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. 2023 Dec;75(4):3621-3627.
doi: 10.1007/s12070-023-04022-7. Epub 2023 Jul 12.

Harmonic Scalpel Tonsillectomy Versus Coblation Tonsillectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ebraheem Albazee  1 , Salman Hussain  2 , Aysha Abduljabbar  3 , Maisem Tariq AlHajri  1 , Mahmoud Abdelaziz Alsakka  4 , Ahmed Abu-Zaid  5   6
Affiliations

Harmonic Scalpel Tonsillectomy Versus Coblation Tonsillectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ebraheem Albazee et al. Indian J Otolaryngol Head Neck Surg. 2023 Dec.

Abstract

Aim: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to comprehensively evaluate the efficacy of coblation versus harmonic scalpel methods among patients undergoing tonsillectomy.

Methods: PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Google Scholar databases were systematically screened from inception until October 2022. The outcomes were summarized as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with 95% confidence interval (CI) in a random-effects model.

Results: Six RCTs were analyzed, encompassing a sum of 461 patients (harmonic scalpel = 233 patients and coblation = 228 patients). The overall quality assessment was low risk of bias in two RCTs, some concerns of bias in three RCTs, and high risk of bias in one RCT. There was no significant difference between harmonic scalpel and coblation groups regarding the mean operative time (n = 6 RCTs, MD=-7.45 min, 95% CI [-15.26, 0.01], p = 0.06) mean intraoperative blood loss (n = 5 RCTs, MD=-36.03 ml, 95% CI [-77.46, 5.41], p = 0.09), and rate of postoperative hemorrhage (n = 5 RCTs, RR = 0.59, 95% CI [0.25, 1.39], p = 0.23). The overall postoperative pain score was significantly reduced in favor of the coblation group compared with the harmonic scalpel group (n = 5 RCTs, MD = 0.40, 95% CI [0.10, 0.69], p = 0.009)".

Conclusions: The harmonic scalpel and coblation techniques share equal efficacy among patients undergoing tonsillectomy. The reduction in postoperative pain score provided by the coblation method is not clinically meaningful in clinical practice. Additional RCTs are needed to consolidate the power and quality of the presented evidence.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04022-7.

Keywords: Coblation; Harmonic scalpel; Hemorrhage; Pain; Tonsillectomy.

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Conflict of interest statement

Conflicts of interest/Competing InterestsNone.

Figures

Fig. 1
Fig. 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart for literature search and study selection
Fig. 2
Fig. 2
Summary of the quality assessment of the included studies
Fig. 3
Fig. 3
Meta-analysis of the mean operative time (min)
Fig. 4
Fig. 4
Meta-analysis of the mean intraoperative blood loss (ml)
Fig. 5
Fig. 5
Meta-analysis of the rate of postoperative hemorrhage
Fig. 6
Fig. 6
Meta-analysis of the mean postoperative pain score (10-point scale)
See this image and copyright information in PMC

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References

    1. Windfuhr JP, Toepfner N, Steffen G, et al. Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol. 2016;273:989–1009. doi: 10.1007/s00405-016-3904-x. - DOI - PubMed
    1. Randall DA. Current indications for Tonsillectomy and Adenoidectomy. J Am Board Fam Med. 2020;33:1025–1030. doi: 10.3122/jabfm.2020.06.200038. - DOI - PubMed
    1. Aldamluji N, Burgess A, Pogatzki-Zahn E, et al. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76:947–961. doi: 10.1111/anae.15299. - DOI - PMC - PubMed
    1. Krishna P, Lee D. Post-tonsillectomy bleeding: a meta-analysis. Laryngoscope. 2001;111:1358–1361. doi: 10.1097/00005537-200108000-00008. - DOI - PubMed
    1. Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy techniques and pain: a review of randomized controlled trials and call for standardization. ORL J Otorhinolaryngol Relat Spec. 2007;69:364–370. doi: 10.1159/000108369. - DOI - PubMed

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