A prospective study comparing PlasmaKnife with bipolar dissection tonsillectomy: a preliminary communication of an emerging technology

Abstract

Objective: To clinically evaluate and compare the PlasmaKnife to bipolar electrocautery in paediatric tonsillectomy.

Design: Prospective comparative non-randomised study.

Setting: Central London teaching hospital with tertiary referrals.

Participants: Forty-three patients aged 3-12 years with recurrent tonsillitis or obstructive adenotonsillar hypertrophy awaiting a tonsillectomy were recruited into the study.

Main outcome measures: Primary outcome was throat, ear and swallowing pain scores over 2 weeks. Secondary measures included: return to normal diet, return to normal activity, analgesic requirements, operation time and intraoperative blood loss.

Results: Surgical dissection was similar between the two groups with minimal blood loss and comparable overall operative times. Median throat pain scores suggest PlasmaKnife to be less painful in the early postoperative period (at 8 h, P < 0.005) but, overall, did not quite reach statistical significance (Mann-Whitney U-test). PlasmaKnife was similar to bipolar in all other measured categories. During the study, three secondary bleeds occurred in the PlasmaKnife group and all were managed conservatively.

Conclusion: PlasmaKnife is a safe new technology with similar outcome to the established bipolar technique. This preliminary study finds PlasmaKnife to be an interesting instrument and warrants a larger randomised study to truly evaluate the potential advantages of lowered pain and early recovery attributed to this emerging technology.