Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials

Abstract

Objective: To systematically review evidence regarding modern technology-assisted tonsillectomy pertaining to operative time, intraoperative and postoperative bleeding, postoperative pain, and other outcomes.

Design: A systematic search for randomized controlled trials comparing total tonsillectomies performed using vessel sealing systems (VSS), Harmonic Scalpel (HS), or radiofrequency ablation (ie, Coblation) with the conventional technique of cold steel and/or electrocautery dissection (CS/EC). Estimation of odds ratios and 95% confidence intervals (CIs), weighted mean differences (WMD), or standardized mean difference (SMD), as appropriate.

Patients: Thirty-three randomized controlled trials studying a total of 3139 patients were included in this meta-analysis.

Main outcome measures: Operative time, perioperative and postoperative bleeding, and postoperative pain.

Results: For the VSS group compared with the CS/EC group, operative time was significantly shorter (WMD), -4.09 minutes; 95% CI, -7.43 to -0.75 minutes; 760 patients), perioperative bleeding was significantly less (SMD, -1.67; -2.80 to -0.53; 355 patients), and postoperative bleeding was significantly less (odds ratio, 0.28; 0.13 to 0.61; 792 patients). Pain on the first and seventh postoperative days was significantly less in the VSS group (SMD, -1.73; 95% CI, -3.07 to -0.39; 740 patients; and SMD, -1.46; -2.35 to -0.57; 684 patients; respectively). For the HS group compared with the CS/EC group, the only studied outcome that differed significantly was perioperative bleeding, which was significantly less in the HS group (WMD -37.71 mL; 95% CI, -52.98 to -22.43 mL; 535 cases). No difference was noted between the Coblation and CS/EC groups for any of the studied outcomes.

Conclusions: For tonsillectomies, the Coblation and HS techniques do not provide any significant advantage compared with CS/EC. Synthesis of the limited and heterogeneous data regarding VSSs showed a significant benefit in all studied outcomes.