Tonsillectomy using the Colorado microdissection needle: a prospective series and comparative technique review.Abstract: Tonsillectomy tonsillectomy /ton·sil·lec·to·my/ (ton?si-lek´tah-me) excision of a tonsil. ton·sil·lec·to·my n. Surgical removal of tonsils or a tonsil. remains one of the most common surgical procedures performed worldwide. Recent advancements in equipment technology have ushered in several new tonsillectomy techniques. Among these is the Colorado tip electromicrodissection needle. In this report, we describe the technical aspects of this modality and report our results in a prospective study of 12 adults and 13 children. We then compare our results with several published series using a variety of techniques. We found tonsillectomy using the electromicrodissection needle compares most favorably in all criteria examined, including operative and perioperative perioperative /peri·op·er·a·tive/ (-op´er-ah-tiv) pertaining to the period extending from the time of hospitalization for surgery to the time of discharge. per·i·op·er·a·tive adj. blood loss, perioperative pain, return to regular diet, and cost. We conclude that electromicrodissection tonsillectomy is an excellent option for all surgeons performing tonsillectomy. ********** Despite being originally described by Celsus more than 2,000 years ago (1) and performed more than 500,000 times per year in the United States, (2) the optimal method for tonsillectomy is still hotly debated. The literature in the last decade has focused on a variety of techniques using various modalities, including cold steel, electrocautery electrocautery /elec·tro·cau·tery/ (-kaw´ter-e) an apparatus for surgical dissection and hemostasis, using heat generated by a high-voltage, high-frequency alternating current passed through an electrode. , bipolar forceps, bipolar scissors scissors Cutting instrument or tool consisting of a pair of opposed metal blades that meet and cut when the handles at their ends are brought together. Modern scissors are of two types: the more usual pivoted blades have a rivet or screw connection between the cutting ends , argon argon (är`gŏn) [Gr.,=inert], gaseous chemical element; symbol Ar; at. no. 18; at. wt. 39.948; m.p. −189.2°C;; b.p. −185.7°C;; density 1.784 grams per liter at STP; valence 0. beam coagulator coagulator /co·ag·u·la·tor/ (ko-ag´u-la?ter) a surgical device that utilizes electrical current or light to stop bleeding. argon beam coagulator , carbon dioxide laser The carbon dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed (invented by Kumar Patel of Bell Labs in 1964[1]), and is still one of the most useful. , potassium-titanyl-phosphate (KTP KTP Knowledge Transfer Partnership KTP Potassium Titanyl Phosphate KTP Kartu Tanda Penduduk (Indonesian ID card) KTP Kaj Tiel Plu (Esperanto: Et Cetera) KTP KTiOPO4 ) laser, and coblation, to name a few. The paramount goal in nearly all published studies is to be able to perform tonsillectomy in a efficacious fashion with minimal blood loss, with few perioperative complications, while incurring little postoperative pain. Rarely mentioned but certainly significant in this commonly performed procedure is the cost for each modality. The goal of this prospective study was to compare the use of the Colorado tip electromicrodissection needle to other recently studied modalities. Patients and Methods The study population consisted of 25 patients aged 1 to 49 years (mean age, 10 yr) (Table 1). Eleven were older than 12 years and 14 were less than 12 years. The most common diagnosis was chronic tonsillitis tonsillitis Inflammatory infection of the tonsils, usually with hemolytic streptococci (see streptococcus) or viruses. The symptoms are sore throat, trouble in swallowing, fever, and enlarged lymph nodes on the neck. (n = 18) followed by tonsillar tonsillar /ton·sil·lar/ (ton´si-lar) of or pertaining to a tonsil. ton·sil·lar or ton·sil·lar·y adj. Of or relating to a tonsil, especially the palatine tonsil. hypertrophy hypertrophy (hīpûr`trəfē), enlargement of a tissue or organ of the body resulting from an increase in the size of its cells. Such growth accompanies an increase in the functioning of the tissue. (n = 7). All patients underwent the following standard operative procedure performed by the senior author (GYS GYS Great Yorkshire Show ) (Figs. 1-4). A Crowe-Davis retractor retractor /re·trac·tor/ (-trak´ter) 1. an instrument for holding open the lips of a wound. 