Resident Pearls: Pediatric Otolaryngologists Share Tips for Safer, Smarter Tonsillectomies

Safety First—Every Time

If there’s one message residents need to hear, it’s this: Never underestimate a tonsillectomy. “Not to take the tonsillectomy procedure lightly. You may land in trouble even in your 1001st case,” one respondent warned. “Be ready for any emergency, any time.” Over half of the surgeons emphasized the importance of meticulous technique and constant vigilance for bleeding, the most feared complication. “Although it is a simple surgery, complications can be serious,” said another. “Trust is the worst enemy.” “Ensure strict hemostasis throughout the surgical procedure … which may reduce post-operative morbidities, including bleeding, which may impair patient outcomes. This is after careful dissection, identification, and ligation of vessels and respecting all the adjacent structures …,” said another. Safety isn’t just a checkbox—it’s the foundation.

Know When Not to Operate

Tonsillectomy isn’t always the answer. More than a third of respondents encouraged residents to be cautious about patient selection, particularly when it comes to recurrent throat infections.

“It is a serious and potentially life-threatening operation,” one expert emphasized. “The decision to operate should not be made without confirmation that it is necessary, following recognized international guidelines.”

The best way to prevent complications? Fewer surgeries—and only when truly indicated. “Tailor the technique to the patient and indication,” another respondent stressed.

It is important to apply stricter indication criteria and align more closely with national patient selection guidelines. Guidelines are a foundation for refining surgical decision making, balancing the benefits of tonsillectomy with associated risks. The message here is clear: Let guidelines and clinical judgment guide you, not routine.

Stay Curious, Stay Current

Half of the surveyed surgeons urged trainees to remain open to new techniques and technologies—from intracapsular approaches to the use of tranexamic acid.

“Learn as many methods as possible and never forget: This is not a routine operation for the family, only for the surgeon,” one said. Another added, “Coblation intracapsular tonsillectomy in experienced hands has been a major advance. After 3,000, you get better.”

Even seasoned surgeons continue refining their craft. Residents should, too.

Bring Everyone In

Success in tonsillectomy isn’t just about the otolaryngologist. Surgeons highlighted the role of anesthesiologists, nurses, and—most critically—parents.

“Anecdotally, patients whose parents ensure early and regular eating, drinking, and analgesics have fewer post-op complications,” noted one respondent. “Operative counseling pre- and post-operatively is as important as surgical technique.”