Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom

Mathews, J P; Lancaster, Jeffrey; Sherman, Ian; Sullivan, Gavin

doi:10.1258/002221502761698694

Cited by 14 publications

(17 citation statements)

References 12 publications

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“…That document contained information about different throat conditions such as peritonsillar abscess as well as tonsillectomy [1,2,3]. …”

Section: Introductionmentioning

confidence: 99%

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Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts

Hultcrantz

Ericsson²

2013

ORL

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Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later ʼguillotineʼ were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants - the ‘focal infection theory' was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only ‘correct' tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

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“…That document contained information about different throat conditions such as peritonsillar abscess as well as tonsillectomy [1,2,3]. …”

Section: Introductionmentioning

confidence: 99%

“…The indications for those early operations were not described in detail. Since the procedure was both dangerous, because of the risk for bleeding, and very painful, one can expect that only life-threatening conditions were treated [1,2,3]. …”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts

Hultcrantz

Ericsson²

2013

ORL

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“…Automated procedures like guillotine tonsillectomies were historically designed for rapid removal of (parts of) the tonsils at a time, when general anesthesia was not available [53,54]. Few institutions still use the device [55][56][57][58]. A targeted dissection or preservation of the capsule is not a part of the technique.…”

Section: Classification Of Intratonsillar Proceduresmentioning

confidence: 99%

Tonsillotomy: it's time to clarify the facts

Windfuhr

Werner

2013

Eur Arch Otorhinolaryngol

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“…2 Various tonsillectomy instruments and techniques have evolved over time, with the first tonsillar guillotine being developed in the eighteenth century. 1,3 Perhaps the most recognised is Popper's haemostatic guillotine, developed and introduced in 1929 by Otto Oswald Popper. Its two-blade design was revolutionary, with the crushing blade sealing vessels before the deployment of the cutting blade ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…1 By the end of the 1990s, only 12.5 per cent of respondents to a survey of British otolaryngologists reported regularly performing guillotine tonsillectomy. 3 The 'cold steel' dissection tonsillectomy technique involves removal of the tonsils using scissors and a blunt tonsil dissector. It is currently the most commonly performed technique, being used in 53 per cent of tonsillectomy cases in a recent National Prospective Tonsillectomy Audit.…”

Section: Introductionmentioning

confidence: 99%

Guillotine versus dissection tonsillectomy: randomised, controlled trial

et al. 2012

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Link to this article: http://journals.cambridge.org/abstract_S002221511200196XHow to cite this article: S J Frampton, M J A Ward, V S Sunkaraneni, H IsmailKoch, Z A Sheppard, R J Salib and P K Jain Guillotine versus dissection tonsillectomy: randomised, controlled trial. AbstractObjective: This trial aimed to compare the guillotine technique of tonsillectomy with 'cold steel' dissection, the current 'gold standard'.Design: A single centre, randomised, controlled trial. Methods: One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intraoperative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.Results: Operative time and intra-operative blood loss were both significantly less for the guillotine technique ( p < 0.001) and there was a significantly reduced haemostasis requirement ( p < 0.001). Pain was also less on the guillotine side ( p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage. Conclusion:This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

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Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom

Cited by 14 publications

References 12 publications

Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts

Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts

Tonsillotomy: it's time to clarify the facts

Guillotine versus dissection tonsillectomy: randomised, controlled trial

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