Intracapsular tonsillectomy performed with a microdebrider results in less pain and quicker recovery than does tonsillectomy involving electrocautery, Dr. Craig S. Derkay said at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
A study of 300 patients aged 2–17 years found that, compared with the electrocautery group, the microdebrider group returned to normal activities an average of 1.5 days earlier and stopped taking pain medications 2.5 days earlier.
Intracapsular tonsillectomy performed with a microdebrider “seems to result in a quicker recovery and resumption of normal activities than standard tonsillectomy. Because this method leaves the connective tissue capsule intact, the muscles of the pharynx aren't exposed to secretions and food, so patients experience less pain and are able to start eating sooner,” Dr. Derkay, director of pediatric otolaryngology at Eastern Virginia Medical School in Norfolk, said in an interview.
The prospective, single-blind, randomized controlled trial was funded by a grant from Medtronic Inc., which markets the debrider used in the study. A total of 300 children with obstructive sleep disorders were enrolled. Half received tonsillectomy using low-wattage electrocautery (15 watts); half received microdebrider intracapsular tonsillectomy. Adjuvant therapy was standardized, and the only variation was in the instrument used to remove the tonsils.
Dr. Derkay, who disclaimed any financial interest in Medtronic or the device, described the microdebrider as a powered instrument connected to suction and irrigation, with a small blade rotating 2,000 times per minute.
The researchers used validated quality- of-life scales before and after the operation, and a special visual scale (FACES) for younger children. Parents filled out diaries every 12 hours until their children were fully recovered; nurses called them every day with reminders.
Intraoperative blood loss, surgical complications, and emergency department visits were similar in both groups.
The microdebrider method was associated with significantly shorter time needed to return to normal activities (2.5 days vs. 4 days) and to stop taking pain medication (4 days vs. 6.5 days).
Dr. Derkay also reported statistically significant improvements in quality- of-life measures related to emotional distress and activity limitations. “The results in this prospective study confirm favorable results seen in previous retrospective studies,” Dr. Derkay said.
In addition to comparing two different tonsillectomy methods, the researchers followed evidence-based measures to attain the best possible outcomes in both groups.
They used standardized adjuvant therapy including intraoperative and postoperative ampicillin and dexamethasone, and pre- and postincisional bupivacaine. “That resulted in the electrocautery patients actually doing better than we thought they would do,” Dr. Derkay said. “But the microdebrider patients did even better.”
Because most otolaryngologists already use the microdebrider frequently for endoscopic sinus surgery, it will be relatively easy for them to make the transition to this new form of tonsillectomy, Dr. Derkay said in an interview.
Innovations in surgical therapy need to justify their existence via improved outcomes and/or decreased costs, Dr. Derkay said. At his institution there is no additional charge to set up the microdebrider, and the disposable blades cost approximately $100.