Argon plasma coagulation versus cold steel tonsillectomy: a comparison of safety and efficacy

Emily Zhen, Chi-kee Leslie Shaw


Background: Various tonsillectomy techniques have been introduced as alternatives to cold steel (CS) dissection. The aim of this study was to compare safety and efficacy of Argon plasma coagulation (APC) with CS tonsillectomy, by evaluating: (I) operative time; (II) intraoperative haemorrhage; (III) postoperative pain and (IV) postoperative haemorrhage.
Methods: This study was a retrospective analysis of a 5-year prospectively collected database. Five hundred patients who underwent elective tonsillectomies performed by a single surgeon were included in this study (age range 1–57, male/female ratio =0.68, APC group n=232, CS group n=268).
Results: APC group had shorter operative time than CS [12.33 min, standard deviation (SD) 0.284 vs. 20.68 min, SD 0.16, P<0.001], and less intraoperative haemorrhage (P<0.001). Intraoperative haemorrhage was described by a grading system: the majority of APC group in grade 1a bleeding (equivalent to 0–2 mL) and majority of CS in grade 2 bleeding (equivalent to 14–65 mL). Pain scores were lower in CS group by only 0.45 on a 10-point scale (P=0.04) and pain profiles over a 2-week postoperative period were similar. There was less secondary postoperative haemorrhage in APC group compared to CS, which was not statistically significant (3.88% vs. 5.22%, P=0.16). Primary haemorrhage did not occur in either group.
Conclusions: APC appears to be a safe and efficacious technique for paediatric and adult tonsillectomy. It offers shorter operative time, reduced intraoperative haemorrhage and same postoperative pain experience. Rates of secondary haemorrhage require further evaluation with higher powered studies.