2. a muscle that retracts. re·trac·tor n. 1. (or a McIvor in case of edentulous edentulous /eden·tu·lous/ (-tu-lus) without teeth. e·den·tu·lous adj. Having no teeth; toothless. patients) was used for oral retraction In the law of Defamation, a formal recanting of the libelous or slanderous material. Retraction is not a defense to defamation, but under certain circumstances, it is admissible in Mitigation of Damages. Cross-references Libel and Slander. ; 1% lidocaine lidocaine /li·do·caine/ (li´do-kan) an anesthetic with sedative, analgesic, and cardiac depressant properties, applied topically in the form of the base or hydrochloride salt as a local anesthetic; also used in the latter form as a with 1:100,000 epinephrine was injected into the anterior pillar bilaterally. Microneedle electrocautery (Colorado Needle tip; Stryker-Leibinger, Freiburg, Germany) set at 8 W coagulation coagulation (kōăg'y  lā`shən), the collecting into a mass of minute particles of a solid dispersed throughout a liquid (a sol), usually followed by the precipitation or (Valley Lab, Inc., Norwalk,
CT) was performed to create an anterior pillar incision. A tonsil tonsilSmall mass of lymphoid tissue in the wall of the pharynx. The term usually refers to the palatine tonsils on each side of the oropharynx. They are thought to produce antibodies to help prevent respiratory and digestive tract infection but often become infected tenaculum tenaculum /te·nac·u·lum/ (te-nak´u-lum) a hooklike surgical instrument for grasping and holding parts. te·nac·u·lum n. pl. is used to grasp the tonsil and medial edge of the incised incised /in·cised/ (in-sizd´) cut; made by cutting. pillar. Staying precisely on the tonsil capsule, the needle cautery cautery, searing or destruction of living animal tissue by use of heat or caustic chemicals. In the past, cauterization of open wounds, even those following amputation of a limb, was performed with hot irons; this served to close off the bleeding vessels as well as is used to separate the constrictor muscle constrictor muscle plain muscle surrounding cylindrical organs at orifices. constrictor muscle pupillae muscle muscle constricting the pupil. constrictor muscle vestibuli muscle muscles constricting the vagina. attachments generally beginning from the superior pole. As vessels are encountered, they are coagulated co·ag·u·late v. co·ag·u·lat·ed, co·ag·u·lat·ing, co·ag·u·lates v.tr. To cause transformation of (a liquid or sol, for example) into or as if into a soft, semisolid, or solid mass. v.intr. . Dissection proceeds in this fashion until the tonsil is removed. Rarely, when a tonsillar artery branch has persistent bleeding, a 4-0 chromic chromic /chro·mic/ (kro´mik) of, pertaining to, or related to chromium. chromic phosphate P 32 suture is used to ligate li·gate v. To tie or bind with a ligature. ligate (lī´gāt), v to tie or bind with a ligature or suture. ligate to apply a ligature. the persistent vessel. Once both tonsils tonsils, name commonly referring to the palatine tonsils, two ovoid masses of lymphoid tissue situated on either side of the throat at the back of the tongue. are removed, 1 cc of 40 mg/cc triamcinilone acetonide (Kenalog; Bristol-Meyers Squibb, New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY) diluted with 4 cc of 0.5% bupivacaine (Marcane/Sensorcaine; Astra-Zeneca Pharmaceuticals LP, Wilmington, DE) is injected into the superior, middle, and inferior pole of both tonsil fossa fossa /fos·sa/ (fos´ah) pl. fos´sae [L.] a trench or channel; in anatomy, a hollow or depressed area. acetabular fossa a nonarticular area in the floor of the acetabulum. . Immediately postoperatively, adult patients are administered IM or IV morphine sulfate morphine sulfate, n brand names: Duramorph PF, MS Contin, Roxanol; drug class: narcotic analgesic (Controlled Substance Schedule II); action: (Abbott Laboratories, Inc., Abbott Park, IL) (2-8 mg) and children are administered 10 to 20 mg meperidine HCL meperidine HCl (m  per´ (Demerol;
