Yi-Chan Lee1,2, Li-Jen Hsin2,3, Wan-Ni Lin2,3, Tuan-Jen Fang2,3, Yao-Te Tsai2,4, Cheng-Ming Luo1. 1. Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan. 2. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4. Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Abstract
Importance: Several temperature-controlled surgical instruments (TCSIs) have been used in tonsillectomy. However, to our knowledge, a meta-analysis of the differences between modern TCSIs and electrocautery (EC) has not been conducted. Objective: To compare TCSIs with EC with regard to the intraoperative and postoperative parameters of tonsillectomy. Data Sources: PubMed (MEDLINE), Embase, and the Cochrane Library were searched independently by 2 authors for relevant articles. Study Selection: A literature search identified randomized clinical trials comparing the outcomes of TCSIs vs EC. The search keywords were harmonic scalpel, ultracision, PlasmaBlade, coblation, radiofrequency ablation, and tonsillectomy. Studies of adult and adolescent patients were included. Data Extraction and Synthesis: Data from each study were extracted. A random-effects model was used in the pooled analysis. Main Outcomes and Measures: Four outcomes were analyzed: postoperative pain level on days 1, 2, 7, and 14 after surgery; postoperative bleeding; operative time; and intraoperative blood loss. Results: This meta-analysis included 11 studies with a total of 629 unique patients. (Mean ages ranged from 16 to 55 years.) The studies were further categorized by the methods of comparison. Five articles used between-participant comparisons, and 6 used within-participant comparisons (of the left vs right sides of the participant's body). The pooled results of the studies with between-participant measures showed that postoperative pain scores were lower in the TCSI group on the first day (standardized mean differences [SMD], -0.41 [95% CI, -0.77 to -0.06]) and seventh day (SMD, -0.76 [95% CI, -1.47 to -0.04]). The pooled results of the studies with within-participant measures showed that the postoperative pain scores were lower in the TCSI group on the first day (SMD, -0.37 [95% CI, -0.63 to -0.12]) and second day (SMD, -0.60 [95% CI, -1.10 to -0.10]). The pooled analysis of overall bleeding, major bleeding, minor bleeding, primary bleeding, and secondary bleeding in both the types of studies with between-participant measures and those with within-participant measures showed no significant differences between the TCSI and EC groups. Intraoperative blood loss and operative time were not significantly different between the groups. Conclusions and Relevance: Compared with EC, TCSIs were associated with significantly reduced pain on the first day after tonsillectomy, per this meta-analysis. The rates of overall bleeding, primary bleeding, secondary bleeding, major bleeding, and minor bleeding between TCSIs and EC were comparable. Intraoperative blood loss and operative time also showed no significant intergroup differences. Surgeons may consider using these modern instruments according to personal experiences, preferences, and cost-effectiveness criteria.
Importance: Several temperature-controlled surgical instruments (TCSIs) have been used in tonsillectomy. However, to our knowledge, a meta-analysis of the differences between modern TCSIs and electrocautery (EC) has not been conducted. Objective: To compare TCSIs with EC with regard to the intraoperative and postoperative parameters of tonsillectomy. Data Sources: PubMed (MEDLINE), Embase, and the Cochrane Library were searched independently by 2 authors for relevant articles. Study Selection: A literature search identified randomized clinical trials comparing the outcomes of TCSIs vs EC. The search keywords were harmonic scalpel, ultracision, PlasmaBlade, coblation, radiofrequency ablation, and tonsillectomy. Studies of adult and adolescent patients were included. Data Extraction and Synthesis: Data from each study were extracted. A random-effects model was used in the pooled analysis. Main Outcomes and Measures: Four outcomes were analyzed: postoperative pain level on days 1, 2, 7, and 14 after surgery; postoperative bleeding; operative time; and intraoperative blood loss. Results: This meta-analysis included 11 studies with a total of 629 unique patients. (Mean ages ranged from 16 to 55 years.) The studies were further categorized by the methods of comparison. Five articles used between-participant comparisons, and 6 used within-participant comparisons (of the left vs right sides of the participant's body). The pooled results of the studies with between-participant measures showed that postoperative pain scores were lower in the TCSI group on the first day (standardized mean differences [SMD], -0.41 [95% CI, -0.77 to -0.06]) and seventh day (SMD, -0.76 [95% CI, -1.47 to -0.04]). The pooled results of the studies with within-participant measures showed that the postoperative pain scores were lower in the TCSI group on the first day (SMD, -0.37 [95% CI, -0.63 to -0.12]) and second day (SMD, -0.60 [95% CI, -1.10 to -0.10]). The pooled analysis of overall bleeding, major bleeding, minor bleeding, primary bleeding, and secondary bleeding in both the types of studies with between-participant measures and those with within-participant measures showed no significant differences between the TCSI and EC groups. Intraoperative blood loss and operative time were not significantly different between the groups. Conclusions and Relevance: Compared with EC, TCSIs were associated with significantly reduced pain on the first day after tonsillectomy, per this meta-analysis. The rates of overall bleeding, primary bleeding, secondary bleeding, major bleeding, and minor bleeding between TCSIs and EC were comparable. Intraoperative blood loss and operative time also showed no significant intergroup differences. Surgeons may consider using these modern instruments according to personal experiences, preferences, and cost-effectiveness criteria.
Authors: Jaakko Matias Piitulainen; Tapani Uusitalo; Henrik M Sjöblom; Lotta E Ivaska; Henri Jegoroff; Tommi Kauko; Hannu Kokki; Eero Kytö; Iisa Mansikka; Jenni Ylikoski; Jussi Jero Journal: BMJ Open Date: 2022-09-14 Impact factor: 3.006