Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Kılavuz, Ahmet Erdem; Bayram, Armagan

doi:10.1017/s0022215119000434

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Windfuhr et al reported that the PTH rate was higher in the suture hemostasis group 26 . According to a 10‐question survey completed at a national congress, suture ligating the lower pole and suturing faucial pillars were the main methods surgeons would choose to prevent PTH 27 . Our results showed a significant difference in the incidence of primary PTH between the TIS and TsIS groups.…”

Section: Discussionmentioning

confidence: 56%

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Wang

et al. 2022

Laryngoscope Investig Oto

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Objective This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH). Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle‐Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs. Results A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47–0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30–0.64) and 0.70 (95% CI, 0.54–0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13–2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16–0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32–0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34–0.64). Conclusions Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure. Level of Evidence 5.

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Section: Discussionmentioning

confidence: 56%

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Wang

et al. 2022

Laryngoscope Investig Oto

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“…Despite this, there remains some morbidity and inherent risks of the procedure. Pain and bleeding remain the top concerns 2,3,6,13,19,27,28 and the number one and two reasons cited for changing techniques 28 …”

Section: Discussionmentioning

confidence: 99%

“…It is a low‐risk procedure with few complications. Postoperative pain is a significant concern, but hemorrhage is the most feared complication due to its association with fatality, especially in pediatric patients with insufficient vascular reserve 2 . Post‐tonsillectomy hemorrhage (PTH) remains the number one complication causing mortality and malpractice settlements, apart from the increased cost of necessary treatment 3 …”

Section: Introductionmentioning

confidence: 99%

“…A recent American survey reported monopolar cautery is currently the most popular technique utilized for tonsillectomy 21 . Very few studies examining bleeding complications related to electrosurgical tonsillectomy state the power settings used to perform the dissection or hemostasis 6,7,22 compared to studies that do not 2,4,8,11–13,15–17,19,20,23,24 . Given the association of electrosurgical techniques with secondary hemorrhage, this seems a critical factor to ignore.…”

Section: Introductionmentioning

confidence: 99%

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Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques

et al. 2021

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Objectives/Hypothesis To compare rates of post‐tonsillectomy hemorrhage (PTH) between a very‐low energy transfer monopolar technique (VLET) and standard energy techniques. Study Design Retrospective controlled cohort study. Methods All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive “hot” technique without exclusive monopolar use [Mixed “Hot”]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared. Results During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed “Hot”), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed “Hot” group experienced similar rates (1.57%, P = .54; 1.68%, P = .64), but the VLET group experienced significantly lower rates (0.15%, P = .0026, adjusted odds ratio [OR] 0.114 [0.028–0.469]; 0.22%, P = .0016, adjusted OR 0.155 [0.048–0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P = .0025, P = .0024, adjusted OR 1.02/year [1.01–1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies. Conclusions Standard energy techniques had an adjusted odds ratio over 8‐fold higher for secondary PTHRSI and over 6‐fold higher for total PTHRSI compared to the minimized energy transfer VLET technique. Level of Evidence 3 Laryngoscope, 131:2505–2511, 2021

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“…The anxiety levels experienced by surgeons who perform adenotonsillectomy is a topic that is not often discussed, and is studied even less. The paper from Turkey 4 examines European paediatric ENT surgeons, and finds fair levels of anxiety, particularly with respect to fear of bleeding. This lessens with experience.…”

mentioning

confidence: 99%

Adenoidectomy technique, surgeon anxiety and augmenting the medical school ENT curriculum

Fisher¹,

Hussain²,

Fishman³

2019

J. Laryngol. Otol.

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Although the standard technique for adenoidectomy is curettage and this has remained prevalent as judged from recent surveys, the situation is evolving. This technique leaves a lot to be desired, especially in terms of the precision of tissue removal. 1 Alternatives include suction diathermy, coblation or powered endoscopic techniques, sometimes performed endoscopically rather than blindly or via a mirror. These approaches have advantages over traditional methods. This issue contains an article, from New Delhi, 2 on the topic of adenoidectomy technique, in which endoscopic-assisted powered adenoidectomy is compared with conventional curettage. The endoscopic method used a curved microdebrider blade inserted through the mouth, with visualisation endoscopically through the nose. The benefits of greater precision, less pain, better teaching and more complete excision (especially in the awkward areas around the posterior choana) were only slightly offset by more bleeding in the microdebrider group. In the paper from Pune, India, 3 the comparison was similar, except that ablation was achieved via coblation rather than a microdebrider. The new technique gave a more complete excision, less pain and less bleeding, at the expense of greater time spent on the surgery. Times are changing and the days of curettage seem to be numbered. The anxiety levels experienced by surgeons who perform adenotonsillectomy is a topic that is not often discussed, and is studied even less. The paper from Turkey 4 examines European paediatric ENT surgeons, and finds fair levels of anxiety, particularly with respect to fear of bleeding. This lessens with experience. There is room for more studies of this type. Medical student education in otorhinolaryngology is close to the heart of practising surgeons, as this is the seed corn for future recruitment and enthusiasm in the discipline, and so is vital for ongoing service delivery. With many medical schools in the UK and abroad paring down the ENT content of the undergraduate curriculum, often to such an extent that this specialty is often an 'option' rather than part of the core curriculum, 5 the question arises as to how we overcome this threat to standards and to recruitment. Medical students need to have a positive view of the specialty, and of what it offers to work-life balance, family finances and prospects for career progression, and previous Journal of Laryngology & Otology papers have covered this topic. 6 The paper by Spiers and colleagues, from St George's Hospital in London, 7 describes the effects of a 1-day ENT course for students (provided at minimal cost) on participants' perception of the specialty and what it offers, as well as specific tracheostomy skills. The results were encouraging on all parameters, and this could provide a generally applicable model to offset the inadequacies of the standard undergraduate curriculum in representing the specialty in a favourable (and realistic) light.

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Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Cited by 5 publications

References 14 publications

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques

Adenoidectomy technique, surgeon anxiety and augmenting the medical school ENT curriculum

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