Lokman UZUN, Fikret ÇINAR, Mehmet Birol UĞUR, Levent Bekir BEDER, Metin YILMAZ

Traditional tonsillectomy versus radiofrequency dissection tonsillectomy in adults

Amaç: Amacımız geleneksel diseksiyon tonsillektomi (GLT) He radyofrekans tonsillektomiyi (RFT) postoperatif ağrı, operasyon süresi ve operasyondaki kan kaybı miktarı açısından karşılaştırmaktı. Yöntem: 15 tanesi RFT, 15 tanesi GLT grubuna ait olmak üzere 30 hastaya genel anestezi altında tonsillektomi yapıldı. '3.5' ayarında (17 watt) saf kesme ve koagulasyon modunda çalışmak üzere ayarlanmış iğne elektrottu radyofrekans cerrahi ünitesi (Surgitron FFPF 140 watt machine, Ellman Corporation, Hewlett New York) RFT grubunda tonsil soğuk diseksiyonu için kullanıldı. Postoperatif ağrı vizüel analog skalasıyla (VAS) değerlendirildi. VAS skorları ilk 24 saatte saat başı ve onuncu güne kadar günlük olarak kaydedildi. Operasyon süresi ilk keşiden entübasyon kanülünün çıkarılmasına kadar olan süre olarak belirlendi. İntraoperatif kanamayı değerlendirmek üzere aspire edilen kan hacmi ölçüldü. Bulgular: VAS skorları, operasyon süresi ve intraoperatif kanama açısından iki grup arasında istatiksel olarak anlamlı bir fark yoktu (p>0,05) ancak VAS skorları GLT grubunda daha iyiydi. RFT grubunda operasyon süresi daha kısaydı ve intraoperatif kanama daha az bulundu. Sonuç: Her iki yöntemin de güvenilir olduğu ve postoperatif ağrı, operasyon süresi ve intraoperatif kan kaybı miktarı açısından benzer sonuç verdikleri gözlendi. RFT tekniğinin, geleneksel tekniğe göre belirgin avantajlar taşıdığı gözlenmedi.

Erişkinlerde geleneksel tonsillektomiyle radyofrekans diseksiyon tonsillektominin karşılaştırılması

Purpose: To compare traditional dissection tonsillectomy (TRT) with radiofrequency dissection tonsillectomy (RFT) in terms of postoperative pain, intraoperative blood loss, and operation time. Methods: Thirty patients underwent elective tonsillectomy under general anesthesia. RFT was performed in 15 and TRT was performed in the remaining. A radiofrequency surgical unit (Surgitron FFPF 140 watt machine, Ellman Corporation, Hewlett New York) equipped with a needle electrode on pure cut and coagulate setting of about '3.5' (17 watts) was used for cold dissection of the tonsils in the RFT group. Postoperative pain was assessed by visual analog scale (VAS). The VAS scores were recorded every hour in the first 24 hours and daily until the 10th day. The operation time was regarded as the period between the first incision and extubation. The amount of blood in the suction container was considered the amount of intraoperative bleeding. Results: There was no significant difference between the groups regarding VAS scores, intraoperative bleeding, or operation time (p>0.05, c2 test). Conclusion: Both TRT and RFT techniques are safe and similar in terms of postoperative pain, operation time, and intraoperative blood loss. RFT does' not have any significant advantage over the traditional technique.

PDF

___

1 . Turner RI, Cohen RA. Voet RL, Stephens SR. Analysis of tisrue margins of cone biopsy speciemens obtained with cold knife, C02 and Nd:yag lasers and radiofrequency surgical unit. J Repr Med 1992; 24: 607.610,
2. Back L, Paloheimo M, Ylikokski J. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults. Arch Otolaryngol Head Neck Surg 2001: 127: 1106-11 12.
3. Brown JS. Radiosurgery: a new instrument for minor operations. Practitioner 1995; 239: 446-8.
4. Blomgrcn K, Qvarnberg YH. Valtonen HI. A prospective study on pros and cons of electrodinsection tonsillectomy. Laqmgoscope 2001: 11 1: 478-82.
5. Wcxlcr DB. Recovery after tonsillectomy: electrodissection vs. sharp dissection techniques. Otolaryngol Hcad Neck Surg 1996; 114: 576-81.
6. Silveira H. Soares JS. Lima HA. Tonsillectomv: cold dissection versus bipolar electmdissection. Int J Pediatr Otorhinolaryngol. 2003; 67: 345-51.
7. Pang YT. Paediatric tonsillectomy: bipolar electrodissectian and diasectionlsnare compared. J Laryngal Otal 1995; 109: 733-6.
8. Saito T, Honda N. Saim H. Advantage and disadvantage of KTP-532 laser tonsillectomy compared with conventional method. Auris Nasur Larynx 1999: 26: 447- 52.
9. Kothmi P, Patel S, Brown P, Obara L, 0 Malley S. A prospective double-blind randomized controlled trial compeing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery Clin Otolaryngol 2002; 27: 369-73.
10. Akural El, Koivunen PT, Teppo H. Alahuhta SM, Lopponen HI. Post-tonsillectomy pain: a prospective. randomised and double-blinded sNdv to commare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaesthesia 2001; 56: 1045-50.
11. Metternich N. Sagawski C, Wenzel S. Jake1 K. Tonsillectomy with the ultrasound activated scalpel. Initial results of technique with Ultracision Harmonic Scalpel. HNO 2001; 49: 465-70.
12. Haegner U. Handrock M. Schade H. "Ultrasound tonsillectomy" in comparison with conventional tonsillectomy. HNO 2002: 50: 836-43.
13. McAuliffc Curlin J. The history of tonsil and adenoid surgery, Otolaryngol Clin Nonh Am 1987: 20: 415.419.
14. Choy ATK, Su AP. Bipolar diathermy or ligation for hatmostasis? A prospective study on postoperative pain. 1. Lan.i n-~ ol0 to1 1992: 106: 21-22.
15. Calkins H. Langberg I. Sausa I, el-Afassi R, Leon A, Kou W, Kalbfleisch S. Morady F. Radiofrequency catheter ablattan of accessow auiovenuicular connections in 250 patients: abbreviated therapeutic approach to Wolff- Parkinson-While syndrome. Circulation 1992; 85: 1337- 1346.
16. Yoon KB, Wiles JR. Miles 10. N u d o TJ. Long-term outcome of percutaneous thermocoagulation for vlgeminal neuralgia. Anaesthesia 1999.54: 803-808.
17. Chapple CR, lssa MM. Woo H. Transurethral needle ablation (TUNA). Eur Uml 1999; 35: 119-128.
18. Allgaier HP, Delbm P, Zuber I, Olschewski M. Blum HE. Percutaneous radiofrequency interstitial thermal ablation of small hepatocellular carcinoma. Lancet 1999: 353: 1676-1677.
19. Powell NB. Riley RW, Troell RJ. Li K, Blumen MB. Guilleminault C. Radiofrequency volumeuic tissue reduction of the palate in subjects with sleep disordered breathing. Chest 1998: 113: 1163-1174.
20. Utley DS, Goode RL, Hakim I. Radiofrequency energy tissue ablation for treatment of nasal abstmctian secondary to furbinate hypemophy. Laryngorcape. 1999: 109: 683-686.
21. Powell NB. Riley RW. Guilleminault C. Radiofrequency tongue base reduction in sleep disordered breathing. Otolaryngol Head Neck Surg 1999; 120: 656-664.
22. Bridenstine JB. Use of ulbahigh frequency elecmsurgery (radiosurgery1 for cosmetic surgical procedures. Dermatol Surg 1998; 24: 397-UXl.