Harmonic scalpel versus electrocautery tonsillectomy: a comparative study in adult patients

To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.

Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.

The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes; p<0.05). The mean intra operative blood loss was less in HS group (EC 3.43 +/- 3.42 ml Vs HS 2.40 +/- 2.74 ml; p =0.10). Post operative pain was significantly lower in harmonic scalpel group as compared to electrocautery group on 1st, 2nd and 3rd postoperative day (p < 0.05). From 3rd postoperative day onwards, although harmonic scalpel group was slightly better in terms of pain on visual analog scale but it was not statistically significant. Secondary haemorrhage after tonsillectomy was less in HS (EC 10% Vs HS 3%; p=0.61).

Except lesser pain score in early postoperative period, the harmonic scalpel does not provide a major benefit over the more traditional method of electrocautery tonsillectomy.