Laser Versus Cold Steel Dissection Tonsillectomy in Recurrent Acute Tonsillitis: A Systematic Review and Meta-Analysis

Abstract

Objectives: Severe recurrent acute tonsillitis (RAT) is commonly treated by removing the palatine tonsils, namely tonsillectomy (TE). Laser TE has been suggested as an alternative to cold steel dissection, although its efficacy and safety for the surgical treatment of RAT remain unclear. Therefore, we conducted a systematic review and meta-analysis comparing laser TE to cold steel dissection TE in patients with RAT. Methods: We systematically searched PubMed, Embase, and Cochrane Central for eligible studies. Outcomes of interest were intraoperative blood loss, operation time, quality of life, postoperative pain, and postoperative hemorrhage. Subgroup and sensitivity analyses were performed. RStudio v4.1.0 and Review Manager v5.4 were used for statistical analysis. A prospective protocol was registered in PROSPERO (CRD42024533742). Results: Nine studies, including six randomized trials, met eligibility criteria, comprising 612 patients with RAT. In total, 1224 tonsils were excised; 612 (50%) were submitted to laser TE, and the remaining to cold steel dissection. Laser was associated with lower intraoperative blood loss (mean difference [MD] −35.89; 95% confidence interval [CI] [−53.08, −18.71]; p < 0.01; I² = 100%) and operation time (MD −10.46; 95% CI [−16.63, −4.29]; p < 0.01; I² = 99%). No significant differences between interventions were found in postoperative pain, quality of life, or postoperative hemorrhage. Conclusions: In patients with RAT, laser TE yielded reduced intraoperative blood loss and operation time, with comparable hemorrhage risk, postoperative pain, and quality of life to cold steel dissection. Yet, the occurrence of post-surgery sore throat remains uncertain, highlighting the need for further randomized trials reporting long-term outcomes after tonsil surgery.