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Tonsillectomy by Means of Plasma-Mediated Ablation
Prospective, Randomized, Blinded Comparison With Monopolar Electrosurgery
Udayan K. Shah, MD;
Jeffrey Galinkin, MD;
Rosetta Chiavacci, RN, BSN;
Marianne Briggs, RN, MSN, CRNP
Arch Otolaryngol Head Neck Surg. 2002;128:672-676.
Objective To compare plasma-mediated ablation (PMA) with monopolar electrosurgery
(MES) for pediatric tonsillectomy.
Design Prospective, randomized, blinded study.
Setting Academic children's hospital.
Participants Thirty-four children, aged 4 to 7 years.
Interventions Tonsillectomy by means of PMA (n = 17) or MES (n = 17).
Outcome Measures We measured surgical efficacy, estimated blood loss, and surgical time
during tonsillectomy and morphine use, immediate postoperative pain, and recovery
scores after tonsillectomy. Parents recorded recovery of normal diet and activity
and their own return to work for 10 days after surgery. Histopathologic evaluation
of excised tonsils was performed. We reviewed medical records and attempted
follow-up telephone contact.
Results With no significant difference in blood loss compared with MES, PMA
was effective for tonsillectomy. Performance of PMA took longer (24 vs 16
minutes; P = .002). Results of histopathologic evaluation
showed less thermal injury with PMA than with MES (P
= .03). Morphine consumption, pain, and recovery scores were equivalent between
groups. We found no significant difference in recovery of normal diet and
activity or parental return to work. Patients undergoing PMA had a greater
number of perioperative complications than those undergoing MES, including
2 patients in the PMA group (compared with none in the MES group) who required
unplanned admission for postoperative airway obstruction.
Conclusions Plasma-mediated ablation for pediatric tonsillectomy resulted in less
histopathologic thermal injury than MES, but did not show a statistically
faster recovery to normal activity and diet or parental return to work. In
addition, PMA took longer to perform, and had more complications. Therefore,
PMA should not replace MES for pediatric tonsillectomy. The reduced thermal
injury with PMA supports investigation into other means of using plasma ablation
to treat tonsillar hypertrophy.
From the Divisions of Otolaryngology (Dr Shah and Ms Briggs) and Anesthesiology
and Critical Care (Dr Galinkin and Ms Chiavacci), The Children's Hospital
of Philadelphia, and the Department of Otorhinolaryngology–Head and
Neck Surgery, University of Pennsylvania School of Medicine (Dr Shah and Ms
Briggs), Philadelphia, Pa.
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