Coblation, Harmonic scalpel comparable to conventional tonsillectomy
MedWire News: Meta-analysis findings suggest equal benefit when performing tonsillectomies using radiofrequency ablation (ie, coblation), Harmonic scalpel (HS), cold steel (CS), or electrocautery dissection (EC).
However, limited available data also suggest that procedures using vessel sealing systems (VSS) might provide superior outcomes compared with CS/EC.
"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," say Vangelis Alexiou (Northampton General Hospital, UK) and co-authors.
However, they caution: "Equivalence [in surgical outcomes] may not be enough to justify a change in the current clinical practice."
For the meta-analysis, the researchers included 33 randomized controlled trials (RCTs) studying a total of 3139 patients who were treated with VSS, HS (Ethicon Endo-Surgery Inc, Cincinnati, Ohio, USA), coblation, or CS/EC. Studied outcome measures included operative time, peri-operative bleeding, and postoperative bleeding and pain.
Comparison of tonsillectomies performed using HS with those performed using CS/EC revealed no significant difference for operative time, postoperative bleeding, and average postoperative pain. However, peri-operative bleeding was significantly lower for patients treated with HS than CS/EC, at a difference of 37.71 ml.
However, the researchers say that "it is commonly accepted that this variable does not have any measurable clinical significance."
No significant differences were found for any of the surgical outcomes when comparing coblation with CS/EC.
Conversely, tonsillectomies performed using VSS provided superior outcomes compared with CS/EC for operative time (-4.09 minutes), peri-operative bleeding (standard mean difference [SMD]=-1.67), postoperative bleeding (odds ratio=0.28), and pain on postoperative day 1 (SMD=-1.73) and 7 (SMD=-1.46).
"Well-designed and well-performed RCTs are warranted to further investigate the effectiveness of VSS techniques for tonsillectomy," conclude the study authors in the Archives of Otolaryngology-Head and Neck Surgery.
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By Ingrid Grasmo