Abbott Laboratories, Inc.). Discharge medications include 1.25 to 5.0 ml
acetaminophen acetaminophen (əsēt'əmĭn`əfĭn), an analgesic and fever-reducing medicine similar in effect to aspirin. It is an active ingredient in many over-the-counter medicines, including Tylenol and Midol. with codeine codeine (kō`dēn), alkaloid found in opium. It is a narcotic whose effects, though less potent, resemble those of morphine. An effective cough suppressant, it is mainly used in cough medicines. Like other narcotics, codeine is addictive. (Tylenol #3 Elixir elixir /elix·ir/ (e-lik´ser) a clear, sweetened, alcohol-containing, usually hydroalcoholic liquid containing flavoring substances and sometimes active medicinal ingredients. e·lix·ir n. ; McNeil-PPC, Inc., Fort Washington, PA) for children and acetaminophen with oxycodone oxycodone /oxy·co·done/ (-ko´don) an opioid analgesic derived from morphine; used in the form of the hydrochloride and terephthalate salts. ox·y·co·done n. (Lortab 7.5; UCB UCB - University of California at Berkeley Pharma, Inc., Smyrna, GA) in adults. Operative time was recorded from the moment the oral retractor was placed to the time it was removed. The anesthesiologist Anesthesiologist A medical specialist who administers an anesthetic to a patient before he is treated. Mentioned in: Anesthesia, General, Appendectomy, Parathyroidectomy anesthesiologist estimated operative blood loss by evaluating the blood in the suction tubing and weighing saturated tonsil sponges. All subjects were given a 14-day survey sheet (Table 2) and instructions to record on a daily visual analog pain scale from 1 (no pain) to 10 (severe pain), blood loss, pain medicine use, unscheduled visits to health professionals, return to normal diet, and days of school or work missed. [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] [FIGURE 3 OMITTED] [FIGURE 4 OMITTED] Results Twenty-five patients underwent tonsillectomy. The estimated mean blood loss for patients under 12 years of age was 5.9 ml (range, 0-30 ml). For patients older than 12 years, mean blood loss was 13.5 ml (range, 0-50 ml). No suture ligation ligation /li·ga·tion/ (li-ga´shun) the application of a ligature. tubal ligation sterilization of the female by constricting, severing, or crushing the uterine tubes. was necessary in children, whereas suture ligature Two or more typeface characters that are designed as a single unit (physically touch). Fi, ffi, ae and oe are common ligatures. was used in two adults. Median operative time was 8 minutes in children and 10 minutes in adults. There was no significant postoperative bleeding. The widely accepted visual analog pain scale (0-10), no pain to the worst possible pain, first described by Lassalotta et al (3) used a numeric scale, a verbal description, and pictures of faces with different expressions, and is felt to be an accurate measure of pain in adults and most children. The mean postoperative interval to normal was 6 days in children and 8 days in adults. The mean interval above a pain rating of 5 was 3 days in children and 6 days in adults. Both adults and children returned to a regular diet by Day 6. Mean school or preschool absence in children was 2 days. Adults missed 5 days of work or school. Both adults and children tended to use prescription pain medicine for 5 days postoperatively. Neither age group required a health care professional visit before their scheduled 2-week postoperative visit. [FIGURE 5 OMITTED] Discussion The goals of any tonsillectomy technique are efficient and cost-effective excision, minimal blood loss, low complications, and rapid recovery. To this end, a number of tonsillectomy