Comparative Study On The Outcomes Of Thermal Welding Tonsillectomy, Radiofrequency Tonsillectomy And Cold Knife Tonsillectomy

Tonsillectomy is one of otolaryngology common operations. Currently the surgical procedure has been dramatically evolved from a single traditional cutting method to various forms of excision modalities. Of the more popular approaches are thermal welding, radiofrequency and cold knife tonsillectomy.The traditional tonsil cut method as the oldest method of surgery, is not difficulty and quite mature in clinical practice. It has now become the basic clinical skills that doctors in the department of otolaryngology must master. However, special attention should be payed to the intraoperative and postoperative bleeding problems.In recent years, plasma knife, as a kind of new way of surgical instrument is more and more coming into the line of sight of people. According to research report, its action principle is based on bipolar radio frequency technology, i.e, the bipolar probe released RF energy. The energy turns the conductive medium (saline) which stays between the probe head and the target tissue into charged particles in highly ionized state. These charged particles gather around the electrode and form a steam plasma layer which is called the plasma zone. The potential gradient difference between two sides of the area makes high-speed movement of the plasma in the bipolar. It also makes molecular strand breaks and disintegration necrosis of the cell on the pathway. Then tonsil is cut along its capsule.And the same popular Starion thermal knife has two arms, one of the front end can generate heat nickel-chromium alloy resistance wire, resistance wire insulation around,which prevent the heat diffusion surrounding tissue damage. Another arm front is cover silicone resin "coat", in which the temperature of the center of the cutting area is high enough to complete gasification organization and cutting. Use of sophisticated equipment heat and pressure makes the denaturation of proteins within the organization, and its degeneration sticks together to form a homogeneous protein structure, the layers bond together, strongly close vessel stump, the organization easily separated.In previous research results, the superiority analysis of plasma cutter are obvious difference, some people think that is superior to the traditional cutting method, whereas others just think conversely. The past research had been often done between patients and patients, so different surgical methods for each patient leads to great difference in individuals, then, the error often increases. We did the tonsillectomy with two methods on both sides of the same patient, which largely avoided patients and performer differences in personal factors. Through these, we can do further study on the advantages and disadvantages of thermal welding, radiofrequency and cold knife tonsillectomy. ObjectivesComparative analysis of the advantages and disadvantages of thermal welding, radiofrequency and cold knife for tonsillectomy. MethodsAccording to the randomized double-blind principle, the120patients with tonsil hypertrophy and chronic tonsillitis were divided into three operating groups: group A, B, and C. Patients in each group underwent bilateral removal of tonsils by two distinct approaches in each side as designed previously. They are performed under general anesthesia,and hosted by experienced doctors. We respectively use low temperature plasma of Jessie companies in the United States, Starion thermal welding and conventional cutting method. In particular, we observe and analyze the key parameters in terms of operating time, intraoperative blood loss, postoperative pain strength, white membrane shedding time, and histological alterations.ResultsComparing thermal welding, radiofrequency and cold knife tonsillectomy the operation time, intraoperative blood loss, and the healing time are shown in table1, postoperative pain degree of7days is shown in table2. It can be seen from the table in group A, the method of thermal knife tonsils in operation time (9.7±3.56), intraoperative blood loss (5.85±3.23) and postoperative pain intensity exhibits no statistical significance difference (p>0.05)between plasma knife in surgery time (10.47±3.62), intraoperative blood loss (6.85±3.78) and postoperative pain intensity. On the incision healing time, plasma knife has longer healing time (11.0±2.73) than thermal welding (8.15±1.95), and the difference is statistically significant (p<0.05), In group B, thermal welding knife is superior to the traditional cutting method in operation time (10.05±3.84), intraoperative blood loss (16.05±3.34) and postoperative pain degree, and the differences are statistically significant (p<0.05), the differences in the healing time was not statistically significant (p>0.05), In group C, plasma knife tonsils removed in operation time, intraoperative blood loss, wound healing time and postoperative pain degree are superior to the traditional cutting method, and the differences were statistically significant (p<0.05).Traditional cutting method never has thermal tissue damage. In the group A, damage depth can be seen in table3.The table showed the Mean of plasma knife thermal damage depth is higher than thermal welding knife, but there is not statistically significant difference (p>0.05). ConclusionRadiofrequency knife and thermal welding knife showed advantages in the operation time, intraoperative bleeding and postoperative pain compared with traditional cutting methods. Plasma knife, as a novel modality, is adapt to tonsillectomy, but, the disadvantages of higher cost, delayed bleeding, slowly healing, and longer duration of pain still need to improve. Starion thermal welding’s heat insulation material makes tissue adhesion and avoids deep tissue injury, It is now widely used in the cavity mirror technology methods. The thermal welding knife which possesses the advantages of short operating time, less bleeding and pain, rapid healing, lower cost, and rare late complications, is worth applying in tonsil surgery.