Pediatrik Hastalarda Parsiyel İntrakapsüler Bizact™ ve Bipolar Elektrokoter Tonsillektominin Sonuçları: Prospektif Bir Değerlendirme

Yıl 2025, Cilt: 7 Sayı: 2, 173 - 180, 23.06.2025

Elvin Alaskarov , Necdet Özçelik

https://doi.org/10.52827/hititmedj.1581528

Öz

Amaç: Bu çalışmanın amacı, pediatrik hastalarda Parsiyel Intrakapsüler Bizact™ Tonsillektomi (PIBT) ve Bipolar Elektrokoter Tonsillektomi (BET) tekniklerinin intraoperatif ve postoperatif sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: Genel anestezi altında tonsillektomi yapılan 260 pediatrik hasta dahil edildi. Tek merkezli, prospektif ve randomize bir çalışma gerçekleştirildi. Hastalar rastgele olarak PIBT grubuna veya BET grubuna atandı. Demografik ve klinik veriler toplandı; değerlendirme ölçütleri arasında ameliyat süresi, intraoperatif kanama, postoperatif ağrı skorları, normal diyete dönüş süresi ve sekonder kanama insidansı yer almaktaydı.
Bulgular: Hastaların yaş ortalaması PIBT ve BET grupları arasında benzerdi. PIBT grubunda ameliyat süresi (11 ± 3,3 dakika), BET grubuna göre anlamlı olarak daha kısaydı (18 ± 3,7 dakika, p<0,05). İntraoperatif kanama miktarı PIBT grubunda diğer guruba göre azdı. (PIBT: 11 ± 2,7 ml; BET: 13 ± 2,3 ml, p<0,05). PIBT grubunda postoperatif ağrı skorları 3. ve 7. günlerde anlamlı derecede düşüktü. PIBT grubundaki hastalar, BET grubuna kıyasla normal diyete daha erken döndü (7,3±1,5 gün). İkincil kanama insidansı PIBT grubunda (%3,6) BET grubuna (%4,7) göre istatistiksel anlamlı olmasa da düşük olarak gözlendi.
Sonuç: Parsiyel İntrakapsüler Bizact™ Tonsillektomi, elektrokoter tonsillektomiye kıyasla daha kısa ameliyat süresi, azalmış intraoperatif kanama, düşük postoperatif ağrı ve normal diyete erken dönüş gibi önemli avantajlar sunmaktadır. Bu bulgular, PIBT’nin pediatrik tonsillektomide tercih edilen bir teknik olabileceğini göstermektedir.

Anahtar Kelimeler

Bizact™ , intraoperatif kanama , postoperatif ağrı , tonsillektomi

Outcomes of Partial Intracapsular Bizact™ Versus Bipolar Electrocautery Tonsillectomy in Pediatric Patients: A Prospective Analysis

Öz

Objective: : This study aimed to compare the intraoperative and postoperative outcomes of Partial Intracapsular Bizact™ Tonsillectomy (PIBT) and Bipolar Electrocautery Tonsillectomy (BET) in pediatric patients.
Material and Method: We conducted a single-center, prospective, randomized study involving 260 pediatric patients who underwent tonsillectomy under general anesthesia. Patients were randomly assigned to either the PIBT group or the BET group. Demographic and clinical data were collected, and the measured outcomes included operation time, intraoperative bleeding, postoperative pain scores, time to resume a normal diet, and the incidence of secondary bleeding.
Results: The mean age of patients was similar between the PIBT and BET groups. The PIBT group demonstrated a significantly shorter operation time (11 ± 3.3 minutes) compared to the BET group (18 ± 3.7 minutes, p<0.05). Intraoperative bleeding was significantly lower in the PIBT group (PIBT: 11 ± 2.7 ml; ET: 13 ± 2.3 ml, p<0.05). Postoperative pain scores were significantly lower in the PIBT group on days 3 and 7. Patients in the PIBT group resumed a normal diet significantly earlier (7.3±1.5 days) than those in the BET group. The incidence of secondary bleeding was slightly lower in the PIBT group (3.6%) compared to the BET group (4.7%).
Conclusion: Partial Intracapsular Bizact™ Tonsillectomy offers significant advantages over electrocautery tonsillectomy, including shorter operation time, reduced intraoperative blood loss, decreased postoperative pain, and a faster return to a normal diet. These findings suggest that PIBT may be a preferred technique for pediatric tonsillectomy.

Anahtar Kelimeler

Bizact™ , intraoperative bleeding , postoperative pain , tonsillectomy.

