Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

Kandemir, Süheyla; Pamuk, Ahmet Erim; Özel, Gökçe; Şencan, Ziya

doi:10.1055/s-0042-1758715

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Original Research • iao 27 (4) • June 2023 • https://doi.org/10.1055/s-0042-1758715 copy

Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Tonsillectomy is among the most common otolaryngological surgeries.

Objective

To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation.

Methods

The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted.

Results

The CSD group had less analgesic use and shorter return to normal activity than the MEC group (p =0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery (p <0.016). The postoperative bleeding rate was similar in all groups (p = 0.096).

Conclusion

Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.

Keywords
tonsillectomy; coblator; cold steel dissection; monopolar cautery; postoperative pain

	CSD	MEC	Coblation	p-value
Patients, n	61	32	30
Age in years, median (range)	7 (3–55)	8 (3–44)	7 (3–39)	0.733
Male/Female, n	30/31	21/11	17/13	0.332
Surgical duration, mean ± SD (min)	28.98 ±4.8	30.75 ± 3.8	29.43 ±2.8	0.157
Analgesic (paracetamol) tablets used, median (range)	1 (0-3)^ Indicates statistically significant difference between the CSD and MEC groups, regarding analgesic use (p = 0.013).	2 (0-3)^ Indicates statistically significant difference between the CSD and MEC groups, regarding analgesic use (p = 0.013).	1 (0–2)	0.037^* * Bonferroni adjustment was applied for pairwise comparison of groups. p < 0.0166 was accepted as statistically significant.
Time to return to normal activity, days	7.11 ± 1.1^* ***** Indicates that time to return to normal activity was significantly shorter in the CSD group than in the MEC group (post-hoc Tamhane test, p < 0.001).	8.75 ± 1.6^* ***** Indicates that time to return to normal activity was significantly shorter in the CSD group than in the MEC group (post-hoc Tamhane test, p < 0.001).	7.87 ± 1.5	< 0.001
Postoperative bleeding, yes/no	1/60	4/28	2/28	0.096

Hours	CSD, Median (range)	MEC, Median (range)	Coblation, Median (range)	p-value^ Abbreviations: CSD, cold steel dissection; MEC, monopolar electrocautery.*
1 hour	6 (1–9)	7 (2–9)^§ § Indicates that the VAS pain score in the coblation group was significantly lower than in the MEC group the first 4 hours postsurgery (p < 0.016).	3 (1–9)^§ § Indicates that the VAS pain score in the coblation group was significantly lower than in the MEC group the first 4 hours postsurgery (p < 0.016).	0.026
4 hours	3 (0-8)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	5 (1-8)^§ § Indicates that the VAS pain score in the coblation group was significantly lower than in the MEC group the first 4 hours postsurgery (p < 0.016). , ^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	3 (2–8)^§ § Indicates that the VAS pain score in the coblation group was significantly lower than in the MEC group the first 4 hours postsurgery (p < 0.016).	0.005
12 hours	3 (0-8)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	5 (2-8)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	3 (2–8)	0.001
24 hours	2 (0-7)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	3(1-6)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	3 (2–3)	0.025
Days
day 2	2 (0-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016). ^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	2(1-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	2(1-4)^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	0.002
day 5	0 (0-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016). ^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	1 (0-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	1 (0-3)^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	0.001
day 7	0 (0-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016). ^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	1 (0-3)^ Indicates that the VAS pain score in the CSD group was significantly lower than in the MEC group between 4hours and 7 days postsurgery (p < 0.016).	0 (0-3)^µ µ Indicates that the VAS pain score in the CSD group was significantly lower than in the coblation group between days 2 and 7 postsurgery (p < 0.016).	< 0.001

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[1] Address for correspondence Süheyla Kandemir, MD, Department of Otorhinolaryngology, Kırıkkale Yüksek İhtisas Hospital, 71400 Kırıkkale, Turkey (e-mail: dr.suheyla_bostan@hotmail.com).