Harmonic scalpel versus bipolar tonsillectomy: a double-blind clinical trial

Area of Science:

• Otolaryngology
• Surgical Technology
• Pediatric Surgery

Background:

• Tonsillectomy is a common surgical procedure for conditions like obstructive sleep apnea and chronic tonsillitis.
• Choosing the appropriate surgical technique is crucial for optimizing patient outcomes and minimizing complications.
• Harmonic scalpel and bipolar diathermy are two frequently used methods for tonsillectomy, each with distinct characteristics.

Purpose of the Study:

• To compare the efficacy and safety of harmonic scalpel versus bipolar diathermy tonsillectomy in a pediatric population.
• To evaluate differences in intraoperative bleeding, operative time, postoperative pain, and complications between the two techniques.

Main Methods:

• A double-blind clinical trial involving 144 patients aged 4-18 years undergoing tonsillectomy.
• Patients were randomly assigned to either the bipolar dissection (BD) group or the harmonic scalpel (HS) group.
• Data collected included intraoperative bleeding, operative time, postoperative pain scores on multiple days, and complication rates.

Main Results:

• The bipolar dissection group exhibited significantly less intraoperative bleeding compared to the harmonic scalpel group (p < 0.05).
• Postoperative pain scores were significantly lower in the harmonic scalpel group on postoperative days 4, 7, and 14, but not on day 1.
• There were no statistically significant differences in immediate or delayed bleeding, operative time, or overall complication rates between the two groups.

Conclusions:

• The harmonic scalpel technique is associated with reduced postoperative pain in pediatric tonsillectomy compared to bipolar diathermy.
• Both techniques demonstrate similar safety profiles regarding bleeding and complications.
• The choice between harmonic scalpel and bipolar diathermy may depend on balancing the need for reduced intraoperative bleeding with the goal of minimizing postoperative pain.