双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

Pediatric intracapsular tonsillectomy with bipolar electrosurgical scissors

This article describes the benefits of performing intracapsular tonsillectomy with bipolar electrosurgical scissors as an alternative to the powered microdebrider These scissors are used to excise approximately 90% of the tonsillar mass en bloc. The remaining tonsillar tissue is electrodesiccated by monopolar suction cautery, while the anterior and posterior pillars are completely preserved. The procedure leaves a smaller surgical wound than do extracapsular techniques. Surgical time averages 6 minutes. There is typically no intraoperative blood loss. Bipolar electrosurgical scissors are an efficient and low-cost tool for performing pediatric intracapsular tonsillectomy.     

双极电凝在全身麻醉下扁桃体摘除术中的应用

目的 探讨双极电凝在全身麻醉下扁桃体摘除术中的应用效果。方法 全身麻醉下采用双极电凝、单极电刀与传统剥离法实施扁桃体摘除,三种术式共实施扁桃体摘除65例。比较各术式对应的手术时间、术中出血量及术后并发症、疼痛程度及恢复时间。结果 用双极电凝镊行扁桃体摘除在包埋型扁桃体、扁桃体周围明显粘连患者中与单极电刀及传统的剥离法扁桃体摘除相比,术时短,术中出血少,术后并发症发生率低。结论 全身麻醉下,采用双极电凝扁桃体摘除手术尤其适用于包埋型扁桃体以及扁桃体周围明显粘连的患者。     

低温等离子刀对比双极电凝镊在扁桃体切除术中治疗效果观察

目的分析变应性鼻炎(AR)患者接受鼻腔冲洗治疗的临床疗效。方法将2019年6月~2020年8月作为研究时间段,选取期间我院接诊的78例AR患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入39例)、研究组(加用鼻腔冲洗治疗,纳入39例),对组间气道反应性、症状消失时间展开分析。结果(1)组间气道反应性指标在治疗前无明显差异,P>0.05;研究组共振频率(Fres)、中心气道阻力(R20)、气道总阻力(R5)在治疗后低于对照组,P<0.05;(2)研究组鼻塞、流涕、喷嚏、鼻痒消失时间均少于对照组,P<0.05。结论鼻腔冲洗对改善AR患者气道反应、临床症状均有明显效果,值得推广。     

Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study

OBJECTIVES: To assess the morbidity and efficacy of bipolar radiofrequency thermal ablation tonsillectomy and compare it with traditional cold dissection tonsillectomy with diathermy hemostasis. DESIGN: Prospective, randomized, single-blinded, controlled clinical study. SETTING: Helsinki University Central Hospital, Department of Otorhinolaryngology-Head & Neck Surgery, Helsinki, Finland. PATIENTS: Forty healthy volunteer patients aged 18 to 65 years admitted for elective tonsillectomy with recurrent or chronic tonsillitis, obstructive tonsillar hypertrophy, or history of quinsy. Two patients were excluded from the study and 1 patient cancelled the operation. INTERVENTIONS: Nineteen patients underwent a traditional cold dissection tonsillectomy with diathermy hemostasis, and 18 patients underwent a bipolar radiofrequency thermal ablation tonsillectomy. There was no intergroup difference in age, sex, weight, and indications for tonsillectomy. The subjects were not informed of the type of procedure until the telephone interview 3 weeks after the operation. MAIN OUTCOME MEASURES: Operating time and intraoperative blood loss; need for anesthetics during the operation; different recovery indicators in the recovery room (ie, duration and medications administered), surgical ward (ie, medications administered, use of corticosteroids, general condition, and status of the uvula on the first postoperative day), and in the 2 weeks following surgery (ie, visual analog scale scores on 6 symptoms, medications needed, the day patients returned to work, use of antibiotics, and retreatment acceptance); and complications and certain laboratory parameters. RESULTS: There was a statistically significant but clinically insignificant difference in operating time and intraoperative blood loss in favor of the traditional tonsillectomy group. The other outcome measures showed no statistically significant differences. CONCLUSION: Bipolar radiofrequency thermal ablation and traditional tonsillectomy were associated with similar postoperative morbidity.     

