Bipolar scissors versus cold dissection for pediatric tonsillectomy--a prospective, randomized pilot study.
OBJECTIVE
To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. The outcome measures used were: (1) intra-operative bleeding; (2) operative time; (3) post-operative pain; and (4) complication rates including reactionary and secondary hemorrhage.


METHODS
A prospective, randomized multiunit study involving three teaching hospitals in Belfast. Fifty consecutive children aged 10-16 years undergoing tonsillectomy for recurrent or chronic tonsillitis, between March 2000 and September 2000 were recruited as a subgroup of 200 patients selected for this study. These children were analysed separately from the adults, in a pilot study for the above parameters.


RESULTS
The mean age of the study population was 14.3 years. Sixty-eight percent of the children were girls. Median intra-operative blood loss was 6 ml for bipolar scissors tonsillectomy and 86 ml for cold dissection tonsillectomy (P<0.001). The median operative time was 10.5 min for bipolar scissors tonsillectomy compared to 14.5 min for the cold dissection method (P=0.001). There was no statistically significant difference in the pain scores between the two methods (P>0.05). The overall reactionary hemorrhage rate was 4% while the overall secondary hemorrhage rate was 14%. The hospital readmission rate was 4%. The reactionary and secondary hemorrhage rates were unaffected by the surgical method.


CONCLUSIONS
This pilot study has shown that bipolar scissors tonsillectomy is a relatively safe technique in children aged 10-16 years with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in surgical time and blood loss compared to the cold dissection method. These advantages make it a favourable instrument for pediatric tonsillectomy especially in this age group.
Raut
V V
VV
Department of Otolaryngology, Royal Victoria Hospital, Belfast, UK. rautvivek@hotmail.com
Bhat
N
N
Sinnathuray
A R
AR
Kinsella
J B
JB
Stevenson
M
M
Toner
J G
JG
D000293:Adolescent; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D003452:Cryosurgery / Q000295:instrumentation; D004564:Electrocoagulation / Q000295:instrumentation; D006801:Humans; D008297:Male; D010146:Pain / Q000517:prevention & control; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D014068:Tonsillectomy / Q000295:instrumentation / Q000379:methods*; D014069:Tonsillitis / Q000601:surgery*