HÜSAMETTİN YAŞAR, Haluk ÖZKUL, Ayşegül VERİM

Comparison of the thermal welding technique and cold dissection for pediatric tonsillectomy

Amaç: Çocuk tonsillektomisinde thermal welding tekniği (TWT) ile soğuk diseksiyon tekniğini (SDT) karşılaştırmak. Hastalar ve Yöntemler: Kronik tonsillit ve/veya üst solunum yolu tıkanıklığı olan 50 çocuk TWT veya SDT grupları için ardışık olarak ayrıldı. Yaş, cinsiyet, ameliyat süresi, ameliyat esnasındaki hemostaz yöntemi, ameliyat sonrası erken dönemdeki ağrı, normal yemeğe geçiş süresi ve ameliyattan sonraki 10. günde tonsillar fossanın iyileşme durumu değerlendirildi. Bulgular: Ameliyat esnasındaki hemostaz bakımından TWT SDT'ye göre önemli oranda daha iyiydi (p=0.0001). Ortalama normal yemeğe geçiş süresi SDT grubuna göre TWT grubunda daha iyiydi (p=0.015). Ancak bu fark klinik olarak anlamlı değildi. Ameliyat sonrası erken dönemdeki ağrı (p=0.542) ve ameliyatın onuncu gününde tonsillar fossanın iyileşmesi (p=0.152) bakımından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Cerrahi girişimin süresi SDT grubunda önemli oranda daha kısaydı (p=0.001). Sonuç: Ameliyat esnasındaki hemostaz bakımından TWT'nin SDT'ye göre tonsillektomide daha etkili olduğu saptandı.

Anahtar Kelimeler:

Çocuk, Tonsillektomi, Ameliyat sonrası dönem, Hemostaz, cerrahi, Ağrı

Çocuk tonsillektomisinde thermal welding tekniği ile soğuk diseksiyon tekniğinin karşılaştırılması

Objectives: To compare the thermal welding technique (TWT) with cold dissection (CD) for pediatric tonsillectomy. Patients and Methods: Fifty consecutive children with chronic tonsillitis and/or upper airway obstruction were alternately assigned to the TWT or CD group. Age, gender, operation time, intraoperative hemostasis method, early postoperative pain, time to regain normal diet, and extent of healing of the tonsillar fossa on the tenth postoperative day were evaluated. Results: Thermal welding technique was significantly better than CD with regard to intraoperative hemostasis (p=0.0001). The mean time to regain normal diet was significantly shorter in the TWT group compared to the CD group (p=0.015); however, this difference was not clinically relevant. There were no statistically significant difference between the groups in early postoperative pain score (p=0.542) and healing of the tonsillar fossae on the tenth day of the surgery (p=0.152). Duration of the surgical procedure was significantly shorter in the CD group (p=0.001). Conclusion: Thermal welding technique was found to be effective for tonsillectomy than CD in terms of intraoperative hemostasis.

Keywords:

Child, Tonsillectomy, Postoperative Period, Hemostasis, Surgical, Pain,

PDF

___

1) Shah UK, Galinkin J, Chiavacci R, Briggs M. Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Arch Otolaryngol Head Neck Surg 2002;128:672-6.
2) Prokopakis EP, Lachanas VA, Benakis AA, Helidonis ES, Velegrakis GA. Tonsillectomy using the Ligasure vessel sealing system. A preliminary report. Int J Pediatr Otorhinolaryngol 2005;69:1183-6.
3) Kirazli T, Bilgen C, Midilli R, Ogüt F, Uyar M, Kedek A. Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol 2005;262:716-8.
4) Lassaletta L, Martín G, Villafruela MA, Bolaños C, Alvarez-Vicent JJ. Pediatric tonsillectomy: post-operative morbidity comparing microsurgical bipolar dissection versus cold sharp dissection. Int J Pediatr Otorhinolaryngol 1997;41:307-17.
5) Raut VV, Bhat N, Sinnathuray AR, Kinsella JB, Stevenson M, Toner JG. Bipolar scissors versus cold dissection for pediatric tonsillectomy--a prospective, randomized pilot study. Int J Pediatr Otorhinolaryngol 2002;64:9-15.
6) Karatzias GT, Lachanas VA, Papouliakos SM, Sandris VG. Tonsillectomy using the thermal welding system. ORL J Otorhinolaryngol Relat Spec 2005;67:225-9.
7) Shapiro NL, Bhattacharyya N. Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 2007;117:406-10.
8) Treat MR. A new thermal device for sealing and dividing blood vessels. Available from: http://www. starioninstruments.com/PDFs/Treat.pdf
9) Weinstock BI. An improved method for tonsillectomy using thermal welding technology. Available from: http://www.starioninstruments.com/PDFs/ Tonsil.pdf
10) Nunez DA, Provan J, Crawford M. Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial. Arch Otolaryngol Head Neck Surg 2000;126:837-41.
11) Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol 2000;52:239-46.
12) Silveira H, Soares JS, Lima HA. Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 2003;67:345-51.
13) von Baeyer CL. The Faces Pain Scale - Revised (English, French and 33 other languages). Available from: http://www.painsourcebook.ca/docs/pps92. html
14) Karatzanis AD, Bourolias CA, Prokopakis EP, Panagiotaki IE, Velegrakis GA. Tonsillectomy with thermal welding technology using the TLS(2) thermal ligating shear. Int J Pediatr Otorhinolaryngol 2007;71:999-1002.
15) Windfuhr JP, Chen YS. Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients. Ear Nose Throat J 2002;81:626-8.
16) Karatzanis A, Bourolias C, Prokopakis E, Panagiotaki I, Velegrakis G. Thermal welding technology vs ligasure tonsillectomy: a comparative study. Am J Otolaryngol 2008;29:238-41.
17) Chimona T, Proimos E, Mamoulakis C, Tzanakakis M, Skoulakis CE, Papadakis CE. Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children. Int J Pediatr Otorhinolaryngol 2008;72:1431-6.