Adolescents and Adults Undergoing Temperature-Controlled Surgical Instruments vs Electrocautery in Tonsillectomy

Abstract

IMPORTANCE Several temperature-controlled surgical instruments (TCSIs) have been used in tonsillectomy. However, to our knowledge, a meta-analysis of the differences between modern TCSIs and electrocautery (EC) has not been conducted. OBJECTIVE To compare TCSIs with EC with regard to the intraoperative and postoperative parameters of tonsillectomy.DATA SOURCES PubMed (MEDLINE), Embase, and the Cochrane Library were searched independently by 2 authors for relevant articles.STUDY SELECTION A literature search identified randomized clinical trials comparing the outcomes of TCSIs vs EC. The search keywords were harmonic scalpel, ultracision, PlasmaBlade, coblation, radiofrequency ablation, and tonsillectomy. Studies of adult and adolescent patients were included.DATA EXTRACTION AND SYNTHESIS Data from each study were extracted. A random-effects model was used in the pooled analysis.MAIN OUTCOMES AND MEASURES Four outcomes were analyzed: postoperative pain level on days 1, 2, 7, and 14 after surgery; postoperative bleeding; operative time; and intraoperative blood loss. RESULTSThis meta-analysis included 11 studies with a total of 629 unique patients. (Mean ages ranged from 16 to 55 years.) The studies were further categorized by the methods of comparison. Five articles used between-participant comparisons, and 6 used within-participant comparisons (of the left vs right sides of the participant's body). The pooled results of the studies with between-participant measures showed that postoperative pain scores were lower in the TCSI group on the first day (standardized mean differences [SMD], −0.41 [95% CI, −0.77 to −0.06]) and seventh day (SMD, −0.76 [95% CI, −1.47 to −0.04]). The pooled results of the studies with within-participant measures showed that the postoperative pain scores were lower in the TCSI group on the first day (SMD, −0.37 [95% CI, −0.63 to −0.12]) and second day (SMD, −0.60 [95% CI, −1.10 to −0.10]). The pooled analysis of overall bleeding, major bleeding, minor bleeding, primary bleeding, and secondary bleeding in both the types of studies with between-participant measures and those with within-participant measures showed no significant differences between the TCSI and EC groups. Intraoperative blood loss and operative time were not significantly different between the groups.CONCLUSIONS AND RELEVANCE Compared with EC, TCSIs were associated with significantly reduced pain on the first day after tonsillectomy, per this meta-analysis. The rates of overall bleeding, primary bleeding, secondary bleeding, major bleeding, and minor bleeding between TCSIs and EC were comparable. Intraoperative blood loss and operative time also showed no significant intergroup differences. Surgeons may consider using these modern instruments according to personal experiences, preferences, and cost-effectiveness criteria.

A novel electrosurgical divider: performance in a self-controlled tonsillectomy study

“…A potential explanation could be that adults tend to have more scar tissues, due to previous infections, and consequently, they require more "invasive" surgical techniques with "hot" cauterization [13]. Previous studies found that postoperative pain was reduced when temperature-controlled instruments were used [6]. An internal report conducted at Medtronic stated that the device generated less external heat compared to a monopolar electrosurgical device (79.6 ± 2.4 °C versus 123.9 ± 10.0 °C) [15].…”

“…Furthermore, the risk of secondary haemorrhage is well documented [4]. Temperature-controlled surgical instruments may cause less postoperative pain than conventional instruments, but reports on postoperative bleeding are inconsistent [5,6].…”

A single‐centre change of practice audit of pain after coblation intracapsular tonsillectomy compared to standard dissection tonsillectomy in a discrete pediatric population

“…A meta‐analysis 4 of pediatric studies considering pain after Coblation tonsillectomy vs DT identified only two studies with adequate pain data both of which are extracapsular rather than intracapsular coblation procedures. A meta‐analysis of adult tonsillectomy studies 5 compared multiple different cold techniques (including coblation) with hot techniques (cautery) unsurprisingly found more pain with hot techniques.…”

Cost-reduced engineering of functional biomedical products in Kenya: a case study on electrocautery pens

“…However, postoperative pain and other complications are reported to occur as a result of the high temperatures used (400-600 • C) and thus lower temperature tools have been developed, such as the Harmonic Scalpel and the PlasmaBlade. These work at lower temperatures than common electrocautery operating temperatures but still enable coagulation from temperaturs of 60 • C as they can operate at temperature ranges between 40-70 • C and 40-100 • C, respectively [7].…”