Randomized, Controlled, Multisite Study of Intracapsular Tonsillectomy Using Low-Temperature Plasma Excision

• Published in: Archives of otolaryngology--head & neck surgery Vol. 130; no. 11; pp. 1303 - 1307
• Main Authors: Chan, Kenny H, Friedman, Norman R, Allen, Gregory C, Yaremchuk, Kathleen, Wirtschafter, Ari, Bikhazi, Nadim, Bernstein, Joseph M, Kelley, Peggy E, Lee, Kelvin C
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.11.2004
• Subjects: Biological and medical sciences; Child; Child, Preschool; Electrosurgery - methods; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Medical sciences; Otorhinolaryngology. Stomatology; Pain, Postoperative - epidemiology; Recovery of Function; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Tonsillectomy - methods; Temperature; Treatment; Excision; Tonsillectomy; Surgery; Intracapsular; Blood plasma
• ISSN: 0886-4470; 2168-6181; 1538-361X; 2168-619X
• DOI: 10.1001/archotol.130.11.1303

OBJECTIVE To determine the efficacy of intracapsular tonsillectomy using low-temperature plasma excision for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively. DESIGN Prospective, randomized, controlled, single-blind study. SETTING Multiple private or institutional otolaryngology clinics. PATIENTS Fifty-five children (aged 3-12 years) with obstructive tonsillar hypertrophy. INTERVENTION Patients were randomly assigned and blinded to undergo either intracapsular tonsillectomy using low-temperature plasma excision (n = 27) or total tonsillectomy using conventional electrosurgery (n = 28). MAIN OUTCOME MEASURES Operative data, 14-day recovery variables, and obstructive symptoms were prospectively collected through 12 months. RESULTS During the first 14 days, significantly fewer children in the intracapsular group reported nausea (P = .01) or lost weight (P = .003). The intracapsular group had a significantly faster resolution of pain (P = .01), had an earlier return to a normal diet (P = .004), ceased taking pain medication sooner (P = .002), and returned to normal activity sooner (P = .04). Postoperatively, the intracapsular group had more residual tonsil tissue than the total tonsillectomy group (P = .002 for the 3- and 12-month visits). However, the incidence of recurring obstructive symptoms, pharyngitis, and antibiotic use was similar in both treatment groups during the 12 months. CONCLUSIONS Postoperative morbidity normally associated with traditional (total) tonsillectomy was significantly reduced after intracapsular tonsillectomy using low-temperature plasma excision. The residual tonsillar tissue associated with this technique was of no clinical consequence.Arch Otolaryngol Head Neck Surg. 2004;130:1303-1307-->