KeypointsSurgeon‐controlled study of 200 cold/cold and 200 hot/hot tonsillectomy cases in one institution.Hot/hot resulted in higher overall rates of early and late post‐tonsillectomy haemorrhage and return to theatre when compared to cold/cold methods.Bipolar diathermy tonsillectomy resulted in a statistically significant higher rate of secondary post‐tonsillectomy haemorrhage than cold‐steel of nearly 3 times.Trainee surgeons performed better in bipolar haemostasis than cold‐steel dissection with regard to postoperative morbidity.With continued use of cold‐steel tonsillectomy methods in both junior and senior surgeons, it is hoped that the rates of PTH and RTT will continue to improve.INTRODUCTIONTonsillectomy represents 40% of the procedures performed in otolaryngology departments; equivalent to 45 000 tonsillectomies in the UK each year.The tonsillectomy procedure consists of 2 phases: tonsil excision and haemostasis, which can be classified as “hot” or “cold.”Hot Excision: Bipolar diathermy involves high‐frequency electric current being applied directly to the tonsil tissue from forceps.Cold Excision: Steel dissection involves an incision being made in the mucosa with scissors and mobilisation of tonsil using dissecting forceps.Hot Haemostasis: Diathermy heat coagulates vessels within tissue.Cold Haemostasis: Swabs control initial then ligatures control residual bleeding.A combination of techniques can be employed to create an entirely hot, cold or combined approach. Bipolar diathermy is used
Clinical Otolaryngology – Wiley
Published: Jan 1, 2018
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