Comparison of transnasal and transoral routes of microdebrider combined curettage adenoidectomy and assessment of endosc
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HEAD AND NECK
Comparison of transnasal and transoral routes of microdebrider combined curettage adenoidectomy and assessment of endoscopy for residue: a randomized prospective study Kamil Gokce Tulaci1 · Erhan Arslan1 · Tugba Tulaci1 · Aziz Dinek1 · Hasmet Yazici1 Received: 16 July 2020 / Accepted: 16 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of this study is to investigate the frequency and locations of residual adenoid tissue in conventional curettage adenoidectomy (CA) via transnasal endoscopic examination at the end of the operation and to determine the most appropriate technique for residual adenoid tissue removal by transoral or transnasal microdebrider usage. Methods Sixty-three patients aged 4–12 years who were scheduled for CA were included in this randomized prospective study in a tertiary reference center. Patients who underwent CA had the endoscopic residual tissue exploration at the end of surgery. The amount and locations of residual tissue were recorded. Patients with > 20% residual tissue were divided into two groups according to randomization list for removing the residual tissue, depending on the use of transoral microdebrider (TOMD) and transnasal microdebrider (TNMD). Two procedures were compared in terms of duration, bleeding, pain, postanesthesia care unit (PACU) transfer time, and complications. Results Residual tissue was detected in 38 patients (60.2%). The most common location of residual tissue was peritubal area (41.3%). The TOMD group had lower surgical duration, blood loss, pain scores and shorter PACU transfer time (p = 0.001, p = 0.002, p˂0.001, and p = 0.006, respectively). Conclusion Endoscopic exploration at the end of CA should be considered to avoid residual tissue retention. Furthermore, if residual tissue is present, the use of TOMD is easier, faster, and associated with lower morbidity than the use of TNMD Keywords Adenoidectomy · Microdebrider · Endoscopic adenoidectomy · Curettage · Adenoid hypertrophy
Introduction
* Kamil Gokce Tulaci [email protected] Erhan Arslan [email protected] Tugba Tulaci [email protected] Aziz Dinek [email protected] Hasmet Yazici [email protected] 1
Departments of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University Health Practice and Research Hospital, 10440 Cagis, Balikesir, Turkey
Adenoidectomy is one of the most commonly performed pediatric otorhinolaryngologic surgical procedures [1, 2]. There have been several adenoidectomy techniques in history, such as conventional curettage adenoidectomy (CA), curettage adenoidectomy with indirect imaging methods (mirror), curettage with endoscopic imaging, transnasal or transoral endoscopy-assisted coagulation diathermy and microdebrider adenoidectomy [3, 4]. Although there are various surgical techniques that can be applied in adenoidectomies, CA remains the most common, being a quick, simple and low-cost surgical procedure [5, 6]. Because CA cannot be performed under direct v
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