To prospectively compare monopolar electrocautery tonsillectomy and thermal welding system (TWS) tonsillectomy in adult patients. Fifty patients over 20 years old, admitted for tonsillectomy between January 2010 and March 2012, were randomized to have one tonsil removed using monopolar electrocautery and the other tonsil removed using the TWS.
Tonsillectomy is a frequently performed procedure in otorhinolaryngology. The technique, which involves dissection of the tonsillar tissue from the underlying pharyngeal constrictor muscles, has changed little in the last 60 years. Despite the use of several new methods and devices, cold dissection tonsillectomy is still considered as the gold standard.
Subjects used the FACES scale to rate the pain on each side 21 days postoperatively. Postoperative hemorrhaging and tonsillar fossa wound healing were also recorded. The mean time required to remove one tonsil was 8.3±1.5 min for the TWS and 7.5±1.6 min for monopolar electrocautery (p=0.033).
There was no significant difference between monopolar electrocautery and TWS groups in terms of postoperative FACES pain scores and bleeding rates. The tonsillar fossa wound healing scores were statistically significantly higher for monopolar electrocautery tonsillectomy versus the TWS (p<0.001).
Since the TWS is more expensive than monopolar electrocautery and use of the TWS did not confer any clear advantage over monopolar electrocautery for tonsillectomy in terms of postoperative pain, hemorrhage, and wound healing; monopolar electrocautery should be preferred over TWS for tonsillectomy operations.
Monopolar electrocautery is the most common method of tonsillectomy; it is preferred because it is known to reduce intraoperative bleeding and facilitates hemostasis. In the present study, no significant difference was followed between the frequency of hemorrhage encountered with the TWS versus monopolar electrocautery.
Another reason for performing electrocautery tonsillectomies is the shorter operation time matched with other tonsillectomy techniques such as radiofrequency, plasma-mediated ablation, and the use of microdissection needles.
The researchers found that the operative time for the TWS was significantly longer than that for monopolar electrocautery (8.3±1.5 min vs. 7.5±1.6 min; p=0.033), although this difference in operation time was statistically significant, it was clinically insignificant.
In the present study, we found no clear advantage of monopolar electrocautery and TWS over each other with respect to operative time, postoperative bleeding, pain, and wound healing.
Taking into the consideration of the limitations of our study, such as low sample size, dependent groups, short postoperative follow-up, this is the first study comparing monopolar electrocautery and TWS techniques for tonsillectomy in adults.
Since the TWS is more expensive than monopolar electrocautery and use of the TWS did not confer any clear advantage over monopolar electrocautery for tonsillectomy.
Further randomized, controlled studies with larger sample sizes are needed to further clarify and evaluate the morbidity associated with monopolar electrocautery versus the TWS for tonsillectomy.