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Technical optimization in adenotonsillar surgery: A practical narrative review of strategies to improve surgical
Joan Lorente-Piera1, Francisco Javier Cervera-Paz1
1Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.
Objective:
To critically synthesize and integrate intraoperative technical strategies designed to optimize visualization, surgical exposure, tissue protection, and/or hemostatic control during adenotonsillar surgery.
Methods:
A structured narrative review was conducted using PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library to identify studies published between January 1996 and May 2026. The search strategy combined MeSH terms and free-text keywords related to adenotonsillectomy, operative visualization, surgical exposure, hemostasis, tissue protection, microscopy, endoscopy, and suction-assisted techniques. Following title and abstract screening and full-text assessment, 38 studies were included in the final qualitative synthesis.
Results:
The available evidence indicates that multiple complementary intraoperative strategies can improve operative precision and surgical safety during adenotonsillar surgery. Microscope- and endoscope-assisted techniques enhance anatomical visualization, facilitate targeted hemostasis, and improve the identification of residual lymphoid tissue and occult bleeding sites. Cheek expanders and modified retraction systems increase transverse surgical exposure and improve instrument maneuverability. Protective measures, including salivary cotton rolls and moist gauze, may reduce pressure- and thermal-related mucosal injury involving the oral commissures, uvula, and posterior pharyngeal wall. Mirror-assisted visualization and soft palate retraction using a Nelaton catheter optimize nasopharyngeal inspection during adenoidectomy. Additional hemostatic measures, including topical vasoconstrictors, gauze packing, warm saline irrigation, continuous suction, and suction coagulation, may reduce intraoperative bleeding while minimizing unnecessary thermal injury.
Conclusions:
Optimizing adenotonsillar surgery extends beyond the choice of surgical device. Simple, inexpensive, and reproducible technical modifications can substantially improve visualization, surgical exposure, hemostatic control, tissue preservation, and operative ergonomics, thereby contributing to safer, more standardized, and potentially more effective surgical procedures.
