The ideal tonsillectomy procedure should achieve a safe, atraumatic, painless, and bloodless removal of the tonsils. This procedure should also be simple to perform by the surgeon, with consistent results among surgeons.
The cost of surgical instrumentation and the speed of the procedure must also be considered. Various tools and techniques have been proposed over the years, including lasers, microbipolarcautery,electrosurgical scissors ,ultrasonic or argon plasma scalpels, and intra-capsular microdebrider, with reports of better results than conventional cautery technique.
Recently, the contact diode laser (CDL) has been introduced as a new tool in general surgery. Laser light originates in a solid-state laser diode at a wavelength of 980 nm (near infrared), and is delivered through the tip of a flexible optical fiber.
In tonsillectomies the mucosa of the anterior tonsillar pillar was incised with aoptical fiber, with a power setting of 9 W in the pulse mode. The dissection proceeded along the plane of the tonsillar capsule, and suction spot laser was applied to any remaining bleeding sites. Blood loss was estimated on the scale of the suction collection canister.
No course of antibiotics was prescribed after surgery . Neither local spray nor infiltration anesthesia nor steroid medication was used after completion of the procedure in any patient. Patients began a standard pain control protocol of oral acetaminophen (25 mg/kg) 3 times a day for 4 days, then as needed for 10 days after surgery. All patients were treated on an inpatient basis with an overnight observation. There were no restrictions on food or fluid intake.