Comparison of microdebrider subcapsular tonsillectomy to harmonic scalpel and electrocautery total tonsillectomy

Abstract 

Objective

The aim of this study was to compare microdebrider subcapsular tonsillectomy (MST) with total tonsillectomies either by harmonic scalpel (TTH) or electrocautery (TTE) in children with obstructive sleep-disordered breathing from tonsillar hypertrophy.

Design

Retrospective review of prospectively collected data.

Setting

Tertiary academic hospital.

Patients

Eighty consecutive children with obstructive sleep-disordered breathing from tonsillar hypertrophy who underwent MST between January and April of 2003 were compared with a smaller historical cohort of 25 patients who underwent TTEs and TTHs from January to December of 2001.

Main outcome measures

Primary: days to no narcotic pain medicine use and days to solid food intake; secondary: estimated blood loss, surgical time, and postoperative complications.

Results

Fifty-four patients who underwent MSTs and 25 patients who underwent total tonsillectomies met study criteria for a total of 79 patients. The cohorts showed no significant demographic differences between groups. The MST group had a significantly shorter duration of pain medicine use (3.7 ± 0.5 days) than the TTE (7.0 ± 0.6 days) or TTH groups (6.8 ± 0.7 days; P < .001). The MST group (3.5 ± 0.6 days) and the TTH group (3.6 ± 0.8 days) achieved solid food intake faster than the TTE group (5.4 ± 0.7 days; P = 0.004). There was a significantly higher estimated blood loss with the MST group (38.8 ± 6.1 mL) than the TTH group (19 mL ± 8.2) and the TTE group (15.1 ± 7.4 mL; P < .001). TTH (27.3 ± 3.1 minutes) took longer than MST (20.3 ± 2.3 minutes) and TTE (21.9 ± 2.8 minutes; P = .018).

Conclusion

Microdebrider subcapsular tonsillectomy is valuable in treatment of children with tonsillar hypertrophy because of the decreased pain medicine use and more rapid return to solid food.