Systematic Review

Harmonic scalpel versus other techniques for tonsillectomy: a systematic review and meta-analysis

Daniel Jun Yi Wong, Paul Paddle


Background: The objective of this review was to compare treatment effects of harmonic scalpel tonsillectomy versus alternative techniques on postoperative pain. Secondary outcomes included delayed bleeding and intraoperative blood loss.
Methods: Medline, Embase, and Central were searched for randomized controlled trials where harmonic tonsillectomy was compared to any alternative technique for participants of any age undergoing tonsillectomy. The primary outcome was pain scores using validated pain scores on day 1, day 4, and day 7 postoperatively. Data for postoperative pain scores were synthesized using random effects model and presented as standard mean difference (SMD). All outcomes were presented with 95% confidence intervals (CI). Subgroup analyses were performed based on hot or cold techniques.
Results: Eleven trials were identified in this review. Five trials (637 patients) contained data that permitted meta-analysis for postoperative pain. Harmonic scalpel tonsillectomy was associated with less postoperative pain compared to other hot techniques on day 1, 4, and 7 (P<0.001). Harmonic tonsillectomy had lower rates of delayed bleeding compared to cold steel (RR 0.44, 95% CI: 0.22–0.89, P=0.02), but no significant difference compared to other hot techniques (RR 1.01, 95% CI: 0.66–1.55, P=0.97).
Conclusions: The harmonic scalpel technique may cause less pain in the postoperative period compared to other techniques, but the difference is small. The harmonic scalpel does demonstrate evidence for superiority compared to blunt dissection, with a 56% reduction in delayed haemorrhage.

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