A prospective double-blind randomized controlled trial comparing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery

Kothari, Prasad; Patel, Samir R.; Brown, P. Bhadra; O'Bara, Lynn; O’Malley, Stephanie S.

doi:10.1046/j.1365-2273.2002.00596.x

Cited by 22 publications

(20 citation statements)

References 11 publications

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“…PTH may have been reported as primary (generally defined as occurring within 24 hours of surgery), secondary (generally defined as occurring more than 24 hours postoperatively), or at an undefined or unspecified time. 8–108 Seventy-three studies contributed data to the meta-analysis (66 RCTs, 19,20,23,25,27,29,33,34,36,38–41,43,44,46,47,49,50,52–59,62–64,67,71,72,74–79,81–84,88–92,95,101–105,108–122 6 nonrandomized trials, 24,35,37,45,48,94 and 1 prospective cohort study 70 ). The resulting subset of studies included the following tonsillectomy techniques: cold dissection, electrocautery, coblation, harmonic scalpel, laser, molecular resonance, thermal welding, and microdebrider.…”

Section: Resultsmentioning

confidence: 99%

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Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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Objective To assess post-tonsillectomy hemorrhage (PTH), associated non-operative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and also conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was below 4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also below 5% overall (4.2% for total tonsillectomy; 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH occurred with tonsillectomy for obstructive sleep-disordered breathing than throat infection. In meta-analysis, frequency of PTH-associated non-operative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least four deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Though studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus we cannot conclude that a given technique is superior.

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Section: Resultsmentioning

confidence: 99%

“…PTH may have been reported as primary (generally defined as occurring within 24 hours of surgery), secondary (generally defined as occurring >24 hours postoperatively), or at an undefined or unspecified time. 8…”

Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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“…Few good randomized studies ( table 3 ) have compared laser tonsillectomies to other techniques [33][34][35][36] and although the PTB rates are not significantly different, they tend to be higher than the comparison group. Overall, there are few good reasons to select lasers as a tonsillectomy technique and disadvantages include cost, increased pain, and a prolonged healing phase.…”

Section: Surgical Technique: Other Methodsmentioning

confidence: 99%

Hemorrhage after Tonsillectomy: Does the Surgical Technique Really Matter?

Gysin

Dulguerov

2013

ORL

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A thorough review of the publications on surgical techniques used for tonsillectomy is provided, emphasizing randomized studies and meta-analysis. In the assessment of the data it is important to clearly define and categorize the types of posttonsillectomy bleeding (PTB), as well as the various factors that have been associated with increased PTB. In recent audits of a large number of tonsillectomies, the PTB rates seem to concur: 1% early and 2.5% delayed PTB; 10% anamnestic, 2% objective, and 2% re-operation PTB. Objective PTB rates beyond 10% should require an audit. The bipolar technique seems associated with the least early PTB, while the cold technique is associated with the least delayed PTB. Because of the lack of large well-conducted randomized trials, it is difficult to conclude which technique is the best. With electrocautery techniques, the current power should be adjusted to the minimal level providing hemostasis. Surgical techniques for tonsillectomy that should probably be abandoned include monopolar electrocautery, Coblation, various lasers, and the harmonic scalpel. Vesselsealing systems might hold promise and deserve further evaluation. Tonsillotomy might be associated with less postoperative pain, but the hemorrhagic advantage in randomized studies is not obvious. Tonsil regrowth rates and efficacy to treat obstruction need also further evaluation.

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“…Compared with standard dissection, the Harmonic scalpel method appears to be associated with less pain after surgery; compared with electrocautery, it seems to provide a reduction in pain throughout the postoperative recovery period [18]. In one of the largest prospective double-blind randomized controlled trial to date (151 patients) comparing KTP laser with standard dissection tonsillectomy, by Kothari et al [19], they found that there was significantly less peroperative haemorrhage if tonsillectomy was performed using the KTP laser, but it did caused more postoperative pain, more depression in mood and a higher rate of both reactionary and secondary haemorrhage, which was not significant when compared with conventional dissection and conclude that KTP laser tonsillectomy offers no benefit apart from less intraoperative bleeding over standard dissection tonsillectomy. In another study, Jackel et al [20], state that CO 2 LASER microsurgery improves the precision of tonsillectomy and provides a maximum protection for the peritonsillar tissue; the incidence of severe bleeding events being markedly reduced.…”

Section: Antibiotic Therapymentioning

confidence: 99%

Assessment of Operative Blood Loss and the Factors Affecting it in Tonsillectomy and Adenotonsillectomy

Prasad

2011

Indian J Otolaryngol Head Neck Surg

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To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the various factors affecting it. A prospective study of estimation of blood loss in 100 patients who underwent tonsillectomy and adenotonsillectomy. Data collected included the age, sex, operative indication, clotting time, Hb levels and usage of pre-operative antibiotics. Cold knife dissection method for tonsillectomy and curettage method for adenoidectomy were used. Measurement by calorimetric method of estimation being simple and accurate was used for estimation. Study undertaken at a tertiary referral hospital catering to an urban, semi-urban and rural populace. Blood loss was more in males and increases as age advances both in adenotonsillectomy and tonsillectomy. Blood loss was more in fibrosed tonsils, at lower hemoglobin levels and at higher clotting times. It was less in cases who received pre-operative antibiotics. The average blood losses in males and females during tonsillectomy were 106.91 and 96.26 ml respectively. In adenotonsillectomy, the average blood losses in males and females were 81.44 and 76.82 ml respectively. In our series we found that blood loss in tonsillectomy and adenotonsillectomy depended on various factors like age, sex, the type of tonsillitis, method of dissection, hemoglobin concentration, clotting time and the use of antibiotics. All these factors must be taken into consideration while taking up patients especially those who cannot tolerate blood loss, for surgery.

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A prospective double-blind randomized controlled trial comparing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery

Cited by 22 publications

References 11 publications

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Hemorrhage after Tonsillectomy: Does the Surgical Technique Really Matter?

Assessment of Operative Blood Loss and the Factors Affecting it in Tonsillectomy and Adenotonsillectomy

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