Different tonsillectomy techniques in Egypt: advantages and disadvantages — experience and review of literature

Abstract The debate about which surgical technique for tonsillectomy could be superior over another is continuous. Tonsillectomy techniques are classified into cold and hot procedures. In cold techniques, no heat is used; they include dissection, guillotine, microdebrider, harmonic scalpel, and cryosurgery. Hot techniques include electrocautery, coblation, radio frequency, and laser. In Egypt, the used methods are cold dissection, electrocautery, cold dissection with electrocautery hemostasis, coblation, and less commonly laser. In this study, we described the advantages and disadvantages of each technique. Hot techniques have shorter operative time and less intraoperative bleeding, while cold dissection technique has less postoperative pain and less postoperative complications especially secondary hemorrhage, with more rapid wound healing. However, coblation technique may have less pain in the first few hours postoperatively relative to cold technique. Electrocautery technique is the most painful method with delayed wound healing. Laser technique is nearly equivalent to electrocautery with slightly less pain. Cold dissection technique is less costly when compared to other techniques. Family satisfaction after tonsillectomy is dependent mainly on less postoperative pain and rapid recovery. Cold dissection is still considered the gold standard technique. Caution should be taken on using hot techniques especially when used for dissection, and the trainee surgeons should become familiar with cold dissection before shifting to other tonsillectomy techniques. From this study, we can say that hot techniques should not be used except after mastering the cold dissection tonsillectomy; also, the new advanced techniques can be reserved for high-risk patients such as having bleeding disorders.