techniques have been advocated. The Colorado tip electromicrodissection needle was introduced into clinical practice in 1997, and a number of applications were described. The tip itself is a finely machined, insulated, tungsten diathermy diathermy (dī`əthûr'mē), therapeutic measure used in medicine to generate heat in the body tissues. Electrodes and other instruments are used to transmit electric current to surface structures, thereby increasing the local blood needle that fits any standard cautery handpiece. Farnsworth et al (4) described the advantage of electromicroneedle dissection. By reducing the surface area of the cautery device, high power densities can be maintained at relatively low wattage wattage the output or consumption of an electric device expressed in watts. . The net result allows for less dissipation of energy Same as See also: Dissipation as heat into the surrounding tissues, which results in a smaller zone of tissue necrosis than any other described modality. Akkielah et al (5) in 1997 first described the use of the microdissection needle in tonsillectomy. They prospectively compared bipolar to microneedle electrocautery using the patient as their own control by performing one side with a bipolar forceps and the other using the microneedle. They noted markedly less eschar eschar /es·char/ (es´kahr) 1. a slough produced by a thermal burn, by a corrosive application, or by gangrene. 2. tache noire. es·char n. formation in the tonsil fossa in the microdissection needle tip group. [FIGURE 6 OMITTED] We compared our results with those of a number of recent reports in the literature that described other advocated tonsillectomy techniques (Table 3, Figs. 5-7). Although tonsillectomy reporting is not standard in the literature, certain trends were discernible. We used a visual analog pain scale that has been frequently used in the past. When reporting postoperative pain from tonsillectomy, adults optimally should be separated from children; unfortunately, in many studies this format is not always followed. On the basis of our literature review, less pain is associated with guillotine tonsillectomy if no coagulation cautery is performed, (6) followed closely by the electromicrodissection needle and then coblation, (7) bipolar scissors, (8) and the KTP laser. (9) Operative time was well under 15 minutes for all techniques except the laser. [FIGURE 7 OMITTED] Although this is, of course, operator dependent, it is interesting to note that even in patients with the preoperative pre·op·er·a·tive adj. Preceding a surgical operation. preoperative preceding an operation. preoperative care the preparation of a patient before operation. diagnosis of recurrent tonsillitis (as opposed to tonsillar hypertrophy), the mean operative time for the electromicrodissection tip was 9 minutes. Blood loss was least for coblation, followed closely by the electromicrodissection tip and then bipolar scissors. Blood loss was greatest for monopolar electrocautery (either flat blade or suction tip), argon plasma coagulator, and cold steel. Postoperative bleeding was relatively common in argon plasma coagulator and blade electrocautery and rare in other techniques. Finally, in these days of cost consciousness, of the techniques that use disposable items, the cost at our institution are as follows: electromicrodissection tip, $40; coblation tip, $350; 0.6-cm KTP laser fiber, $125; and argon beam coagulator delivery device, $25.00. Of the nondisposable items, the electrocoagulation electrocoagulation /elec·tro·co·ag·u·la·tion/ (-ko-ag?ul-a´shun) coagulation of tissue by means of an electric current. e·lec·tro·co·ag·u·la·tion n. unit with handpiece is universally available. A tonsil coblation unit costs approximately $20,000, a KTP laser costs $140,000, bipolar scissors are $375, and an argon beam coagulator costs $100,000. Clearly, although costs are not the only concern, the prevalence of tonsillectomy makes expensive disposable equipment prohibitive. In contrast, durable equipment purchases can be justified