Arif Raza Khan, Muhammad Hafeez, Asad Ullah Arif.
Tonsillectomy by harmonic scalpel: a systematic review of evidence for postoperative hemorrhage.
J Med Sci Jan ;28(1):87-93.

Objective: To review the literature systematically on tonsillectomy by harmonic scalpel with a view of comparing its postop-erative hemorrhagic rate with the conventional methods for tonsillectomy. Data Sources: Cochrane Library, Medline, Embase, CINAHL, INAHTA, CRD (Centre for Review and Dissemination, York, UK), and related databases. papers were considered irrespective of language of publication.Review Methods: Inclusion and exclusion criteria were applied independently by two reviewers with a third reviewer available for adjudication. The papers were quality assessed using Chalmers` criteria. Eleven randomized controlled trials (RCT) were included in the final review with 5 RCTs comparing harmonic scalpel tonsillectomy with `cold steel` tonsillectomy and 6 RCTs comparing harmonic scalpel with `hot` tonsillectomy techniques.Results: All studies were underpowered to detect a significant difference in the postoperative hemorrhagic complication between harmonic scalpel and the comparator tonsillectomy techniques. The heterogeneity of studies made quantitative combination of results impossible.Conclusion: The evidence reviewed is of low quality and does not support any significant difference in postoperative hem-orrhage rates when harmonic scalpel is compared with other tonsillectomy techniques. As studies have numerous method-ological flaws and incorporate biases and confounding factors, these results need to be interpreted with caution. Larger and better-conducted studies would be needed in order to compare the safety of harmonic against conventional tonsillectomy methods. The need for a large sample size might make an RCT impractical; therefore a large, well-controlled cohort study could be more suitable.

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