Powered Adenoidectomy & Tonsillectomy Bibliography Notable Abstracts

"Microdebrider Partial Tonsillectomy vs Electrosurgical Tonsillectomy: Randomized, Paired-Control Study of Postoperative Pain"
Microdebrider partial tonsillectomy vs. electrosurgical tonsillectomy: a randomized, double-blind,
paired-control study of postoperative pain.
Presented at: Twentieth Annual Meeting of the American Society of Pediatric Otolaryngology, Las Vegas, NV.
May 27-30, 2005

The purpose of this randomized, double-blind, matched-pair clinical trial conducted at two hospitals affiliated with Harvard Medical School was to test the hypothesis that microdebrider intracapsular tonsillotomy (MT) results in less pain than electrosurgical extracapsular tonsillectomy (ET). Twenty-five children with noninfectious, obstructive tonsillar hypertrophy were randomly assigned to have one tonsil removed by MT and the other by ET. Parents, children, and the study nurse were blinded to the side of MT and ET. Children rated their pain on each side by using the Faces Pain Scale-Revised. Data were obtained by telephone daily, and all study participants completed the 2-week follow-up course. On postoperative days 1 to 10, patients reported less pain on the MT side than on the ET side (P < 0.001). By postoperative days 11 to 14, the difference between groups had disappeared. Sixteen patients had asymmetric otalgia, and there was a 100% correlation between otalgia and ET. No child in the study had postoperative bleeding. The authors conclude that the microdebrider method is significantly less painful than the electrosurgical technique in children undergoing surgery for obstructive tonsillar hypertrophy.

In this large, comprehensive, retrospective study conducted at three prestigious US institutions, the medical records of 870 children who underwent powered intracapsular tonsillectomy (PIT) and of 1121 children who had conventional tonsillectomy (performed by the same surgeons during the same time period) for obstructive sleep-disordered breathing were compared with respect to the outcome measures of postoperative bleeding and readmission for dehydration. Mean follow-up time was 1.2 years in the PIT group and 1.5 years in the conventional tonsillectomy group. The overall rate of postoperative bleeding was 3.3% in the conventional tonsillectomy group and 0.8% in the PIT group (P = 0.001). The rate of readmission for dehydration was 3.6% after conventional surgery and 1.1% after PIT (P = 0.002). Overall, complications occurred three times more often in the children who underwent conventional tonsillectomy than in those who had PIT. Tonsil regrowth occurred in four patients in the PIT group (0.46%). The authors conclude that their data show PIT to be a safe and effective treatment for sleep-disordered breathing in children. They also state that the microdebrider (powered) intracapsular method represents a revolution in tonsil surgery and provides a high degree of safety.

This nonrandomized prospective study enrolling 8,472 children compared the rate of secondary hemorrhage (ie, postoperative bleeding requiring intervention) after tonsillectomy in patients who underwent traditional, extracapsular tonsillectomy with the corresponding rate in those who had intracapsular tonsillectomy using a microdebrider. Thirteen surgeons from several centers in the same health care system (Nemours) participated in the study, using similar methods for reporting results in individual patients. The system's centralized clinical management program monitored the study.

The investigation found that the extracapsular tonsillectomy group had a secondary bleeding rate of 1.7%, whereas the rate in the intracapsular tonsillectomy group was 0.6%. The difference in rates was significant. According to the authors, their findings indicate that the depth of the wound is an important factor in complications after tonsillectomy. With the intracapsular procedure, they note, the tonsil capsule serves as a "biological dressing" to promote healing. The authors conclude that the microdebrider method reduces postoperative bleeding "dramatically" and thereby greatly enhances the safety of tonsil surgery, particularly for young and frail children.