Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes

Abstract

Objective To analyze patients’ return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. Study Design Randomized double-blinded clinical trial based on prospective parallel design. Setting Academic medical center and tertiary children’s hospital between March 2018 and July 2019. Methods Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient’s return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. Results Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity ( P = .89), daily pain scores over 15 postoperative days ( P = .46), postoperative narcotic use ( P = .61), or return to hospital for any reason ( P = .60), including bleeding as an adverse event ( P = .13). Conclusions As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.

Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

“…In one of the largest randomized controlled trials, Prussin et al did not observe any difference in postoperative pain between MEC and coblation. 6 Of note, pain scores in their coblation group 1 day postsurgery were significantly lower than in their MEC group, which was mostly similar to the pain scores of MEC and coblation groups within 1 day postsurgery in the present study. 6 Tan et al also did not note any difference in pain scores between their coblation and MEC groups; however, Magdy et al reported that coblation was associated with less pain than MEC.…”

“…Earlier studies reported that coblation causes more post-tonsillectomy bleeding than other techniques; however, more recent studies on MEC versus coblation and CSD versus coblation report there are no differences in bleeding rates, which might be attributed to gains in surgical proficiency over time. 6,11,[20][21][22] In contrast, a 2013 review reported that CSD was associated with the least delayed post-tonsillectomy bleeding. 23 Differences in the reported rates of post-tonsillectomy bleeding might be due to nonhomogenous patient groups and nonstandardization of surgical techniques (e.g., using a combination of 2 techniques).…”

“…Earlier studies reported findings similar to those in the present study regarding shorter return to normal activity for CSD versus coblation and MEC versus coblation. 6,7 Surgical duration is also an important factor affecting the choice of tonsillectomy technique. The level of surgeon experience, and familiarity with a particular technique and the equipment used is inversely correlated with surgical duration.…”

Analysis on the Effect of Radiofrequency Ablation and Electrocautery in the Treatment of Vaginal Intraepithelial Neoplasia

“…Radiofrequency ablation is a minimally invasive technique to eliminate pathological changes by generating heat from high-frequency radio frequency waves, which leads to cell coagulation and necrosis [ 10 ]. Electrocautery is performed by direct electrocautery of the diseased tissue with a high-frequency electrotome [ 11 ]. In recent years, there is little information about VaIN treatment by the two methods.…”

Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy

“…One study (9) reported 2 types of postoperative bleeding, coblation (3%) and electrocautery (3.4%), and there was no significant difference between the 2 groups (P>0.05). It was reported in another study (17) that there were 6 cases of bleeding, 2 cases of vomiting, 3 cases of dehydration, and a total of 17 cases (15.2%) of complications after coblation, while there were 2 cases of bleeding, 3 cases of vomiting, 2 cases of dehydration, and a total of 20 cases (16.9%) of complications after electrocautery. There was no significant difference in the incidence rate of total complications between the 2 groups (P>0.05).…”