title: Diathermy tonsillectomy: comparisons of morbidity following bipolar and monopolar microdissection needle excision.
abstract: Tonsillectomy is frequently associated with a considerable post-operative morbidity. In some cases reactionary or secondary haemorrhage occurs and all patients suffer a degree of post-operative pain. The use of bipolar diathermy excision has become popular because it reduces intra-operative blood loss, but all diathermy inevitably produces a degree of damage to adjacent normal soft tissues. In turn this inadvertent injury must act to increase the post-operative pain. Monopolar dissection using a fine tungsten diathermy needle (the Colorado needle) allows sharp dissection at low power levels and in previous studies has been shown to produce a reduction in collateral tissue damage. In this prospective study the morbidity associated with tonsillectomy using this needle was compared to that following a standard bipolar dissection. Using the monopolar needle produced no enhanced risk of reactionary or secondary haemorrhage while causing significantly less post-operative pain and a reduction in eschar. We believe that excision using this needle preserves the advantages associated with bipolar dissection while reducing local soft tissue damage.
authors.affiliation: Department of Otolaryngology, Royal Hospitals Trust, St Bartholomew's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Akkielah
authors.forename: A
authors.initials: A
authors.lastname: Kalan
authors.forename: G S
authors.initials: GS
authors.lastname: Kenyon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000295:instrumentation*; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology; D014068:Tonsillectomy / Q000379:methods*