As researchers are finding in many areas of medicine, new and higher tech ways aren't necessarily better than tried and true techniques once they're put to the test. And so it goes with one of the most frequently performed procedures, the tonsillectomy, according to a summary analysis.
As reported in the Archives of Otolaryngology—Head and Neck Surgery, published by the Journal of the American Medical Association, newer coblation and harmonic scalpel (HS) strategies to seal vessels and stop bleeding were not better than conventional cold steel and/or electrocautery dissection (CS/EC).
Tonsillectomies are considered safe, but they are usually accompanied by a lot of post-surgical pain, bleeding, and long convalescence before the patient can return to normal diet and activity levels.
That's why at least five technological innovations have been developed over the last decade in an effort to minimize those results. "Yet no definite consensus has been reached regarding the optimal technique with the lowest morbidity rates," wrote Vangelis G. Alexiou, MD, of Northampton General Hospital in England, along with co-authors from Tufts University School of Medicine in Boston, and Henry Dunant Hospital in Athens, Greece.
The authors looked at 33 randomized controlled trials that studied 3,139 patients who underwent the surgery in which doctors employed a variety of technologies:
- The LigaSure Vessel Sealing System (VSS)
- The Thermal Welding System
- The BiClamp
- The Harmonic Scalpel
- Radiofrequency ablation or cold ablation, "referred to by the trade name coblation."
The five were compared with conventional techniques, which use cold steel and/or electrocautery dissection.
"The main finding of this meta analysis of randomized clinical trials is that Coblation and HS tonsillectomy techniques that have been used during the past decade in an attempt to decrease postoperative morbidity in terms of pain and bleeding do not provide any significant advantage over the conventional CS/EC technique," they wrote.
The only outcome that differed significantly in tonsillectomies performed using HS compared with those using CS/EC was peri-operative bleeding, which has no measurable clinical significance, they said. Comparing HS and Coblation. "In all outcomes, HS and Coblation were at least equivalent to the conventional technique.
Many studies have been published regarding the use of all these surgical techniques and devices. However, the reported results are, in many cases, "conflicting and controversial," they wrote.
In conclusion, despite its limitations, this meta-analysis provides evidence that the use of Coblation and HS for tonsillectomy is equivalent to the use of conventional CS/ES technique. However, they emphasized, "surgeon experience, training and preferences as well as cost-effectiveness criteria, should be considered."