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


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

Funding Information:
The authors of this study thank the fellow members of Advanced ENT, including billing director Lisa Pillow for her expert assistance with data collection, CEO Danielle Fife, and the current and former surgeons who provided us with data of remarkable quality: Daniel Akin MD, Gregory Abbas, MD, Wes Allison, MD, Eric Carter, MD, Craig Fichandler, MD, Keith Forwith, MD, PhD, Kenneth Hodge, MD, Andrew Gould, MD, Amy Ingram, MD, Venkata Kakarlapudi, MD, MBA, Gordon McMurry, MD, John Morris, MD, Colin Neumann, MD, Eric Oliver, MD, Kenneth Richmond, MD, Thomas Sonne, MD, and Matthew Yantis, MD. The authors would especially thank Raleigh Jones, MD, and Matthew Bush, MD, of the University of Kentucky ENT Department as well as Michael Shohet, MD of ENT and Allergy Associates for their assistance in reviewing and guidance. The authors would additionally thank University of Louisville Research and Innovation Department and specifically Jeffrey Bumpous, MD, of the Otolaryngology Department for their assistance. Thanks to Dina Bushteyn of the Baptist Hospital East Medical Library for her tireless assistance in reference collection.

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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