Harmonic Scalpel Tonsillectomy Using the Curved Shears Instrument versus Cold Dissection Tonsillectomy: A Retrospective Study

Abstract

Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.

Six years of evidence-based adult dissection tonsillectomy with ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection

“…Gilbey et al compared the post-operative bleeding rate amongst harmonic scalpel tonsillectomy patients versus cold dissection patients, and found a significant increase only in those above 12 years of age. 8 The National Prospective Tonsillectomy Audit in England and Northern Ireland found a significantly higher postoperative bleeding rate (i.e. a 3.1-fold increase) for electrodissection tonsillectomy.…”

“…6 Tonsillectomy using the harmonic scalpel, also known as the ultrasonically activated scalpel, has also been described. 7,8 This scalpel is able to cut and coagulate at the same time due to its blade vibrations, which occur at a frequency of 55 000 per second over an excursion of 50-80 μm. These ultrasonic vibrations transfer frictional energy to tissues, which cause protein to denature by cleaving hydrogen bonds at a temperature of 60-80°C.…”

Comparison of post-tonsillectomy pain with two different types of bipolar forceps: Low temperature quantum molecular resonance device versus high temperature conventional electrocautery

“…PlasmaKnife was also tried but did not have any advantage in reducing postoperative pain [18]. In terms of operation time or intraoperative hemorrhage, newly developed devices could be better [9,12,19,20], although that is still controversial. Summarizing these results, no device or technique has been shown to be definitely advantageous for tonsillectomy.…”

Occlusion of the Thoracic Duct Using Ultrasonically Activated Shears in Six Dogs

“…Hence lymphangiographic studies were available in all dogs to document TDO using the UAS. Others have successfully used open mesenteric, percutaneous popliteal lymph node injection, or contrast computed tomography (CT) as an alternative to the cannulation method we used …”

“…More recently, UAS use in people has centered on lymphatic tissue applications. Much of the work has been for otolaryngology applications where tonsillectomy performed with UAS is faster and creates less hemorrhage compared to cold excision . Other reports have focused on the use of the UAS for laparoscopic lymphadenectomy in various types of gynecologic cancers to reduce the incidence of postoperative lymphatic leakage .…”