Powered Intracapsular Tonsillectomy Is a Safe Alternative to Traditional Tonsillectomy

How does powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy compare to standard tonsillectomy methods in postoperative pain and in perioperative and postoperative morbidity?

Bottom line: PITA is a safe procedure that offers comparable disease control to that of conventional tonsillectomy for children suffering from obstructive sleep apnea due to hypertrophic tonsils, but it leaves remaining tissue that may be a focus for chronic inflammation or tonsillar regrowth.

Background: Despite surgical technique advancement, tonsillectomy is still complicated by postoperative pain, diminished oral intake, and reduced activity. Many groups have suggested subtotal tonsillectomy as an alternative treatment for pediatric OSA. Several studies have suggested that microdebrider tonsillectomy is superior to conventional surgical excision with regard to blood loss, dehydration, and postoperative recovery time.

Study design: Systemic review and meta-analysis of 25 studies with a total of 8,078 participants.

Setting: PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials databases in their entirety through March 2017.

Synopsis: Overall, there was no significant difference in operative time or operative blood loss between the PITA and conventional tonsillectomy groups. However, pain on postoperative days (POD) 1, 3, 5, and 7 was significantly lower in the PITA group, and they required significantly smaller amounts of analgesia in the postoperative period and significantly less time to resume a normal diet; the time to return to normal activity was also significantly lower. Postoperative admission incidence due to dehydration or postoperative bleeding control in the operating room was statistically lower in the PITA group, while postoperative tonsil regrowth incidence was statistically higher. PITA reduced AHI score and OSA-18 total score and significantly improved O2 saturation.

In randomized controlled trials (RCTs), PITA benefit on postoperative pain continued until POD 5, its effect on time to resume a normal diet was moderately significant, and the time to return to normal activity was strongly significant. In the non-RCTs, the effect of PITA on postoperative pain disappeared by POD 5; it had a very strong effect on time to resume a normal diet and postoperative pain.

Citation: Lee HO, Lee HS, Yoon HY, Jin HJ. Hwang SH. The safety and efficacy of powered intracapsular tonsillectomy in children:. Laryngoscope. 2018;128:732–744.