In that same review, she noted, there were three papers that compared operative time, with two of the three reporting a longer operative time for the cold technique, and one with a shorter operative time.
Explore This IssueAugust 2006
Overall, cold probably does take a little bit longer, but that probably has a lot to do with the surgeon’s experience. But when we’re thinking about operative time, are we talking about it in terms of being clinically significant or, realistically, financially significant? she said. If that extra amount of time pushes you into the next fifteen-minute increment for your OR time, that can be incredibly expensive. On the plus side, two wires for a snare cost approximately $1.63, which is, by medical standards, an incredible bargain.
What about postoperative hemorrhage, morbidity, and recurrence?
You do probably have, according to the latest data, an improved postoperative hemorrhage rate; you definitely have decreased postoperative morbidity and there’s less risk of recurrence of the problem, Dr. Messner said. My conclusion is, even though it’s old and not very sexy and doesn’t require a lot of equipment, go with the cold.
When evaluating tonsillectomy technique, there is probably less evidence-based medicine (EBM) reflected in the current literature, and more of a completely different EBM-emotionally biased medicine, that is-according to Charles Myer III, MD, Professor of Otolaryngology and Director of the Hearing Impaired Clinic at Children’s Hospital Medical Center in Cincinnati, Ohio.
There’s a preponderance of both evidence and emotion on both sides as relates to cost, hemorrhage, and pain, he said, admitting that his thoughts on the subject are probably no less emotionally biased that what’s in the literature.
Dr. Myer believes that, in light of there being no clear-cut answers to the hot-cold question, surgeons must rely on their own experience to decide which technique is best for their patients.
When you have something that works, and in my case it’s electrocautery, stick with it, he said. Sometimes I think people make a decision to change just for the sake of change. We certainly can’t be staid in our approach to things, as nothing new will be developed if we’re not open to change, but the data must be supportive of those changes that we choose to make.
And, for Dr. Myer, the data just isn’t there to convince him that there is any compelling reason for him to change from a technique that he is comfortable with and has been performing for the past 20 years.