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Original Investigation
February 6, 2020

Adolescents and Adults Undergoing Temperature-Controlled Surgical Instruments vs Electrocautery in Tonsillectomy: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
  • 2College of Medicine, Chang Gung University, Taoyuan, Taiwan
  • 3Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  • 4Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
JAMA Otolaryngol Head Neck Surg. Published online February 6, 2020. doi:10.1001/jamaoto.2019.4605
Key Points

Question  What are the differences between temperature-controlled surgical instruments and electrocautery on the outcomes of postoperative pain, postoperative bleeding, intraoperative blood loss, and operative time for tonsillectomy in adults and adolescents?

Findings  In this systematic review and meta-analysis of 11 studies including 629 patients, temperature-controlled surgical instruments were found to significantly reduce pain on the first day after tonsillectomy compared with electrocautery techniques. There were no significant differences in the risk of overall bleeding, primary bleeding, secondary bleeding, major bleeding, or minor bleeding between the 2 types of surgical instruments, and the volume of intraoperative blood loss and operative time also showed no significant intergroup differences.

Meaning  Temperature-controlled surgical instruments used in tonsillectomy for adults and adolescents may help reduce pain in the early postoperative period.

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.

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