Harmonic scalpel tonsillectomy versus bipolar electrocautery and cold dissection

ABSTRACT

The aim of this study is to compare total tonsillectomy by harmonic scalpel [TTH] with bipolar Electrocautary [TTE] and cold dissection in children with chronic tonsillar hypertrophy. Patients were selected from Dar Al Shifa hospital, Kuwait, complaining of recurrent attacks of acute tonsillitis with possible snoring and obstructive sleep apnea. Twenty children with chronic tonsillitis who underwent harmonic scalpel tonsillectomy [TTH] were compared with twenty children who underwent tonsillectomy with bipolar Electrocautary [TTE] and twenty children with cold dissection from January to December of 2008. The main parameters included Surgical time, estimated blood loss, Postoperative pain, hospital stay and postoperative complications. 60 children were evaluated in this study, 42 [70%] males and 18 [30%] females. TTH group had shorter operating time [[mean 7.1 mm], than the TTE group [mean 7.7 min] or the cold dissection group [mean 11.3 mm]. intra-operative bleeding is significantly reduced in TTH group [mean 6.3ml] than TTE group [mean 8.3 ml] or the cold dissection group [mean 10, 7 ml]. postoperative pain score reduced in the TTH group [1st day mean 3.6 and 1st week mean 2.4] than the TTE group [1st day mean 4.7 and 1st week mean 2.9] or the cold dissection group [1st day mean 4.1 and 1st week mean 2.6]. Postoperative bleeding reduced in the TTH group [0%], than the TTE group [10%] or the cold dissection group [5%].Use of the Harmonic scalpel for tonsillectomy may have several advantages over standard methods like electrocautery or cold dissection. lntraoperative blood loss and episodes of postoperative hemorrhages have been found to be minimal in patients in whom the harmonic scalpel was used for tonsillectomy. The device also appears to be associated with a reduction in operating time and postoperative pain