on the basis of cost per procedure. Although the microdissection needle is recommended for single use only, its cost compares very favorably with other disposable modalities. Conclusions The optimal tonsillectomy technique, we think, should be learned easily, is relatively brief, inexpensive, and results in minimal blood loss, postoperative pain, and perioperative complications. Our experience with the electromicrodissection needle makes it an excellent option. Its unique, extremely fine-pointed tip allows for precise dissection and coagulation at very low power, thus minimizing thermal necrosis and decreasing postoperative pain. Operative time is, in general, brief and blood loss minimal. Its use does not involve any additional training or purchase of an expensive dedicated power source. Our experience would indicate that this technique should be among the preferred techniques in surgeons performing tonsillectomy. What we call results are beginnings. --Ralph Waldo Emerson
Table 1. Summary of home survey sheet data for all age groups
No. of days
Patient Sex/Age Until regular Lost school/ Nausea/
no. (yr) Pain Bleeding diet started work days vomiting
1 M/<12 6 1 6 0 0
2 F/<12 8 1 5 0 0
3 M/<12 5 0 5 0 0
4 F/<12 4 0 3 2 0
5 M/<12 7 0 3 4 0
6 F/<12 5 3 8 10 2
7 M/<12 8 0 3 1 0
8 M/<12 11 0 7 2 0
9 F/<12 11 0 10 9 0
10 M/<12 2 1 3 2 0
11 M/<12 5 1 6 0 0
12 M/<12 14 5 8 14 0
13 M/<12 14 1 11 9 0
14 M/<12 6 0 3 4 0
15 M/>12 14 9 11 1 0
16 F/>12 7 4 5 14 4
17 F/>12 7 3 5 6 2
18 F/>12 8 3 5 3 0
19 M/>12 7 0 14 10 0
20 F/>12 10 0 9 0 2
21 M/>12 14 1 6 5 8
22 F/>12 7 2 4 0 2
23 F/>12 4 3 3 4 1
24 F/>12 14 7 8 6 1
25 F/>12 10 2 10 10 0
Mean 8.3 1.8 6.4 4.6 0.9
No. of days
Pain Unscheduled
Patient medication doctor's
no. used visits
1 5 1
2 7 0
3 4 0
4 2 0
5 5 0
6 5 0
7 9 0
8 7 0
9 14 0
10 3 0
11 5 1
12 14 0
13 14 0
14 5 0
15 7 0
16 7 0
17 6 0
18 4 0
19 7 0
20 5 0
21 5 0
22 3 0
23 3 0
24 7 0
25 5 0
Mean 6.3 0.0
Table 2. Operative data in all age groups (a)
Patient Sex/Age Preoperative Blood loss Arterial
no. (yr) diagnosis (ml) suture
1 M/<12 Recurrent tonsillitis 1 0
2 F/<12 Chronic tonsillitis 0 0
3 M/<12 Recurrent tonsillitis 1 0
4 F/<12 Recurrent tonsillitis 0 0
5 M/<12 Chronic tonsillitis 4 0
6 F/<12 Tonsillar hypertrophy 0 0
7 M/<12 Tonsillar hypertrophy 5 0
8 M/<12 Chronic tonsillitis 3 0
9 F/<12 Recurrent tonsillitis 5 0
10 M/<12 Chronic tonsillitis 2 0
11 M/<12 Tonsillar hypertrophy 30 0
12 M/<12 Chronic tonsillitis 3 0
13 M/<12 Chronic tonsillitis 25 0
14 M/<12 Tonsillitis 0 0
15 M/>12 Chronic tonsillitis 35 1
16 F/>12 Chronic tonsillitis 0 0
17 F/>12 Chronic tonsillitis 3 0
18 F/>12 Chronic tonsillitis 4 0
19 M/>12 Chronic hypertrophic 14 3
tonsillitis
20 F/>12 Chronic tonsillitis 30 0
21 M/>12 Chronic tonsillitis 3 0
22 F/>12 Recurrent tonsillitis 2 0
23 F/>12 Chronic hypertrophic 8 0
tonsillitis
24 F/>12 Chronic tonsillitis 50 0
25 F/>12 Chronic tonsillitis 3 0
Mean 9.0 0.2
Patient Sex/Age Preoperative Operative P/O-D/C Postoperative
no. (yr) diagnosis time (min) (min) bleeding (ml)
1 M/<12 Recurrent 6 120 0
tonsillitis
2 F/<12 Chronic 5 180 0
tonsillitis
3 M/<12 Recurrent 15 120 0
tonsillitis
4 F/<12 Recurrent 6 150 0
tonsillitis
5 M/<12 Chronic 3 120 0
tonsillitis
6 F/<12 Tonsillar 6 100 0
hypertrophy
7 M/<12 Tonsillar 12 120 0
hypertrophy
8 M/<12 Chronic 8 120 0
tonsillitis
9 F/<12 Recurrent 3 120 0
tonsillitis
10 M/<12 Chronic 4 120 0
tonsillitis
11 M/<12 Tonsillar 12 160 0
hypertrophy
12 M/<12 Chronic 12 120 0
tonsillitis
13 M/<12 Chronic 11 120 0
tonsillitis
14 M/<12 Tonsillitis 3 180 0
15 M/>12 Chronic 22 180 0
tonsillitis
16 F/>12 Chronic 11 120 0
tonsillitis
17 F/>12 Chronic 5 128 0
tonsillitis
18 F/>12 Chronic 5 75 0
tonsillitis
19 M/>12 Chronic 18 140 0
hypertrophic
tonsillitis
20 F/>12 Chronic 14 150 0
tonsillitis
21 M/>12 Chronic 3 140 0
tonsillitis
22 F/>12 Recurrent 5 120 0
tonsillitis
23 F/>12 Chronic 13 135 0
hypertrophic
tonsillitis
24 F/>12 Chronic 17 167 0
tonsillitis
25 F/>12 Chronic 7 120 0
tonsillitis
Mean 9.0 133.0 0.0
(a) P/O, postopertive; D/C, discharged.
