Adolescents and Adults Undergoing Temperature-Controlled Surgical Instruments vs Electrocautery in Tonsillectomy: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Yi Chan Lee, Li Jen Hsin, Wan Ni Lin, Tuan Jen Fang, Yao Te Tsai, Cheng Ming Luo*

*此作品的通信作者

研究成果: 期刊稿件文獻綜述同行評審

17 引文 斯高帕斯(Scopus)

摘要

Importance: Several temperature-controlled surgical instruments (TCSIs) have been used in tonsillectomy. However, to our knowledge, a meta-analysis of the differences between modern TCSIs and electrocautery (EC) has not been conducted. Objective: To compare TCSIs with EC with regard to the intraoperative and postoperative parameters of tonsillectomy. Data Sources: PubMed (MEDLINE), Embase, and the Cochrane Library were searched independently by 2 authors for relevant articles. Study Selection: A literature search identified randomized clinical trials comparing the outcomes of TCSIs vs EC. The search keywords were harmonic scalpel, ultracision, PlasmaBlade, coblation, radiofrequency ablation, and tonsillectomy. Studies of adult and adolescent patients were included. Data Extraction and Synthesis: Data from each study were extracted. A random-effects model was used in the pooled analysis. Main Outcomes and Measures: Four outcomes were analyzed: postoperative pain level on days 1, 2, 7, and 14 after surgery; postoperative bleeding; operative time; and intraoperative blood loss. Results: This meta-analysis included 11 studies with a total of 629 unique patients. (Mean ages ranged from 16 to 55 years.) The studies were further categorized by the methods of comparison. Five articles used between-participant comparisons, and 6 used within-participant comparisons (of the left vs right sides of the participant's body). The pooled results of the studies with between-participant measures showed that postoperative pain scores were lower in the TCSI group on the first day (standardized mean differences [SMD], -0.41 [95% CI, -0.77 to -0.06]) and seventh day (SMD, -0.76 [95% CI, -1.47 to -0.04]). The pooled results of the studies with within-participant measures showed that the postoperative pain scores were lower in the TCSI group on the first day (SMD, -0.37 [95% CI, -0.63 to -0.12]) and second day (SMD, -0.60 [95% CI, -1.10 to -0.10]). The pooled analysis of overall bleeding, major bleeding, minor bleeding, primary bleeding, and secondary bleeding in both the types of studies with between-participant measures and those with within-participant measures showed no significant differences between the TCSI and EC groups. Intraoperative blood loss and operative time were not significantly different between the groups. Conclusions and Relevance: Compared with EC, TCSIs were associated with significantly reduced pain on the first day after tonsillectomy, per this meta-analysis. The rates of overall bleeding, primary bleeding, secondary bleeding, major bleeding, and minor bleeding between TCSIs and EC were comparable. Intraoperative blood loss and operative time also showed no significant intergroup differences. Surgeons may consider using these modern instruments according to personal experiences, preferences, and cost-effectiveness criteria..

原文英語
頁(從 - 到)339-346
頁數8
期刊JAMA Otolaryngology - Head and Neck Surgery
146
發行號4
DOIs
出版狀態已出版 - 04 2020
對外發佈

文獻附註

Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press and the Society for the Advancement of Socio-Economics. All rights reserved.

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