Subtotal bipolar tonsillectomy does not decrease postoperative pain compared to total monopolar tonsillectomy

OBJECTIVE: To determine whether a subtotal bovie tonsillectomy decreases postoperative pain following adenotonsillectomy. METHODS: A prospective, randomized, double-blinded clinical trial was undertaken at a University Pediatric Children's Hospital and included 39 otherwise healthy children, aged 2-12 years, undergoing adenotonsillectomy. Patients were randomized to receive either a subtotal or total removal of the tonsils utilizing an electrocautery technique. The main outcome measures included a visual analog scale (VAS) at rest and while eating, time to take 100 cm(3) of fluid, throat, neck, and ear pain, quantity of liquids, activity level and incidence of emesis and retching. RESULTS: A repeated measures analysis using a repeated measures ANOVA failed to demonstrate a statistically significant impact with either treatment for VAS at rest or while eating (p=0.52 and 0.48, respectively). A repeated measures analysis did not show either procedure significantly affecting throat, neck or ear pain, or liquid quantity. Time to take 100 cm(3) liquids and the incidence of emesis or retching were found not to be statistically significantly different between the treatment groups. CONCLUSION: Subtotal tonsillectomy via an electrocautery technique does not reduce postoperative pain or improve outcome parameters. Subtotal tonsillectomy with this technique is not recommended for this patient population.     

A prospective randomised single blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy

OBJECTIVE: To compare the differences in pain, analgesic use and bleeding in children after tonsillectomy using either a harmonic scalpel or a bipolar diathermy surgical technique. METHODS: Children 6-15 years presenting for tonsillectomy were randomised to either a harmonic scalpel or bipolar diathermy surgical technique. Post-operative pain scores (VAS, 0-10) were recorded within 30 min of surgery and again at the 4h hospital discharge. A subsequent telephone interview daily for 7 days and then every second day until day 13 was used to monitor pain scores, analgesic use and tonsil bed bleeding. RESULTS: There were 204 children studied. The response rate over the first 7 days was 93% for the children in the harmonic scalpel group and 87% for the bipolar group. Children experienced moderate post-operative pain for the first 6 days, after which pain declined from 4-7 to reach a score of 1-2 by day 11. Children undergoing harmonic scalpel tonsillectomy (n=103) reported higher mean pain scores than those who underwent bipolar diathermy (n=101) for current pain (4.7 versus 4.2, p=0.002), worst pain of the day (6.9 versus 6.2, p<0.001) and pain on swallowing (5.9 versus 5.2, p<0.001) over the first 6 post-operative days. Analgesic use (acetaminophen, ibuprofen) was similar in both groups. Hospital readmission for bleeding in children who underwent harmonic scalpel was similar to those who underwent bipolar diathermy tonsillectomy (9% versus 11%) as was bleeding requiring surgical re-exploration (4% versus 2%). CONCLUSIONS: Tonsillectomy was associated with considerable pain for the first 6 post-operative days. Children undergoing harmonic scalpel tonsillectomy had a slight increase in pain compared to the bipolar diathermy group during this time. Both methods of tonsillectomy are effective and safe.     

Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy

Bleeding is a major complication of thyroid surgery. A retrospective study was performed comparing the outcomes of patients undergoing thyroid surgery where bipolar diathermy with standard bipolar forceps was used for vessel ligation (n = 64) compared to clamp-and-tie (n = 89). Fewer drains were inserted and patients were discharged earlier when standard bipolar diathermy was used for vessel ligation in hemithyroidectomies (P < 0.001). Complication rates were similar. The use of bipolar diathermy with standard forceps for vessel ligation in thyroid surgery has been shown to be as safe and effective as the clamp-and-tie technique, while resulting in earlier patient discharge. This technique is cost-efficient as it provides the advantage of reduced inpatient stay reported using bipolar vessel sealing devices or the harmonic scalpel, but without the additional expense.     

The use of the bipolar microcoagulator for haemostasis in tonsillectomy

The use of the bipolar microcoagulator for haemostasis in tonsillectomy A two-part prospective trial of the use of bipolar diathermy for haemostasis in tonsillectomy was carried out. The first part of the trial showed that bipolar diathermy was as effective as conventional methods of dealing with bleeding, and has no additional undesirable effects. The second part showed that the method could substantially reduce operating time.     

Cold dissection versus bipolar cauterizing tonsillectomy for bacteriemia

OBJECTIVE: The purpose of this study is to compare transient bacteriemia ratios between cold dissection tonsillectomy and bipolar cauterizing tonsillectomy, and also to analyze the bacteria detected with superficial/central tonsillar cultures. METHODS: A total of 86 patients that were grouped as 46 patients of cold dissection tonsillectomy and 40 patients of bipolar cauterizing tonsillectomy were included in this study. Preoperative surface swab cultures, intraoperative central swab cultures of tonsils, and preoperative and postoperative blood culture samples were obtained. Antibiotic sensitivity tests were determined. Fischer exact chi 2 test was performed to compare the results of postoperative bacteriemia of both techniques statistically. RESULTS: Postoperative bacteriemia was detected in 6 (13%) patients of cold dissection tonsillectomy group. In 5 (83.3%) of the 6 postoperative bacteriemia patients of cold dissection tonsillectomy group, isolated microorganism was confirmed both in the blood cultures and in the central swab cultures of tonsils, and resistance to penicillin was established. No patient of bipolar cauterizing tonsillectomy group appeared with postoperative bacteriemia. There was a statistically significant difference (P=.028) for postoperative bacteriemia between cold dissection tonsillectomy group and bipolar cauterizing tonsillectomy group. CONCLUSION: We recommend bipolar cauterizing tonsillectomy for high-risk patients.     

