ENT-Head & Neck Department, MITERA General & Children’s Hospital, Athens, Greece.
Introduction:
Tonsillectomy is the surgical procedure of removing the tonsils. It is recommended in patients with chronic tonsillitis, recurrent attack of acute tonsillitis, peri-tonsillar abscess, sleep apnoea syndrome and unilateral tonsillar hypertrophy with suspicion.
Surgical removal of the tonsils (tonsillectomy) is one of the most common surgical procedures in Greece. Bipolar diathermy energy applied directly to the tissue. The heat generated may be used in dissection to incise the mucosa and remove the tonsils as well as for haemostasis, by coagulating the bleeding vessels.The most important complications of tonsillectomy are the operative and post operative haemorrhage and severe post operative pain resulting in odynophagia. There have been many different studies of methods of tonsils removal and haemostasis.
Methods:
This is a prospective randomized study to compare the result of laser assisted tonsillectomy with conventional dissection technique. This prospective randomized study was done at ENT-Head & Neck Department in MITERA General & Children’s Hospital of Athens, Greece from January 2013 to December 2013. One hundred patients were divided into two groups of equal number. In one group, the tonsillectomy performed by Diode laser and in the other group the tonsillectomy performed by bipolar cautery. Thepatients were randomized to either the laser group or the bipolar cautery method group of equal number.
Laser tonsillectomy was performed using Cheese Diode Laser Systems . The power was set at 8 watts and laser was used to separate the tonsil tissue from the tonsillar bed. Laser precaution procedures were adhered to. In the conventional dissection technique of tonsillectomy, we used bipolar diathermy dissector to dissect the tonsillar tissue from the tonsillar bed and the lower pole was clamped using Wilson forceps and silk ligature was used. Haemostasis was secured by suture ligation or by bipolar diathermy in bipolar diathermy dissection group and bipolar in laser group, if needed.
Postoperatively, pain scores were charted from day one to day 10 using standardized visual analogue scale in which 0 indicate no pain and 10 for very severe pain. Oral ibuprofen and/or oral paracetamol was a standard pain control regime used in all patients given every 6 hours depending on the severity of pain. Patients were discharge 1 day after the operation and reviewed in the clinic on 10th post operative day.
Results:
Of the 100 patients recruited in this study, 50 patients were in the laser group and another 50 patients were in the bipolar diathrmy dissection group. Of these 50 patients of each group 20 were from 2y to 5y and 30 were from 6y to 14years old.
Laser group results: average postoperative pain score (APPS) was 3,5 (2-5y) and 5 (6-14y)
Bipolar group results: APPS was 4 (2-5y) and 5,5(6-14y)
None of these 100 of children have primary or secondary tonsillar hemorrhage.
Discussion:
This small study will give some ideas about the application of laser in tonsil for the new surgeons who want to start laser. As for the department of ENT, tonsillectomy is the most frequently operativeprocedure performed and conventional blunt dissection technique has been and continue to be considered a most common and standard method of tonsillectomy. There is no consensus on the optimum method of performing tonsillectomy. Various methods have been described which are frequently compared and discussed in otolaryngology literature. The value of a new technique must be judged by the results concerning intra-operative and postoperative morbidity and complications. The most common postoperative concerns following tonsillectomy are hemorrhage and pain. Postoperative pain is the most significant subjective symptoms as far as patient is concerned.
In our study, diode laser offers a new possibility for tonsillectomy, as the 980nm laser cuts under direct vision, typically without collateral tissue damage or charring. It also coagulates blood instantly and seals small blood vessels providing a clean, bloodless field.
As a result, there is no difference in postoperative pain and hemorrhage in children, compared to bipolar cautery.
Conclusion:
Despite questions regarding its efficacy and proven benefits in the past, laser tonsillectomy has become an accepted procedure in Otolaryngology – Head and Neck Surgery. Postoperative pain and hemorrhage is a main concern for surgeons, children and parents. 980nm diode laser allows dissection and hemostasis in a one-step procedure, and reduces the duration of tonsillectomy. However, there was no significant difference between diode laser and bipolar diathermy in the intensity of postoperative pain in both age groups. The same applied for both primary and secondary tonsillar hemorrhage.
A shamble of diode laser tonsillectomy on http://www.artopoulos.com.gr/videos/
