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Snare Tonsillectomy

Tonsillectomy is one of the most common surgeries performed today, yet debate continues regarding the best technique to avoid complications.  We’ll review one method in this video, snare tonsillectomy, which is a “cold” technique.   We’ll discuss it’s advantages over other methods, and a step-by-step instructional video.

The patient is brought to main operating room and given general endotracheal anesthesia and placed supine. The oropharynx is exposed by retracting the tongue and endotracheal tube inferiorly and placing the retractor in suspension. One tonsil is grasped with a curved allis clamp, between the wire of the tonsil snare. With an adequate grasp and medial retraction, the snare wire is wrapped around the tonsil and squeezed to create a natural cleavage plane. The tonsillar fossa is then filled with packing. Lastly, the packing is removed and active Bleeding within the tonsillar fossa is controlled with minimal bipolar diathermy cauterization. The oropharynx is then irrigated with normal saline. The retractor is removed and the procedure is terminated.
Sleep-disordered breathing and tonsillar hypertrophy Recurrent tonsillitis
Bleeding disorders (relative)
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Anterior tonsillar pillar Posterior tonsillar pillar
Surgical techniques can be generally classified as "hot" (using heat to cauterize tissue) versus "cold" (using sharp steel). Multiple studies cite the decreased hemorrhage risk and less post-operative pain with "cold" techniques over "hot". Histological findings have also demonstrated less collateral tissue damage when using a "cold" technique. Disadvantages of "cold" techniques are increased operating time and increased blood loss during surgery.
Hemorrhage Dehydration Pain
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Elinder et al. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol. 2016 Aug;273(8):2249-56. Tan et al. Control of Pain After Tonsillectomy in Children: A Review. JAMA Otolaryngol Head Neck Surg. 2017 Sep 1;143(9):937-942. Rubenstein et al. Rethinking surgical technique and priorities for pediatric tonsillectomy. Am J Otolaryngol. 2017 Mar - Apr;38(2):233-236. Francis et al. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2017 Mar;156(3):442-455. Magdalena et al. Histological analysis of tonsillectomies: relationship with surgical technique, post-operative pain and haemorrhage. J Laryngol Otol. 2016 Dec;130(12):1142-1146.

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