COMPARISON OF NEEDLE-TIP MONOPOLAR AND COLD-KNIFE DISSECTION FOLLOWED BY BIPOLAR HEMOSTASIS TONSILLECTOMY: SIDE-BY-SIDE COMPARISON OF TECHNIQUES WITH RANDOMIZED, SINGLE-BLINDED AND PROSPECTIVE STUDY DESIGN
1Başkent Üniversitesi, İstanbul Hastanesi, KBB Bölümü, İstanbul, Turkey2Sağlık Bilimleri Üniversitesi, Okmeydanı Eğitim ve Araştırma Hastanesi, KBB Bölümü, İstanbul, Turkey Aim and Study Design: Comparison of different tonsillectomy interventions in terms of operation duration, postoperative pain, tonsillar fossa healing and postoperative hemorrhage rate. Study was randomised, prospective, single-blinded and controlled with side-by-side design. One side was operated with monopolar needle-tip electrocautery (MNE) and the other side was operated with cold-knife dissection followed by bipolar hemostasis (CKB).
Methodology: Patients with tonsiller hypertrophy and obstructive symptoms were enrolled in the study. Inclusion criteria consisted of patients aged 13-or-above who had tonsillar hypertrophy and obstructive symptoms that indicated tonsillectomy. Duration of dissection and duration of hemostasis was recorded; these two values were added to calculate the total operative duration for each side. Postoperative pain was evaluated with patient reported pain visual analogue scale (VAS) scores. Tonsillar fossa healing was evaluated single-blindedly.
Results: Total of forty-four tonsils were removed from twenty-two patients with a mean age of 26.5±11.6. Total time for removal of tonsil was shorter for CKB side, but hemostasis was shorter in MNE side. Total overall operative time required for surgery was significantly lower for MNE-operated side. Postoperative pain VAS scores on the MNE side was always lower compared to CKB side. Fossa healing scores were better on postoperative day #1 and #5 in MNE side compared to CKB side, but were similar on postoperative day #10. Postoperative hemorrhage rate was the same (4.5%, 1/22) for both interventions.
Conclusion: MNE is an affordable and cost-effective alternative. Utilization of MNE does not prolong surgical time. Postoperative pain is considerably lower compared to the latter technique. Therefore MNE can be a viable option for surgeons looking for affordable solutions to monopolar electrocautery.
Keywords : Tonsillectomy, cold-knife tonsillectomy, hot tonsillectomy, electrocautery, bipolar, needle-tipped monopolar cautery, visual analog scale, postoperative pain, duration of operation