Gold laser tonsillectomy—A safe new method

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Abstract

Objectives

To determine if Gold laser tonsillectomy is an acceptably safe method of removing tonsils by comparing its complication rates to other established methods, namely Coblation tonsillectomy and cold steel dissection tonsillectomy.

Study design

A retrospective review of 748 consecutive patients, ages 2–18, undergoing tonsillectomy at a pediatric teaching institution.

Methods

Tonsillectomy with or without adenoidectomy was performed utilizing either the Gold laser (n = 435), Coblation device (n = 153), or by cold steel dissection (n = 160) between August 2005 and August 2007. Hospital charts were then reviewed to determine the rates of post-tonsillectomy hemorrhage and dehydration requiring hospital admission.

Results

In the Gold laser group there were 7 bleeding events (1.61%) and 7 dehydration admissions (1.61%). The Coblation group had 9 bleeding events (5.88%) and 1 dehydration admission (0.65%). The cold steel group had 1 bleed (0.63%) and 2 dehydration admissions (1.25%). The hemorrhage rate associated with Gold laser tonsillectomy was statistically equivalent to cold steel dissection (p = 0.3710) and significantly lower than in our Coblation control group (p = 0.0286).

Conclusions

Tonsillectomy by means of the Gold laser can be safely performed in the pediatric population.

Introduction

Tonsillectomy is a frequently performed operation. Challenges associated with tonsillectomy include intra-operative hemorrhage and adequate post-operative pain control. Consequently, many different methods for subcapsular tonsillectomy are currently employed. A newly introduced tool is the Gold contact laser [1]. Preliminary studies indicate that this laser may produce measurable decreases in post-operative pain [2]. Anecdotally, a bloodless tonsillectomy is often possible with this technique. The purpose of this study is to catalogue the complications associated with the Gold laser tonsillectomy and compare them to Coblation and cold steel tonsillectomy complication rates.

Section snippets

Methods

All tonsillectomies, including those performed in conjunction with other procedures (such as adenoidectomy) between 8/1/2005 and 8/1/2007 were identified by searching the hospital database of Children's Hospital of New Orleans using ICD-9 procedure codes (282 and 283). Of the 986 patients identified, 778 patients underwent tonsillectomy by one of the three study methods and had a complete chart available for review. Thirty of these patients were excluded (26 fell outside of the 2–18-year-old

Results

Table 2 shows a list of all complications and unexpected events. In the Coblation group there were two cases (1.31%) of primary hemorrhage (occurring <24 h post-operatively) and seven cases (4.58%) of secondary hemorrhage (occurring >24 h post-operatively), four of which required operative control. In the Gold laser group there were no cases of primary hemorrhage and seven cases (1.61%) of secondary hemorrhage, with four requiring operative control. The cold steel group had one case (0.63%) of

Discussion

The Gold laser (aka “Lightforce” laser, Medical Energy, Pensacola, FL) was FDA approved in 2004 for use in head and neck surgery. It generates electromagnetic radiation for tissue ablation using Gold coated electrodes and inter-electrode islands within a gaseous Indium Gallium Arsenide Phosphate III (InGaAsPIII) medium. Light energy between 960 and 1000 nm (dependant on the power setting selected) is then emitted through a flexible fiberoptic cable attached to the unit. This cable passes through

Conclusions

In our experience, Gold Laser tonsillectomy has been associated with a low incidence of complications, with complication rates comparable to cold steel dissection tonsillectomy. Within our study group, the Gold Laser tonsillectomy patients had a lower risk of post-operative hemorrhage compared to the Coblation tonsillectomies performed at our institution. Based on the results of our study, clinical use of the Gold laser can be recommended for the pediatric population.

Conflicts of interest statement

No author has disclosed any conflict of interest. This study was internally funded, with no funds, materials, oversight, or supplies provided by Medical Energy, Arthrocare ENT, or any other company.

Acknowledgements

Special thanks to C. Lillian Yau, PhD, Department of Biostatistics, School of Public Health and Tropical Medicine at Tulane University for her assistance in the statistical analysis of this paper and to Shane A. Gailushas, MD for assistance with data collection.

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Manuscript presented at the 111th annual meeting of the Triological Society in Orlando, Florida on May 3, 2008.

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