Table 3. Comparative summary of recent tonsillectomy series using
various techniques (a)
No. of
Series (ref. no.) patients Age range (yr)
Strunk & Nichols, 1990 (9) 23 >3
Wexler, 1996 (10) 26 >12
26 <12
Akkielah et al, 1997 (5) 42 5-29 (mean, 15)
Bergler et al, 2001 (12) 48 <12
58 >12
Blomgren et al, 2001 (11) 440 2.4-58.2 (mean, 17.9)
Raut et al, 2001 (8) 92 10-54 (mean, 22)
91
Temple & Timms, 2001 (7) 18 <12
Rideout & Shaw, 2003 25 All
(present series)
14 <12
11 >12
Type of electrocautery
Series (ref. no.) performed (W)
Strunk & Nichols, 1990 (9) KTP/532 Laser (10 W)
Wexler, 1996 (10) Flat-tipped electrocautery (20 W)
Akkielah et al, 1997 (5) Microdissection needle (8 W)
Bergler et al, 2001 (12) Argon plasma coagulator (N/A)
Blomgren et al, 2001 (11) Unipolar (17.5 W)
Raut et al, 2001 (8) Power Star bipolar scissors (N/A)
Cold blade dissection (N/A)
Temple & Timms, 2001 (7) Coblation (N/A)
Rideout & Shaw, 2003 Colorado tip electromicrodissection
(present series) needle (8 W)
Mean Mean blood
blood Arterial loss (ml)
Series (ref. no.) loss (ml) suture age <12 yr
Strunk & Nichols, 1990 (9) 17.65 N/A 21.19
Wexler, 1996 (10) 10 N/A N/A
30 N/A N/A
Akkielah et al, 1997 (5) N/A N/A N/A
Bergler et al, 2001 (12) 13.96 N/A 5.75
16.37 N/A 6.25
Blomgren et al, 2001 (11) 29.1 N/A 15.4
Raut et al, 2001 (8) 5 N/A 13
115 N/A 20
Temple & Timms, 2001 (7) N/A N/A N/A
Rideout & Shaw, 2003 9 0
(present series)
5.9 0 5.9
13.5 0.2
Postoperative Mean pain Extra doctor's
Series (ref. no.) bleeding score visits (no. or %)
Strunk & Nichols, 1990 (9) 0 N/A N/A
Wexler, 1996 (10) 0 N/A 2
0 N/A 0
Akkielah et al, 1997 (5) 0 3 N/A
Bergler et al, 2001 (12) N/A N/A N/A
N/A N/A N/A
Blomgren et al, 2001 (11) 10 (2.3%) N/A 16%
Raut et al, 2001 (8) 2.10% 6.9 25
Temple & Timms, 2001 (7) 0 2.1 N/A
Rideout & Shaw, 2003 0 2 0
(present series)
0 N/A 0
0 N/A 0
No. of days
Pain Until starting
Series (ref. no.) (mean) Bleeding regular diet
Strunk & Nichols, 1990 (9) 7.07 1 3 (53% of patients)
Wexler, 1996 (10) N/A 6 11
N/A 1 8.5
Akkielah et al, 1997 (5) N/A N/A N/A
Bergler et al, 2001 (12) N/A 5 N/A
N/A 9 N/A
Blomgren et al, 2001 (11) 10.8 N/A N/A
Raut et al, 2001 (8) N/A N/A N/A
N/A N/A N/A
Temple & Timms, 2001 (7) 9 0 2.4
Rideout & Shaw, 2003 8 1 6
(present series)
6 1 6
8.3 1.8 6.4
No. of days
Lost school/
Series (ref. no.) work days Medication
Strunk & Nichols, 1990 (9) N/A N/A
Wexler, 1996 (10) N/A N/A
N/A N/A
Akkielah et al, 1997 (5) N/A N/A
Bergler et al, 2001 (12) N/A N/A
N/A N/A
Blomgren et al, 2001 (11) N/A 10.7
Raut et al, 2001 (8) N/A N/A
N/A N/A
Temple & Timms, 2001 (7) N/A N/A
Rideout & Shaw, 2003 4 5
(present series)
2 5
4.6 6.3
(a) N/A, not available.
