Bipolar Radiofrequency Dissection Tonsillectomy: A Prospective Randomized Trial

2005 ◽  
Vol 133 (6) ◽  
pp. 961-965 ◽  
Author(s):  
Sameh M. Ragab
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Operating Time ◽  
Controlled Study ◽  
Operative Blood Loss ◽  
Bipolar Radiofrequency ◽  
Significant Difference ◽  
Cold Dissection

OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT ( P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters ( P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. CONCLUSION: BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy. EBM RATING: A

Coblation versus cold dissection in paediatric tonsillectomy: a systematic review and meta-analysis

2020 ◽  
Vol 134 (3) ◽  
pp. 197-204
Author(s):  
M U Ahmad ◽  
A N Wardak ◽  
T Hampton ◽  
M R S Siddiqui ◽  
I Street
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Operative Time ◽  
Meta Analysis ◽  
Alternative Technique ◽  
Operative Blood Loss ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Dissection Techniques ◽  
Cold Dissection

AbstractBackgroundCold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates.ObjectiveThis study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques.MethodsA systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded.ResultsSeven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05).ConclusionThe coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.

scholarly journals Intravenous Carbetocin to decrease blood loss during open myomectomy: a randomized placebo-controlled study

2017 ◽  
Vol 7 (1) ◽  
pp. 27
Author(s):  
Hany F. Sallam ◽  
Nahla W. Shady
Keyword(s):  
Placebo Group ◽  
Blood Loss ◽  
Operative Time ◽  
Uterine Leiomyomas ◽  
Reproductive Age ◽  
Controlled Study ◽  
Benign Tumors ◽  
Operative Blood Loss ◽  
Abdominal Myomectomy ◽  
To Receive

Background: Uterine leiomyomas are benign tumors of the uterus, which represent the most common neoplasms in women of reproductive age, and have a lifetime incidence of approximately 70% in the general population. The objective of this study was to assess the effect of using a single pre-operative dose of IV 100 μg Carbetocin on intra-operative blood loss in abdominal myomectomy surgeries.Methods: In a randomized double-blind placebo-controlled trial, 86 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of IV 100 μg Carbetocin (n = 43) or placebo (n = 43) just before the operation. The primary outcome was intra-operative blood loss.Results: Intra-operative blood loss was significantly lower in those women randomized to receive IV Carbetocin versus the placebo group (714.19±186.27 ml versus 1033.49±140.9 ml), p = 0.0001 The incidence of blood transfusion was increased in placebo group (69.8%) compared with (18.6%) in Carbetocin group, (P = 0.0001). Also, there was a significant reduction in operative time in Carbetocin group (66.35%±10.18) compared with placebo group (95.95±9.16), (P = 0.0001).Conclusions: A single pre-operative dose of IV Carbetocin (100 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.

Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

2019 ◽  
Vol 160 (6) ◽  
pp. 993-1002 ◽  
Author(s):  
Chung-Hsin Tsai ◽  
Po-Sheng Yang ◽  
Jie-Jen Lee ◽  
Tsang-Pai Liu ◽  
Chi-Yu Kuo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Meta Analysis ◽  
Thyroid Volume ◽  
Vocal Cord Palsy ◽  
Significant Heterogeneity ◽  
Intraoperative Blood Loss ◽  
Significant Difference ◽  
And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

scholarly journals Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Elguindy ◽  
H Hemeda ◽  
M Esmat ◽  
M Nawara ◽  
A M F Metwally
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Controlled Trial ◽  
Demographic Data ◽  
Operative Blood Loss ◽  
Postoperative Fever ◽  
Abdominal Myomectomy ◽  
Randomized Controlled ◽  
Uterine Incision ◽  
Significant Difference

Abstract Objective The Aim of the study is to compare between transverse and longitudinal uterine incision in abdominal myomectomy regarding intraoperative blood loss Design: A randomized Controlled interventional study. Setting Ain Shams Maternity teaching hospital. Patients and methods 52 patients undergoing abdominal myomectomy for single myoma were involved The patients were randomized into two groups that showed no significant difference in demographic data, characters of myoma or indication of surgery Results Our results proved that there was no significant difference between both incisions regarding intra-operative blood loss, need for blood transfusion, post-operative Hgb drop, operative time or incidence of postoperative fever. Conclusion Transverse uterine incision for myomectomy does not cause more blood loss than longitudinal incision. There is no difference between both incisions in operative time or postoperative complications Trial identifier: NCT03009812, MY-789

scholarly journals Use of human fibrin glue (Tisseel) versus suture during transvaginal natural orifice ovarian cystectomy of benign and non-endometriotic ovarian tumor: a retrospective comparative study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu-Ying Su ◽  
Yu-Shan Lin ◽  
Lan-Yan Yang ◽  
Yu-Bin Pan ◽  
Yi-Ting Huang ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Fibrin Glue ◽  
Ovarian Tumors ◽  
Minor Bleeding ◽  
Natural Orifice ◽  
Operative Blood Loss ◽  
Ovarian Cystectomy ◽  
Significant Difference ◽  
Human Fibrin Glue

