Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method

Abstract

Background: Tonsillectomy, a common paediatric otolaryngology  procedure, has undergone several evolutionary trends in the surgical  techniques aimed at minimizing complications and improving patients’ satisfaction. Despite the technological advancements in this respect, search for an ideal method is still ongoing, and some authorities are  reverting back to the conventional methods. We wish to introduce the “Vasoconstrictive hydrolytic cold dissection” (VHCD)
method.

Patients and Methods: The VHCD method was described, and the outcome measures in one hundred and thirty-fi ve patients who had the procedures were presented in tables. Data entrance was done with SPSS 14. Results: A total 135 patients comprising of 107 children aged 1-12 years and 28  adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15  minutes and 5 mls for children and 12 mins and 10 mls for  adults/adolescents, respectively. There was a single case (0.7%) of posttonsillar bleed (reactionary haemorrhage). The rest (99.3%) recorded nil haemorrhage within and beyond first 2 weeks post-surgery. 

Conclusions: Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however, those practicing CSM will benefi t
from VHCD. We hereby recommend this simple, costeffective modification of the cold steel tonsillectomy, which appears to have made dissection easier and also minimizes haemorrhage, a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A  randomized control trial is required for further evaluation of this method.

Key words: Normal saline, tonsillectomy, vasoconstrictive hydrolytic  dissection