Bipolar Tonsillotomy: A Novel and Effective Tonsillotomy Technique

Abstract Objective To present, for the first time, tonsil size reduction using reusable bipolar forceps electrocautery (RBFE), as a treatment for pediatric OSAS and to assess the safety and efficacy of the procedure. Methods A prospective interventional design study was performed. Thirty children ag...

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Bibliographic Details
Published in:International journal of pediatric otorhinolaryngology 2016-05, Vol.84, p.1-5
Main Authors: Shaul, Chanan, M.D, Attal, Pierre D., M.D. Ph.D, Schwarz, Yehuda, MD, Muhanna, Nidal, M.D. Ph.D, Izgelov, Dvora, M.A, Peleg, Uri, M.D, Sichel, Jean-Yves, M.D
Format: Article
Language:English
Subjects:
Adenoidectomy
Adolescent
Child
Child, Preschool
Electrocoagulation - instrumentation
Electrocoagulation - methods
Female
Follow-Up Studies
Humans
Male
Otolaryngology
Pediatrics
Prospective Studies
Sleep Apnea, Obstructive - surgery
Tonsillectomy - methods
Treatment Outcome
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Summary:Abstract Objective To present, for the first time, tonsil size reduction using reusable bipolar forceps electrocautery (RBFE), as a treatment for pediatric OSAS and to assess the safety and efficacy of the procedure. Methods A prospective interventional design study was performed. Thirty children aged 2-15 years with OSAS (AHI > 5) diagnosed by means of polysomnography were included. All children were treated with adenoidectomy and RBFE tonsillotomy without dissection. Re-polysomnography was performed after 1 year. The size of the tonsils was blindly assessed by two ENT specialists and the parents were asked to fill out ‘Pediatric Sleep Questionnaires’ (PSQ), before surgery, and one month and one year after surgery. Results There were no complications during or after surgery. There were no events involving postoperative bleeding or dehydration. The surgery mean time, including adenoidectomy, was 20.6 minutes. The AHI was 10.9 before surgery and decreased to 1.8 after surgery (p < 0.001), minimum saturation (SaO2 min) increased from 86.1% to 93.2% (p < 0.001). The size of the tonsils decreased from a mean of +3.3 before surgery to +1.3 and +1.4 one month and one year after surgery respectively. The mean of the PSQ scores went down from 23.6 to 5.5 and to 6.2 one month and one year after surgery respectively. Conclusion We demonstrated that simple cauterization of the tonsils using a RBFE device with an adenoidectomy is a safe and effective treatment to decrease tonsil size in OSAS. In addition, the method is inexpensive, rapid and does not cause bleeding, which may be particularly interesting in the presence of coagulation problems.
ISSN:0165-5876
1872-8464
DOI:10.1016/j.ijporl.2016.02.012