Teenage and adult tonsillectomy: dose–response relationship between diathermy energy used and morbidity

Abstract

Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.

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

“…Cardozo et al reported that the dose-response relationship between the two parameters was unclear. 14 Lowe and colleagues' study findings further added to the confusion. 18 They found that when bipolar diathermy was used for both dissection and haemostasis, the overall postoperative haemorrhage rate was 4.6 per cent and the risk of haemorrhage was unrelated to the diathermy power setting.…”

“…2 Cardozo et al found a significant relationship between bipolar diathermy energy and post-operative pain in adult tonsillectomy. 14 Sheahan et al reported no significant difference in pain, comparing ultrasonic scalpel and bipolar diathermy; however, their results may have been distorted by the use of bipolar diathermy to control bleeding in 70 per cent of ultrasonic cases. 11 In the current study, the other two hot methods assessed, bipolar radiofrequency and ultrasonic scalpel, did not show the marked increase in post-operative pain seen in the electrodissection group (compared with cold dissection).…”

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

“…It is assumed that enzymes of the saliva and bacterial superinfection are contributing factors for digestion of the soft tissues and capable to expose greater arteries [180], the hyoid bone or larynx [47]. This hypothesis is supported by findings of a significant relationship between postoperative pain and bipolar electric energy [181], [182]. Comparable findings have been reported for Grisel’s syndrome, which is more likely to occur, when monopolar instead of bipolar means are used to achieve hemostasis during AE procedures [183].…”

Tonsillotomy: it's time to clarify the facts

“…At least by the clear evidence of a dose-response relationship between electrosurgical energy and postoperative pain by Cardozo et al [68], it appears self-evident that the surgical technique used in the study of Park et al [45] is unable to result in less pain compared to monopolar TE. Moreover, electrosurgery has been identified as a risk factor for posttonsillectomy hemorrhage in extensive studies [69,70].…”