Very-Low Energy Monopolar Reduces Post-Tonsillectomy Hemorrhage Versus Standard Energy Techniques

Steven D. Shotts, Donald V. Welsh, Aisaku Nakamura, Arnold J. Stromberg

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives/Hypothesis: To compare rates of post-tonsillectomy hemorrhage (PTH) between a very-low energy transfer monopolar technique (VLET) and standard energy techniques. Study Design: Retrospective controlled cohort study. Methods: All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive “hot” technique without exclusive monopolar use [Mixed “Hot”]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared. Results: During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed “Hot”), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed “Hot” group experienced similar rates (1.57%, P =.54; 1.68%, P =.64), but the VLET group experienced significantly lower rates (0.15%, P =.0026, adjusted odds ratio [OR] 0.114 [0.028–0.469]; 0.22%, P =.0016, adjusted OR 0.155 [0.048–0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P =.0025, P =.0024, adjusted OR 1.02/year [1.01–1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies. Conclusions: Standard energy techniques had an adjusted odds ratio over 8-fold higher for secondary PTHRSI and over 6-fold higher for total PTHRSI compared to the minimized energy transfer VLET technique. Level of Evidence: 3 Laryngoscope, 131:2505–2511, 2021.

Original languageEnglish
Pages (from-to)2505-2511
Number of pages7
Issue number11
StatePublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.


  • Tonsillectomy
  • diathermy
  • electrocautery
  • energy
  • hemorrhage
  • monopolar

ASJC Scopus subject areas

  • Otorhinolaryngology


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