Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a...

Area of Science:

• Otolaryngology
• Surgical Techniques
• Minimally Invasive Surgery

Background:

• Tonsillectomy is a common surgical procedure.
• Traditional cold dissection (CD) tonsillectomy carries risks of bleeding and prolonged operating times.
• The harmonic scalpel (HS) offers a potential alternative for tonsillectomy.

Purpose of the Study:

• To compare the efficacy and safety of harmonic scalpel (HS) tonsillectomy with curved shears against cold dissection (CD) tonsillectomy.
• To evaluate differences in operating time, intraoperative blood loss, and postoperative bleeding rates.
• To analyze age-specific outcomes for postoperative bleeding.

Main Methods:

• Retrospective chart review of 560 patients undergoing tonsillectomy.
• Comparison between 319 patients who underwent CD tonsillectomy (1998-1999) and 241 patients who underwent HS tonsillectomy (2001-2005).
• Stratification of patients by age (≤11 years vs. ≥12 years) to assess postoperative bleeding rates.

Main Results:

• HS tonsillectomy demonstrated significantly shorter operating times (7 min vs. 17.57 min) and lower intraoperative blood loss (0 mL vs. 42.12 mL) compared to CD tonsillectomy.
• No significant difference in overall postoperative bleeding rates between HS and CD groups.
• In patients aged 12 years and older, HS tonsillectomy showed a significantly higher postoperative bleeding rate (7.93%) than CD tonsillectomy (1%; p < .05).

Conclusions:

• Harmonic scalpel tonsillectomy using curved shears is advantageous for reducing operative time and intraoperative bleeding.
• For patients over 12 years old, HS tonsillectomy is associated with an increased risk of postoperative bleeding compared to CD tonsillectomy.
• Age stratification is crucial when evaluating postoperative bleeding risks associated with different tonsillectomy techniques.