• S J Frampton, M J A Ward, V S Sunkaraneni, H Ismail-Koch, Z A Sheppard, R J Salib, and P K Jain.
• Department of Otolaryngology, Poole Hospital NHS Foundation Trust, UK.
• J Laryngol Otol. 2012 Nov 1; 126 (11): 1142-9.

ObjectiveThis trial aimed to compare the guillotine technique of tonsillectomy with 'cold steel' dissection, the current 'gold standard'.DesignA single centre, randomised, controlled trial.MethodsOne hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.ResultsOperative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.ConclusionThis study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

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