Thulium laser versus cold steel tonsillectomy with bipolar electrocautery: a prospective pilot study in adult patients

Abstract

Objectives Multiple surgical techniques and instruments with their advantages and disadvantages have been described to minimize intraoperative hemorrhage and reduce the operation time, postoperative pain, and incidence of comorbidities in patients undergoing tonsillectomy. The aim of this pilot study was to compare the operation time, intraoperative and postoperative bleeding, postoperative pain and wound healing of the Thulium Revolix laser tonsillectomy method over the more commonly practiced cold steel tonsillectomy. Methods A prospective, single-blinded randomized pilot trial was conducted from February 2020 to March 2021. The inclusion criteria were adult persons with chronic recurrent tonsillitis. Twelve adult persons (7 males and 5 females) with chronic recurrent tonsillitis were observed and underwent tonsillectomy. All persons were Armenians with a mean age of 28.7 years. The persons were randomly assigned to have one tonsil removed with a Thulium RevoLix laser 200, and the conventional cold steel tonsillectomy method was used for the other side. The operation time for each side and intraoperational bleeding were evaluated. On the second, fifth, seventh and twelfth days, pain intensity was recorded using the numeric rating pain scale, and wound healing was assessed clinically. Results The tonsillectomy time from incision to hemostasis was 12.08 ± 0.77 min with the laser method and 12.08 ± 0.77 min with the cold dissection method, with no statistically significant difference (P < 0.121). Intraoperative blood loss in the cold dissection method was 10.92 ± 1.31 ml, and absolutely no blood loss was observed during laser treatment (p < 0.000, t = 8.363). The highest NRS pain scores were revealed on the second postoperative day, which slightly decreased over the next 12 postoperative days in both groups. In the cold steel tonsillectomy group, the pain score was significantly higher than that in the laser tonsillectomy group on the 7th and 12th postoperative days: 1.67 ± 0.33 via 4.00 ± 0.69 (P = 0.006) on the 7th postoperative day and 0.17 ± 0.11 via 2.67 ± 0.73 (P = 0.003) on the 12th postoperative day. Conclusion The use of the RevoLix 200 laser for tonsillectomy in the present pilot study of 12 patients showed significantly better outcomes than those in conventional cold dissection methods in terms of intraoperative bleeding, postoperative pain and wound healing; however, there was no statistically significant difference in other parameters, such as operational time and late postoperative bleeding. A large full-scale prospective study is needed to increase the generalizability and reliability of the results. Clinical trial registration: ISRCTN16280803 https://www.isrctn.com/ISRCTN16280803