Intrapersonal randomized controlled trial comparing bipolar scissors and conventional cold tonsillectomy

Abstract

Objective: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy in the same patients, utilizing one technique on either side. Study design: Randomized controlled trial. Settings: The ENT day care unit of the Karolinska University Hospital at Danderyd Hospital, Stockholm. Patients: A total of 50 patients of which 49 were eligible (M/F 20/29), mean age 14.3 (4-41) years and included in the study. Thirty-one patients were operated due to upper airway obstruction and 18 for chronic tonsillitis. Outcome measures: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain and (4) complication rates, including postoperative primary and secondary hemorrhage. Methods: Modern cold technique; cold scissors, Henke tonsil elevator, bipolar diathermia. Hot technique; bipolar scissors (Ethicon, set on 20 W), bipolar diathermia if needed. Each side was completed separately. Blood loss and total operative time on each side were registered. Pain was evaluated daily on a visual analog scale, VAS (0-100 mm) in patients from 10 years of age. Results: Mean operative time for the conventional cold technique was 11.6 SD ± 8.5 (range 1.0-55 mins) and for the hot technique 3.1 SD ± 3.1 min (range 0.5-8.5 mins) (Wilcoxon-test, p < 0.001). The corresponding median values were 3 and 1.9 mins, respectively. The mean blood loss was 43.2 SD ± 41.7 ml (range 7-225 ml) vs 3.0 SD ± 4.7 ml (range 0-25 ml) (Wilcoxon-test p < 0.001). The corresponding median values were 30 and 1 ml respectively. No primary or secondary postoperative hemorrhages requiring surgical intervention occurred. There was no difference in pain. Conclusion: Tonsillectomy with bipolar scissors was almost four times faster and the blood loss significantly less than on the side operated with the conventional cold technique, whereas no difference in morbidity was found.