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Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar
Udayan K Shah1, Jeffrey Galinkin, Rosetta Chiavacci
1Division of Otolarynology, The Children's Hospital of Philadelphia and Department of Otolaryngology-Head and neck Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. shah@email.chop.edu
Objective:
To compare plasma-mediated ablation (PMA) with monopolar electrosurgery (MES) for pediatric tonsillectomy.
Design:
Prospective, randomized, blinded study.
Setting:
Academic children's hospital.
Participants:
Thirty-four children, aged 4 to 7 years.
Interventions:
Tonsillectomy by means of PMA (n = 17) or MES (n = 17).
Outcome Measures:
We measured surgical efficacy, estimated blood loss, and surgical time during tonsillectomy and morphine use, immediate postoperative pain, and recovery scores after tonsillectomy. Parents recorded recovery of normal diet and activity and their own return to work for 10 days after surgery. Histopathologic evaluation of excised tonsils was performed. We reviewed medical records and attempted follow-up telephone contact.
Results:
With no significant difference in blood loss compared with MES, PMA was effective for tonsillectomy. Performance of PMA took longer (24 vs 16 minutes; P =.002). Results of histopathologic evaluation showed less thermal injury with PMA than with MES (P =.03). Morphine consumption, pain, and recovery scores were equivalent between groups. We found no significant difference in recovery of normal diet and activity or parental return to work. Patients undergoing PMA had a greater number of perioperative complications than those undergoing MES, including 2 patients in the PMA group (compared with none in the MES group) who required unplanned admission for postoperative airway obstruction.
Conclusions:
Plasma-mediated ablation for pediatric tonsillectomy resulted in less histopathologic thermal injury than MES, but did not show a statistically faster recovery to normal activity and diet or parental return to work. In addition, PMA took longer to perform, and had more complications. Therefore, PMA should not replace MES for pediatric tonsillectomy. The reduced thermal injury with PMA supports investigation into other means of using plasma ablation to treat tonsillar hypertrophy.