Tonsillectomy Techniques: Tradition versus Technology?

Dr. Albert’s institution is one of many across the United Kingdom that participated in the much anticipated National Prospective Tonsillectomy Audit, which included data on nearly 40,000 tonsillectomy procedures performed across England and Ireland.

If you look at the data regarding bipolar versus cold steel, there is a slightly lower risk of primary hemorrhage with bipolar, Dr. Albert said. But if you look at secondary hemorrhage, the risk is five times greater. If you look at monopolar, there are similar slightly reduced rates of primary but considerably higher secondary hemorrhage, and these are all highly statistically significant.

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Figure. Cold steel tonsillectomy offers the most economic choice of equipment-two wires for a snare (pictured) cost approximately $1.63.

Although the audit may be the most comprehensive set of data exploring tonsillectomy technique to date, Dr. Albert said physicians should not be too quick to change from their current techniques.

Unfortunately, some otolaryngologists think of cold steel tonsillectomy as crude and bloody but, like a marine in hand-to-hand combat, it’s fairly effective and really can be quite elegant. – -Anna Messner, MD

Before any of you consider changing techniques, you should perhaps consider your own data, he said. A lot of these techniques have steep learning curves. When I came to the decision for my own son who needed a tonsillectomy, I didn’t choose the technique, I chose the surgeon.

©2006 The Triological Society