Harmonic scalpel versus bipolar tonsillectomy: a double-blind clinical trial

Abstract

This is a double bind clinical trial which evaluated harmonic scalpel versus bipolar diathermy tonsillectomy The study was conducted at Diyarbakir government hospital, Diyarbakir, Turkey. The study population comprised 144 patients, aged 4-18 years (mean 9 years ± 4.12 SD). All patients underwent tonsillectomy with or without adenoidectomy. The indications for tonsillectomy were obstructive sleep apnea (84 patients [58.3%]) and chronic tonsillitis (60 patients [41.7%]). All 144 patients were randomly divided into two groups: bipolar dissection (81 patients [56.2%] with mean age 8.98 years ± 4.22) and harmonic scalpel (63 patients [43.8%] with mean age 9 years ± 4.02). BD group showed statistically significantly less intraoperative bleeding (< 0.05). There was no statistically significant difference on postoperative day 1 but a statistically significant difference was determined on postoperative days 4, 7 and 14. There was no statistically significant difference between the two techniques with regard to immediate and delayed bleeding. The mean operative time was the same in both the groups. Bipolar dissection group showed statistically significant less intraoperative bleeding than harmonic scalpel group. An analysis of postoperative pain scores showed that the harmonic scalpel group pain scores are lower than the bipolar dissection group on all recorded days, and no statistically significant complications was seen in both groups. The results of this study indicate that the HS technique is associated with lower pain scores with the same complication rates as the BD technique.

Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study

“…Kemal et al found lower pain levels in the harmonic scalpel group [9]. As in the present study, Leaper et al on the other hand found no advantage of using harmonic scalpel [10].…”

“…Postoperative pain following other kinds of surgery have been reported to be lowered by the use of the harmonic scalpel [11–13]. Previous reports on the possible pain-reducing effect by the use of the harmonic scalpel for tonsillectomy show contradictory results [9, 14, 15]. …”

Anesthesiological considerations for children with obstructive sleep apnea

“…It has been shown that the degree postoperative pain relates in part to the surgical approach for tonsillectomy, for example, radiofrequency versus dissection versus guillotine versus microdebrider [33][34][35][36][37][38] with extensive use of electrocautery resulting in the most postoperative pain. A recent suggestion has been to perform partial tonsillectomy to reduce airway obstruction while avoiding complete tonsillectomy and thus significantly reducing postoperative pain and therefore reducing the need for postoperative opioids [36,39].…”

A comparison of the results of harmonic scalpel and cold knife tonsillectomy in pediatric patients

“…Tonsillektomi sonrasındaki ağrının genellikle elektrodiseksiyon ya da elektrokoagülasyon yöntemlerinin kullanıldığı hastalarda daha şiddetli olduğu bildirilmiştir. [16] Morgenstein ve ark.nın [10] yaptıkları çalışmada SB ve HB teknik ile tonsillektomi yapılan gruplar karşılaştırıldığında HB grubu hastalarının ek analjezi ihtiyacının oransal olarak daha fazla olduğu bildirilmiştir. Hastaların tek bir hekim tarafından yapılan ameliyat sonrası kontrolleri sırasında ise HB'nin SB'ye oranla daha yoğun peritonsiller ödeme neden olduğu belirtilmiştir.…”