Harmonic scalpel tonsillectomy: a prospective study

Area of Science:

• Otolaryngology
• Surgical Technology
• Minimally Invasive Surgery

Background:

• The harmonic scalpel tonsillectomy (HST) has been utilized for 5-6 years in Western Europe and North America.
• Despite some studies indicating superiority, its adoption in tonsillectomy remains limited.
• Conventional steel tonsillectomy (CST) often involves bipolar diathermy or ligatures for hemostasis.

Purpose of the Study:

• To evaluate intraoperative events and postoperative morbidity associated with harmonic scalpel tonsillectomy (HST).
• To compare HST with conventional steel tonsillectomy (CST) regarding operative time, blood loss, and pain.
• To assess the efficacy of HST in reducing secondary hemorrhage post-tonsillectomy.

Main Methods:

• A single-blinded prospective study involving 180 patients undergoing HST and 100 patients undergoing CST across two hospitals.
• Patients were randomized regardless of age, sex, medical history, or surgical indication.
• Comparison focused on surgical duration, intraoperative blood loss, and postoperative pain in subgroups (120 HST, 70 CST).

Main Results:

• Mean operative time for HST was comparable to CST.
• Intraoperative blood loss was significantly lower in the HST group.
• Postoperative pain was less severe in the HST group, with no major hemorrhages requiring surgical intervention.

Conclusions:

• Harmonic scalpel tonsillectomy (HST) demonstrates a significant advantage over conventional steel tonsillectomy (CST) in reducing secondary hemorrhage.
• HST is a safe and effective alternative, potentially superior to conventional methods for minimizing post-tonsillectomy bleeding.
• While CST with disposable blades mitigates Creutzfeldt-Jakob disease transmission risk, HST offers superior hemorrhage control.