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Ultrasonically activated scalpel compared with electrocautery in tonsillectomy.
Aleksi Schrey1, Jaakko Pulkkinen, Christian Fremling
1Department of Otorhinolaryngology, Turku University Central Hospital, Turku, Finland. aleksi.schrey@tyks.fi
Summary
Ultrasonically activated scalpel (UAS) reduced operative bleeding during tonsillectomy but increased secondary bleeding. Monopolar diathermy (MPD) had higher primary bleeding rates compared to UAS and bipolar diathermy (BPD).
Area of Science:
- Otolaryngology
- Surgical Technology
- Minimally Invasive Surgery
Background:
- Tonsillectomy is a common surgical procedure.
- Postoperative bleeding is a significant complication.
- Various surgical techniques are employed to minimize bleeding and operative time.
Purpose of the Study:
- To compare the effectiveness of ultrasonically activated scalpel (UAS), bipolar diathermy (BPD), and blunt dissection with monopolar diathermy (MPD) in tonsillectomy.
- To evaluate the rates of primary and secondary postoperative bleeding.
- To assess the quantity of operative bleeding and the duration of the operation.
Main Methods:
- Retrospective analysis of 407 tonsillectomy patients.
- Comparison of three surgical techniques: UAS, BPD, and MPD.
- Data collected on primary/secondary bleeding, operative bleeding volume, and operation time.
Main Results:
- Ultrasonically activated scalpel (UAS) showed significantly less operative bleeding (24.8 ml) compared to MPD (58.7 ml) and BPD (43.8 ml).
- MPD had a higher incidence of primary bleeding (7.1%) than BPD (2.4%) and UAS (1.0%).
- UAS had a higher rate of secondary bleeding (19.6%) compared to MPD (14.5%) and BPD (14.5%), with longer average operation times (32.3 min).
Conclusions:
- Ultrasonically activated scalpel (UAS) offers minimal operative bleeding advantage in tonsillectomy but is associated with increased secondary bleeding and longer operation times.
- No significant overall advantage of UAS over MPD or BPD was found when considering all bleeding parameters and operation duration.
- The choice of surgical technique for tonsillectomy should balance the trade-offs between operative bleeding, postoperative bleeding rates, and procedure length.