Comparison of cold knife tonsillectomy versus thermal welding tonsillectomy in adults: a prospective trial

Amaç: Bu prospektif çalışmanın amacı soğuk bıçak ve termal welding ile tonsillektomi olmuş hastalarda ameliyat süresi ve postoperatif yakınmaları karşılaştırmaktı. Yöntem: Tonsillektomi olmuş 31 erişkin çalışmaya dahil edilmiştir. Hastanın bir bademciğine geleneksel tonsillektomi aynı hastanın diğer bademciğine termal welding tonsillektomi (TWT) uygulanmıştır. Ameliyat süresi, kaybedilen kan miktarı ve morbidite (postoperatif ağrı) kaydedilmiştir. Bulgular: Görsel Analog Skalasıyla değerlendirildiği gibi iki grup arasında birinci postoperatif gün farklı değildi. Geleneksel tonsillektomi grubuna göre TWT grubunda ağrı duyusu 2-14. günlerde anlamlı derecede daha düşüktü. Boğazda şişme ve yemek yemede zorluk duyusu geleneksel gruba göre TWT grubunda daha az olma eğiliminde olmasına rağmen farklılık istatistiksel açıdan anlamlı değildi. Postoperatif kanama açısından iki tonsillektomi tekniği açısından farklılık yoktu. Geleneksel tonsillektomi grubuna göre TWT grubunda ameliyat süresi daha kısa idi. Sonuç: Geleneksel tonsillektomiyle karşılaştırıldığında TWT postoperatif ağrıda azalma ve ameliyat süresinde anlamlı derecede kısalmayla sonuçlanmaktadır. Bu nedenle TWT'nin tonsillektomi işlemi olarak oldukça etkili olduğunu düşünmekteyiz.

Erişkinde soğuk bıçak tonsillektomi ve termal welding tonsillektominin karşılaştırılması: prospektif çalışma

Objective: The aim of this prospective study was to compare the duration and the postoperative complaints of the patients who had tonsillectomies with cold knife vs thermal welding. Methods: Thirty-one adults undergoing tonsillectomy were included. Traditional tonsillectomy was implemented in one tonsil, and thermal welding tonsillectomy (TWT) was implemented in other tonsil of the same patient. Duration of the operation, amounts of blood loss and morbidity (postoperative pain) were recorded. Results: Degree of pain, as assessed by Visual Analogue Scale, within the 1st postoperative day was not different between the two groups. Sensation of pain in 2nd-14th days were significantly lower in TWT group than in traditional tonsillectomy group. Although sensation of throat swelling and difficulty in eating tended to be lower in TWT group than in traditional tonsillectomy group, difference was not statistically significant. Although degree of ear ache on TWT side tended to be lower than traditional tonsillectomy side, difference was not statistically significant. In terms of postoperative hemorrhage, there was no difference between two tonsillectomy techniques. Duration of operation was significantly lower in TWT group than in traditional tonsillectomy group. Conclusion: TWT results in decreased postoperative pain and significantly shortened operation time compared to the traditional tonsillectomy. Therefore, we suggest that TWT is a quite effective in tonsillectomy procedure.

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1. Younis RT, Lazar RH. History and current practice of tonsillectomy. Laryngoscope 2012;112(8 Pt 2 Suppl 100):35.
2. Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:4502.
3. Belloso A, Chidambaram A, Morar P, Timms MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:20103.
4. Treat MR. A new thermal device for sealing and dividing blood vessels [accessed 2015 March 21]. Available from: http://www.starioninstruments.com/PDFs/Treat.pdf.
5. Curtin JM. The history of tonsil and adenoid surgery. Otolaryngol Clin North Am 1987;20:4159.
6. Kirazli T, Bilgen C, Midilli R, Ogut F, Uyar M, Kedek A. Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol 2005;262:7168.
7. Silveira H, Soares J S, Lima HA. Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 2003;67:34551.
8. Karatzias GT, Lachanas VA, Papouliakos SM, Sandris VG. Tonsillectomy using the thermal welding system. ORL J Otorhinolaryngol Relat Spec 2005;67:2259.
9. Karatzias GT, Lachanas VA, Sandris VG. Thermal welding ver- sus bipolar tonsillectomy: a comparative study. Otolaryngol Head Neck Surg 2006;134:9758.
10. Stavroulaki P, Skoulakis C, Theos E, Kokalis N, Valagianis D. Thermal welding versus cold dissection tonsillectomy: a prospective, randomized, single-blind study in adult patients. Ann Otol Rhinol Laryngol 2007;116:56570.
11. Sezen O, Kaytanc H, Kubilay U, Coﬂkuner T, Unver S. Comparison between tonsillectomy with thermal welding and the traditional cold tonsillectomy technique. ANZ J Surg 2008;78:10148.
12. Lee MS, Montague ML, Hussain SS. Post-tonsillectomy hemor- rhage: cold versus hot dissection. Otolaryngol Head Neck Surg 2004;131:8336.
13. Yasar H, Ozkul H, Verim A. Comparison of the thermal welding technique and cold dissection for pediatric tonsillectomy. Balkan Med J 2009;26:32630.
14. Yasar H, Ozkul H. Thermal welding technique versus cold dissection for adult tonsillectomy. B-ENT 2010;6:2514.