From the Department of Surgery at the University of Health Sciences, Kansas City, MO. Poster presentation at the Southern Medical Association 96th Annual Scientific Assembly, November 14-16, 2002, Washington, DC. Reprint requests to Gary Y. Shaw, MD, FACS FACS Fellow of the American College of Surgeons. FACS abbr. Fellow of the American College of Surgeons FACS fluorescence-activated cell sorter. , 6650 Troost Avenue, Suite 308, Kansas City, MO 64131-1249. Email: gshawmd@kc.rr.com Accepted June 9, 2003. Copyright [C] 2004 by The Southern Medical Association 0038-4348/04/9701-0011 References (1.) Curtin JM. The history of tonsil and adenoid adenoid /ad·e·noid/ (ad´e-noid) 1. pharyngeal tonsil. 2. pertaining to a pharyngeal tonsil. 3. resembling a gland. 4. (pl. surgery. Otolaryngol Clin North Am 1987;20:415-419. (2.) Rutkow IM. Ear, nose, and throat operations in the United States, 1979 to 1984. Arch Otolaryngol Head Neck Surg 1986;112:873-876. (3.) Lassaletta L, Martin G, Villafruela MA, et al. Pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. tonsillectomy: Post-operative morbidity comparing microsurgical bipolar dissection versus cold sharp dissection sharp dissection Surgery The separation of tissues in a surgical plane using a scalpel or other sharp instrument. See Dissection. Cf Blunt dissection. . Int J Pediatr Otorhinolaryngol 1997;41:307-317. (4.) Farnworth TK, Beals SP, Manwaring KH, et al. Comparison of skin necrosis in rats by using a new microneedle electrocautery, standard-size needle electrocautery, and the Shaw hemostatic hemostatic /he·mo·stat·ic/ (he?mo-stat´ik) 1. causing hemostasis, or an agent that so acts. 2. due to or characterized by stasis of the blood. he·mo·stat·ic adj. scalpel. Ann Plast Surg 1993;31:164-167. (5.) Akkielah A, Kalan A, Kenyon GS. Diathermy tonsillectomy: Comparisons of morbidity following bipolar and monopolar microdissection needle excision. J Laryngol Otol 1997;111:735-738. (6.) Yuan CC, Yu DY, Jun TS, et al. Guillotine tonsillectomy without anesthesia. Auris Nasus Larynx 1984;11:29-35. (7.) Temple RH, Timms MS. Paediatric Adj. 1. paediatric - of or relating to the medical care of children; "pediatric dentist" pediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195-198. (8.) Raut V, Bhat N, Kinsella J, et al. Bipolar scissors versus cold dissection tonsillectomy: A prospective, randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , multi-unit study. Laryngoscope la·ryn·go·scope n. A tubular endoscope that is inserted through the mouth and into the larynx and that is used for examining the interior of the larynx. la·ryn 2001;111:2178-2182. (9.) Strunk CL, Nichols ML. A comparison of the KTP/532-laser tonsillectomy vs. traditional dissection/snare tonsillectomy. Otolaryngol Head Neck Surg 1990;103:966-971. (10.) Wexler DB. Recovery after tonsillectomy: Electrodissection vs. sharp dissection techniques. Otolaryngol Head Neck Surg 1996;114:576-581. (11.) Blomgren K, Qvarnberg YH, Valtonen HJ. A prospective study on pros and cons pros and cons Noun, pl the advantages and disadvantages of a situation [Latin pro for + con(tra) against] of electrodissection tonsillectomy. Laryngoscope 2001;111:478-482. (12.) Bergler W, Huber K, Hammerschmitt N, et al. Tonsillectomy with argon plasma coagulation Argon plasma coagulation or APC is a medical endoscopic procedure used primarily to control bleeding from certain lesions in the gastrointestinal tract, and also sometimes to debulk tumours in the case of patients for whom surgery is not recommended. (APC (1) (American Power Conversion Corporation, West Kingston, RI, www.apcc.com) The leading manufacturer of UPS systems and surge suppressors, founded in 1981 by Rodger Dowdell, Neil Rasmussen and Emanual Landsman, three electronic power engineers who had worked at MIT. ): Evaluation of pain and hemorrhage. Laryngoscope 2001;111:1423-1429. RELATED ARTICLE: Key Points * The technique using the electromicrodissection needle is easily learned, expeditious ex·pe·di·tious adj. Acting or done with speed and efficiency. See Synonyms at fast1. ex with very low blood loss. * There is a markedly reduced amount of pain, with return to normal diet and normal daily activity when using this technique as compared with other techniques. * There is a relatively economical advantage in using this technique as opposed to some of the other more expensive and complicated techniques (eg, coblation or laser techniques). Benjamin Rideout, MSIV MSIV Main Steam Isolation Valve , and Gary Y. Shaw, MD, FACS |
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