Comparison of microdebrider subcapsular tonsillectomy to harmonic scalpel and electrocautery total tonsillectomy

OBJECTIVE: The aim of this study was to compare microdebrider subcapsular tonsillectomy (MST) with total tonsillectomies either by harmonic scalpel (TTH) or electrocautery (TTE) in children with obstructive sleep-disordered breathing from tonsillar hypertrophy. DESIGN: Retrospective review of prospectively collected data. SETTING: Tertiary academic hospital. PATIENTS: Eighty consecutive children with obstructive sleep-disordered breathing from tonsillar hypertrophy who underwent MST between January and April of 2003 were compared with a smaller historical cohort of 25 patients who underwent TTEs and TTHs from January to December of 2001. MAIN OUTCOME MEASURES: Primary: days to no narcotic pain medicine use and days to solid food intake; secondary: estimated blood loss, surgical time, and postoperative complications. RESULTS: Fifty-four patients who underwent MSTs and 25 patients who underwent total tonsillectomies met study criteria for a total of 79 patients. The cohorts showed no significant demographic differences between groups. The MST group had a significantly shorter duration of pain medicine use (3.7 +/- 0.5 days) than the TTE (7.0 +/- 0.6 days) or TTH groups (6.8 +/- 0.7 days; P < .001). The MST group (3.5 +/- 0.6 days) and the TTH group (3.6 +/- 0.8 days) achieved solid food intake faster than the TTE group (5.4 +/- 0.7 days; P = 0.004). There was a significantly higher estimated blood loss with the MST group (38.8 +/- 6.1 mL) than the TTH group (19 mL +/- 8.2) and the TTE group (15.1 +/- 7.4 mL; P < .001). TTH (27.3 +/- 3.1 minutes) took longer than MST (20.3 +/- 2.3 minutes) and TTE (21.9 +/- 2.8 minutes; P = .018). CONCLUSION: Microdebrider subcapsular tonsillectomy is valuable in treatment of children with tonsillar hypertrophy because of the decreased pain medicine use and more rapid return to solid food.     

A blinded in vitro comparison of five sets of bipolar diathermy forceps

The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.     

Comparison of three techniques in pediatric tonsillectomy

The objective of this study was to compare the thermal welding technique (TWT), classic dissection (CD) tonsillectomy and bipolar cautery dissection (BCD) for pediatric tonsillectomy. Three hundred and five consecutive children with chronic tonsillitis and/or upper airway obstruction were alternately assigned to the TWT, CD, or BCD tonsillectomy groups. Age, gender, operation time, intraoperative blood loss, early postoperative pain, time to regain normal diet, and extent of healing of the tonsillar fossa on the tenth postoperative day were evaluated. The rate of intraoperative blood loss was significantly lower in the thermal welding and BCD groups (p < 0.001). The difference between mean operative time of TWT and BCD groups was not statistically significant (p > 0.001). The difference between mean operative time of the two groups against cold dissection group was statistically significant (p < 0.001). No significant difference was found in the incidence of posttonsillectomy hemorrhage between the three patient groups (p > 0.001). The mean pain score was 4.8 ± 1.2 (median 5, range 4–6) in the TWT group, 8.3 ± 1.3 (median 8, range 7–10) in the BCD group, and 5.1 ± 1.2 (median 5, range 4–7) in the CD group 6 h to 7 days post-surgery. The difference between mean pain score between TWT and CD was not statistically significant (p > 0.001). The difference between mean pain score of the two groups against BCD group was statistically significant (p < 0.001). The results showed TWT as a new tonsillectomy technique with advantages such as shorter operation time and minimal intraoperative blood loss for children patient’s post operative comfort. When we compared TWT with the cold dissection and bipolar cautery tonsillectomy, we found that TWT tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain     

A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis.

OBJECTIVES: To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. DESIGN: A prospective, single blind, randomised controlled trial. SETTING: ENT clinic, University Teaching Hospital. PARTICIPANTS: Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. METHODS: Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. MAIN OUTCOME MEASURES: Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit. RESULTS: The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. CONCLUSION: In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.