- The Washington Times - Monday, February 27, 2006

Most tonsil surgeries during the past two decades have been performed using a procedure that burns away swollen lymphoid tissue and cauterizes throat muscles, putting patients at risk for complications.

But a new, safer surgical technique that removes tonsils with more precision is proving superior for most patients.

A two-year study conducted by a researcher with the Eastern Virginia Medical School (EVMS) in Norfolk has shown that children who underwent tonsillectomies using a motorized rotary shaving device known as a microdebrider experienced less pain and recovered faster than youngsters who had the electrocautery procedure.

Tonsillectomies are the most common major surgeries performed on children. Of the 300,000 tonsillectomies in the United States each year, 75 percent involve patients 15 or younger, and half the operations are performed with electrocautery.

The microdebrider is used in fewer than 10 percent of tonsillectomies, said Dr. Craig S. Derkay, the EVMS surgeon who led the study.

Dr. Derkay’s research, which involved 300 patients ages 2 to 17 from the Hampton Roads area, was published in the Jan. 26 issue of the journal Otolaryngology — Head and Neck Surgery.

“We found improved outcomes with respect to speedier returns to normal diets and activities and less consumption of pain medication in the first week after surgery among patients whose tonsils were removed by the microdebrider,” Dr. Derkay said.

In fact, he said, patients who lost their tonsils to the microdebrider “were three times more likely to fully recover in three days and were three times less likely to still be recovering after seven days” than those whose underwent electrocautery.

The EVMS Chronicle, the school newspaper, reported that microdebrider children returned to normal activity in 2- days on average, compared with four days for those on electrocautery. Although children on electrocautery needed pain medicine for an average of 6- days, those on the microdebrider needed it for only four days.

The microdebrider trims the tonsils so precisely, Dr. Derkay said, that surgeons can leave intact a thin layer of connective tissue to protect underlying throat muscle. It allows a surgeon to leave just 1 percent of the tonsil while avoiding the throat muscle.

Dr. Derkay said this capability means a quicker recovery and retreat from pain medicine “because you are not exposing nerves and saliva to bacteria.”

He said the microdebrider is a familiar tool in sinus surgery and that he experienced success with it in removing adenoids before applying it in tonsillectomies.

Among patients undergoing tonsil removal, he said, 75 percent to 80 percent have had obstructed breathing from sleep apnea or snoring, while 20 percent to 25 percent have suffered recurring streptococcal infections.


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