Intracapsular Tonsillectomy With Monopolar Cautery: A Cost-Effective Surgical Technique

Introduction: Approximately 500,000 pediatric tonsillectomies are performed annually in the US. Intracapsular tonsillectomy (ICT) has been shown to reduce the risk of post tonsillectomy hemorrhage (PTH) compared to the extracapsular tonsillectomy (ECT). ICT is typically performed with either a microdebrider or coblation device. These add to supply costs of the procedure. Only 20% of surveyed pediatric otolaryngologists have adopted ICT. Cost and/or the use of a new instrument may contribute to non-adoption.

Methods: A retrospective, single surgeon chart review of 576 pediatric patients who underwent a tonsillectomy in the last 15 years was done. Of those, 330 patients had ICT performed with a monopolar Bovie electrocautery (ICT w/EC), and 246 were treated with ECT using monopolar electrocautery.

Results: Of the 330 ICTs w/EC, one PTH requiring intervention was identified, resulting in a PTH rate of 0.3%. Of the 246 ECTs, 9 PTHs requiring intervention were identified, resulting in an PTH rate of 3.6%. Disposable instrument cost for ICT w/EC ranged from $22-$44, average $28. These supplies included: pencil-tip cautery, suction cautery, grounding pad and suction tubing. Available pricing data for disposable supplies for coblation technique range from $128-$250, average $189. Available pricing data for disposable supplies for microdebrider technique range from $158-$200, average $179. Estimated disposable cost savings for ICT w/EC averaged $161/case compared with coblator, and $151/case compared with microdebrider. Potential savings of ICT w/EC is $1.5-$1.6 million for every 10,000 cases that transition to ICT w/EC from a microdebrider or coblator technique.

Conclusions: ICT w/EC resulted in a significantly lower PTH risk compared to ECT and compared favorably with other described ICT techniques. Disposable cost for ICT w/EC is significantly less compared with the two common techniques for ICT. The use of a familiar, inexpensive, and readily available instrument might lead to consideration of ICT by those ENTs who have not adopted ICT.