Abstract Background To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors. Methods A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined. Results Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210). Conclusion The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.

scholarly journals Comparison of Granular Bone Grafts and Transverse Process Bone Grafts for Single-Segmental Thoracic Tuberculosis: A Retrospective Single-Center Comparative Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xing Du ◽  
Yunsheng Ou ◽  
Yong Zhu ◽  
Wei Luo ◽  
Guanyin Jiang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Bone Graft ◽  
Cobb Angle ◽  
Operative Time ◽  
Transverse Process ◽  
Bone Grafts ◽  
Operative Blood Loss ◽  
Thoracic Tuberculosis

Background: To compare the clinical efficacy of granular bone grafts and transverse process bone grafts for single-segmental thoracic tuberculosis (TB).Methods: The clinical records of 52 patients who were diagnosed with single-segmental thoracic TB and treated by one stage posterior debridement, bone graft fusion, and internal fixation in our department from 2015 to 2018 were retrospectively analyzed. Among them, 25 cases were in the granular bone graft group and 27 cases in the transverse processes bone graft group. Outcomes including the visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurological function, operative time, operative blood loss, hospital stay, Cobb angle, bone graft fusion time, and postoperative complications were all recorded and analyzed.Results: There were no significant differences in operative time, operative blood loss, and hospital stay between the two groups (P &gt; 0.05). With an average follow-up of 18–33 months, all patients in the two groups showed significant improvement in VAS score, ESR, CRP, and neurological function compared with preoperative measurements (P &lt; 0.05), however, no significant differences were found for the last follow-up (P &gt; 0.05). The two groups showed similar Cobb angle correction (P &gt; 0.05), but the granular bone graft group had a larger Cobb angle loss than the transverse processes bone graft group (P &lt; 0.05). The bone graft fusion time of the granular bone graft group was shorter than that of the transverse processes bone graft group (P &lt; 0.05). No significant difference was found in the postoperative complications rate between the two groups (P &gt; 0.05).Conclusion: Granular bone grafts and transverse process bone grafts may achieve comparable clinical efficacy for single-segmental thoracic TB, but the former method had a shorter bone fusion time.

scholarly journals Robotic versus laparoscopic splenectomy: a systematic review of perioperative outcomes

2021 ◽  
Author(s):  
Anantha Shreepad Bhat ◽  
Alexia Farrugia ◽  
Qazi Rahim Muhammad ◽  
Viera Kulikova ◽  
Gabriele Marangoni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Blood Loss ◽  
Laparoscopic Splenectomy ◽  
Open Surgery ◽  
Operative Time ◽  
Adult Population ◽  
Perioperative Outcomes ◽  
Significant Difference

Summary Background Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population. Methods We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student’s t‑test was used to compare outcomes between the RS and LS patient groups. Results After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduced blood loss in comparison to LS (p = 0.13). RS had no cases converting to open surgery and no postoperative complications in comparison to LS. No significant difference was found between RS and LS with regards to LOS (p = 0.89) and cost benefit (p = 0.74). RS had a higher operative time in comparison to LS which was not statistically significant (p = 0.45). Conclusion The RS approach may be associated with lower blood loss and a lower risk of conversions. There was no statistical difference between RS and LS with regards to length of stay (LOS) and cost. RS takes longer to perform in comparison to LS.

Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy

2008 ◽  
Vol 122 (4) ◽  
pp. 369-373 ◽  
Author(s):  
H M Hegazy ◽  
O A Albirmawy ◽  
A H Kaka ◽  
A S Behiry
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Potassium Titanyl Phosphate ◽  
Complication Rates ◽  
Operative Blood Loss ◽  
Bipolar Radiofrequency ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Laser Group ◽  
Potassium Titanyl Phosphate Laser

AbstractObjectives:To compare the advantages and disadvantages of potassium titanyl phosphate laser with those of bipolar radiofrequency techniques, in paediatric tonsillectomy.Study design:Prospective, randomised, clinical study.Patients and methods:From July 2004 to April 2006, 80 patients aged between 10 and 15 years, with tonsillectomy planned for chronic tonsillitis, were included in the study. Children were prospectively randomised into two equal groups: potassium titanyl phosphate laser tonsillectomy and bipolar radiofrequency tonsillectomy. Operative time and intra-operative blood loss were recorded. Patients were scheduled for follow up during the first, second and fourth post-operative weeks. They were asked to record their pain and discomfort on a standardised visual analogue scale, from zero (no pain) to 10 (severe pain). Post-operative complications were also recorded and managed.Results:The potassium titanyl phosphate laser group showed a slightly longer operative time (mean 12 minutes) than the bipolar radiofrequency group (mean 10 minutes). Intra-operative blood loss was significantly less in the potassium titanyl phosphate laser group (mean 21 cm3) than in the bipolar radiofrequency group (mean 30 cm3). In the first week, post-operative pain scores were less in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 7.5 and 8.5, respectively). However, in the second week pain scores increased more in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 8.5 and 6, respectively). In the fourth week, both groups showed equal and nearly normal pain scores. No case of reactionary post-tonsillectomy haemorrhage was recorded in either group. Only one case of secondary post-tonsillectomy haemorrhage was recorded, in the potassium titanyl phosphate laser group (2.5 per cent), managed conservatively.Conclusion:Both the potassium titanyl phosphate and the bipolar radiofrequency techniques were safe and easy to use for tonsillectomy, with reduced operative time, blood loss and complication rates and better post-operative general patient condition. Potassium titanyl phosphate laser resulted in reduced operative bleeding and immediate post-operative pain, compared with the bipolar radiofrequency technique. However, potassium titanyl phosphate laser required slightly more operative time and caused more late post-operative pain than the bipolar radiofrequency technique. The low rate of recorded complications showed that both techniques cause little damage to the tonsillar bed during dissection, thus minimising complications.

scholarly journals Guillotine versus dissection tonsillectomy: randomised, controlled trial

2012 ◽  
Vol 126 (11) ◽  
pp. 1142-1149 ◽  
Author(s):  
S J Frampton ◽  
M J A Ward ◽  
V S Sunkaraneni ◽  
H Ismail-Koch ◽  
Z A Sheppard ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Blood Loss ◽  
Operative Time ◽  
Controlled Trial ◽  
Operative Blood Loss ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Secondary Haemorrhage ◽  
Randomised Controlled ◽  
Cold Steel Dissection

AbstractObjective:This trial aimed to compare the guillotine technique of tonsillectomy with ‘cold steel’ dissection, the current ‘gold standard’.Design:A single centre, randomised, controlled trial.Methods:One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.Results:Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.Conclusion:This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

scholarly journals The microdebrider, a step forward or an expensive gadget?

2012 ◽  
Vol 50 (2) ◽  
pp. 191-198
Author(s):  
M.E. Cornet ◽  
S.M. Reinartz ◽  
C. Georgalas ◽  
E. van Spronsen ◽  
W.J. Fokkens
Keyword(s):  
Blood Loss ◽  
Controlled Trial ◽  
Operating Time ◽  
Operation Time ◽  
Sinus Surgery ◽  
Operative Blood Loss ◽  
User Friendliness ◽  
Double Blind ◽  
Estimated Blood Loss ◽  
Significant Difference

Background: Although the use of the microdebrider (shaver) is well known in endoscopic sinus surgery (FESS), there is lack of evidence from comparative studies focussing on the difference in operating time, intra-operative blood loss and user-friendliness between the microdebrider and traditional operating techniques. In this study we compared the use of the microdebrider to conventional instruments in FESS in these areas. Methods: A prospective randomised double blind controlled trial in 60 patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) undergoing bilateral FESS. Each subject received FESS using only traditional instruments (Blakseley forceps) on one side and the other side with the additional use of the microdebrider, this way serving as their own control. The primary outcome was operation time, intra-operative blood loss and user friendliness and secondly safety and postoperative healing with a follow-up period at different time points up to three months postoperative. Results: We found a 37% longer operating time when operating without a microdebrider. This difference was highly significant. The microdebrider scored significantly higher on every different parameter of user friendliness, except on the preparation of the instrument needed before surgery. For estimated blood loss during surgery we found no differences. Also there was no significant difference in postoperative healing at any point of time. Conclusions: This study demonstrates that operating patient with CRSwNP with the microdebrider is efficient and that the microdebrider at the same time is safe and easy to use.

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