Etik Beyan

Ethical approval for the study was obtained from the Medipol University Clinical Research Ethics Committee (Date: 03/06/2020; Decision No: E-10840098-202.3.02-3329).

Kaynakça

• Randall DA. Current Indications for Tonsillectomy and Adenoidectomy. J Am Board Fam Med 2020;33(6):1025-1030.
• Audit NP. Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit. Qual Saf Health Care 2008;17(4):264-268.
• Uwiera TC. Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond. Children (Basel) 2021;8(11):944.
• Stepan L, Huang L, Huynh J, Xie P, Woods CM, Ooi EH. Health Related Quality of Life T-14 Outcomes for Pediatric Bizact Tonsillectomy. Medicina (Kaunas) 2021;57(5):480.
• Kumar DS, Valenzuela D, Kozak FK et al. The reliability of clinical tonsil size grading in children. JAMA Otolaryngol Head Neck Surg 2014;140(11):1034-1037.
• Garra G, Singer AJ, Taira BR et al. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Acad Emerg Med 2010;17(1):50-54.
• Dharmawardana N, Chandran D, Elias A, Kao SST, Ooi EH. Management of post tonsillectomy secondary haemorrhage: Flinders experience. Aust J Otolaryngol 2018;1:31.
• Mitchell RB, Archer SM, Ishman SL et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg 2019;160(1_suppl):S1-S42.
• Shih MC, Long BD, Pecha PP et al. A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2022;9(1):9-26.
• Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017;8(8):CD004619.
• Jat SL, Jat KS, Sehra R, Sharma MP, Sharma A. Traditional and Coblation Tonsillectomy in Pediatrics Population: A Comparative Study. Indian J Otolaryngol Head Neck Surg 2022;74(Suppl 3):6414-6421.
• Mukhatiyar P, Nandalike K, Cohen HW et al. Intracapsular and Extracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2016;142(1):25-31.
• Mostovych N, Holmes L, Ruszkay N, LaHurd A, Heinle R, Nardone H. Effectiveness of Powered Intracapsular Tonsillectomy in Children With Severe Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2016;142(2):150-156.
• Chang DT, Zemek A, Koltai PJ. Comparison of treatment outcomes between intracapsular and total tonsillectomy for pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2016;91:15-18.
• MacGregor FB, Albert DM, Bhattacharyya AK. Post-operative morbidity following paediatric tonsillectomy; a comparison of bipolar diathermy dissection and blunt dissection. Int J Pediatr Otorhinolaryngol 1995;31(1):1-6.
• Hong SM, Cho JG, Chae SW, Lee HM, Woo JS. Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults. Clin Exp Otorhinolaryngol 2013;6(2):90-93.
• Kim JW, Mun SJ, Lee WH, Mo JH. Post-tonsillectomy hemorrhage in children: a single surgeon’s experience with coblation compared to diathermy. Eur Arch Otorhinolaryngol 2013;270(1):339-344.
• Lowe D, van der Meulen J, Cromwell D et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117(4):717-724.
• Kim SJ, Kwon C, Koh TK, Lee KH, Kim SW. Lower-pole intracapsular tonsillectomy in obstructive sleep apnea patients. Acta Otolaryngol 2017;137(3):302-305.
• Li J, Luo L, Chen W et al. Application of Coblation Tonsillectomy with Inferior Pole Capsule Preservation in Pediatric Patients. Laryngoscope 2021;131(5):1157-1162.
• Falz H, von Lücken HJ, Münscher A, Möckelmann N. A comparative study of BiZact™ tonsillectomy versus cold steel dissection technique in adults: Analysis of operating time, intraoperative blood loss, postoperative bleeding rate and pain. Clin Otolaryngol 2024;49(3):299-305.
• Dulku K, Toll E, Kwun J, van der Meer G. The learning curve of BiZact™ tonsillectomy. Int J Pediatr Otorhinolaryngol 2022;158:111155.
• Mao B, Woods CM, Athanasiadis T et al. BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series. Clin Otolaryngol 2023;48(4):672-679.
• Kang YJ, Stybayeva G, Hwang SH. Effect of the BiZact™ Low-Temperature Dissecting Device on Intra- and Postoperative Morbidities Related to Tonsillectomy-A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2024;60(9):1415. Published 2024 Aug 29.
• Tierney J, Harrison E, Hodge JC, Carney AS. Coblation versus BiZact extra-capsular tonsillectomy in adults: a randomized control trial. ANZ J Surg 2024;94(5):861-866.
• Yıldırım YSS, Sakallıoglu O. Comparison of BizactTM and Bipolar Tonsillectomy in Pediatric Patients. SAS Journal of Medicine 2023;9(9):984-988.