The Outcome of Microscopic with Bipolar Cautery Assisted and Head Light and Cold Steel Assisted Tonsillectomy: A Comparative Retrospective Study on 276 Patients

Purpose: To evaluate the advantage of microscope assisted tonsillectomy using bipolar cautery over the use of headlight assisted tonsillectomy with cold steel instruments in two comparable groups of patients. Primary objective was to ascertain the intraoperative benefit of using magnification with greater illumination. Secondary objectives were to find advantages of using novel technique in postoperative pain and hemorrage both primary and secondary as well as generation of biomedical waste. Methods The records of all patients who underwent tonsillectomy at our hospital between 2019 and 2024 were reviewed. We classified the patients in two groups solely according to the surgical techniques used. The patients in both groups fulfilled the same criteria of inclusion and exclusion. The protocols for pre-and postoperative treatment were identical. Results: The patients in the microscope with bipolar cautery assisted tonsillectomy had better visualization of tonsillar bed which translated in better hemostasis, shorter operative time, minimal injury to pharyngeal muscles and no residual lymphoid tissue in corners of tonsillar fossa specially tonsillolingual sulcus and upper pole.95% percent of the patients in the microscope and bipolar cautery assisted tonsillectomy and 91% in the head light and cold steel assisted tonsillectomy were pain free after 12 weeks (p < 0.01). The average blood loss in microscope assisted bipolar tonsillectomy was 0.5ml whereas in headlight and cold steel tonsillectomy was 15ml (p < 0.01). The average surgical time was 14min in microscope and bipolar assisted tonsillectomy whereas in another group it was 35min (p < 0.01). Conclusion: Bipolar cautery dissection under microscopic visualisation is better than Cold steel dissection with headlight in terms of intraoperative visualisation, time and hemostasis.