAS scores for pain in the BRC group were significantly higher than the other two groups (p < 0.001). Although PB group had higher VAS scores compared with CD group, the difference was not significant (p > 0.05). The deepest necrosis depths (dND) in patients who were operated with BRC was significantly greater compared to patients operated with PB (p < 0.01), whereas no significant difference was observed between the techniques regarding the most superficial necrosis depth (msND) (p > 0.05). For patients operated with CD technique, only ischemic fields were observed.

Conclusion

Both BRC and PB techniques seem to not provide significant advantage compared with conventional CD technique in terms of postoperative pain. Necrosis depths in tonsillectomy specimens due to thermal damage positively correlate with the postoperative pain level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Leinbach RF, Markwell SJ, Colliver JA, Lin SY (2003) Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 129:360–364

    Article  PubMed  Google Scholar 

  2. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al (2011) Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 144:S1–S30

  3. D'Eredità R1, Bozzola L (2009) Molecular resonance vs. coblation tonsillectomy in children. Laryngoscope 119:1897–1901

  4. Bhattacharyya N, Kepnes LJ (2014) Revisits and postoperative hemorrhage after adult tonsillectomy. Laryngoscope 124:1554–1556

    Article  PubMed  Google Scholar 

  5. Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ (2017) Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 8:CD004619

  6. Thottam PJ, Christenson JR, Cohen DS, Metz CM, Saraiya SS, Haupert MS (2014) The utility of common surgical instruments for pediatric adenotonsillectomy. Laryngoscope 125:475–479

    Article  PubMed  Google Scholar 

  7. Spektor Z, Kay DJ, Mandell DL (2016) Prospective comparative study of pulsed-electron avalanche knife (PEAK) and bipolar radiofrequency ablation (coblation) pediatric tonsillectomy and adenoidectomy. Am J Otolaryngol 37:528–533

    Article  PubMed  Google Scholar 

  8. Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ (2009) Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970–2005. Otolaryngol Head Neck Surg 140:894–901

    Article  PubMed  Google Scholar 

  9. Galindo Torres BP, De Miguel García F, Whyte Orozco J (2018) Tonsillectomy in adults: Analysis of indications and complications. Auris Nasus Larynx 45:517–521

    Article  PubMed  Google Scholar 

  10. Chimona T, Proimos E, Mamoulakis C, Tzanakakis M, Skoulakis CE, Papadakis CE (2008) Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children. Int J Pediatr Otorhinolaryngol 72:1431–1436

    Article  CAS  PubMed  Google Scholar 

  11. Sutters KA, Isaacson G (2014) Posttonsillectomy pain in children. Am J Nurs 114:36–42 (quiz 43)

  12. Elinder K, Söderman AC, Stalfors J, Knutsson J (2016) Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol 273:2249–2256

    Article  PubMed  Google Scholar 

  13. Tan GX, Tunkel DE (2017) Control of pain after tonsillectomy in children: a review. JAMA Otolaryngol Head Neck Surg 143:937–942

    Article  PubMed  Google Scholar 

  14. Windfuhr JP, Toepfner N, Steffen G et al (2016) Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 273:989–1009

    Article  Google Scholar 

  15. Alexiou VG, Salazar-Salvia MS, Jervis PN, Falagas ME (2011) Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg 137:558–570

    Article  PubMed  Google Scholar 

  16. Ozkul MH, Bayram O, Balikci HH, Karakas M, Bayram AA, Gurdal MM, Chatzi T (2014) Impedance-controlled radiofrequency vs. cold dissection tonsillectomy. B-ENT 10:285–289

  17. Philpott CM, Wild DC, Mehta D, Daniel M, Banerjee AR (2005) A double-blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post-operative symptoms. Clin Otolaryngol 30:143–148

    Article  CAS  PubMed  Google Scholar 

  18. Polites N, Joniau S, Wabnitz D, Fassina R, Smythe C, Varley P, Carney AS (2006) Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 76:226

  19. Mitic S, Tvinnereim M, Lie E, Saltyte BJ (2007) A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 32:261–267

    Article  CAS  PubMed  Google Scholar 

  20. Metcalfe C, Muzaffar J, Daultrey C, Coulson C (2017) Coblation tonsillectomy: a systematic review and descriptive analysis. Eur Arch Otorhinolaryngol 274:2637–2647

    Article  PubMed  Google Scholar 

  21. Timms MS, Temple RH (2002) Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 116:450–452

    Article  CAS  Google Scholar 

  22. Wiltshire D, Cronin M, Lintern N, Fraser-Kirk K, Anderson S, Barr R, Bennett D, Bond C (2018) The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques. J Laryngol Otol 132:240–245

    Article  CAS  PubMed  Google Scholar 

  23. Shah UK, Dunham B (2007) Coblation for tonsillectomy: an evidence-based review. ORL J Otorhinolaryngol Relat Spec 69:349–357

    Article  PubMed  Google Scholar 

  24. Magdy EA, Elwany S, el-Daly AS, Abdel-Hadi M, Morshedy MA (2008) Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 122:282–290

Download references

Funding

The authors have no funding to disclose.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Ergani State Hospital, Ministry of Health, Diyarbakır, Turkey

    Mehmet Fatih Boğrul

  2. Department of Otorhinolaryngology–Head and Neck Surgery, Samsun Training and Research Hospital, University of Medical Sciences, Ministry of Health, Samsun, Turkey

    Asude Ünal & Mehmet Eser Sancaktar

  3. Department of Otorhinolaryngology–Head and Neck Surgery, Bozyaka Training and Research Hospital, University of Medical Sciences, Ministry of Health, İzmir, Turkey

    Fatih Yılmaz

  4. Department of Pathology, Samsun Training and Research Hospital, University of Medical Sciences, Ministry of Health, Samsun, Turkey

    Mustafa Bakırtaş

Authors
  1. Mehmet Fatih Boğrul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Asude Ünal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatih Yılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Eser Sancaktar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mustafa Bakırtaş
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Eser Sancaktar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All patients were informed about their disease and its treatment, and the surgical method to be applied was explained in detail. All patients provided informed consent.

Human and animal rights statement

The study has been performed according to the ethical standards of the Helsinki Declaration. We declare that all authors have contributed to it, read and approved the final manuscript for submission.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boğrul, M.F., Ünal, A., Yılmaz, F. et al. Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage. Eur Arch Otorhinolaryngol 276, 2061–2067 (2019). https://doi.org/10.1007/s00405-019-05464-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05464-y

Keywords

Search

Navigation