- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04725305
BiZact Tonsillectomy in the Pediatric Population
BiZact Tonsillectomy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Tonsillectomy is the second most common pediatric surgical procedure, with more than 280,000 performed in children under the age of 15 in the United States in 2010. The most common indications for tonsillectomy in children include recurrent infections and obstructive sleep apnea. While tonsillectomy in the pediatric population is generally safe and well-tolerated, post-operative complications are not uncommon, with post-operative pain, respiratory compromise, and post-tonsillectomy hemorrhage being chief among them.
Post-operative pain has been described as the main morbidity associated with tonsillectomy and is often ineffectively controlled. Pain beyond the initial 24-hour post-operative period has been noted to be worse with the use of electrocautery when compared to cold-knife dissection and snare tonsillectomy, perhaps attributable to the high levels of heat (400 °C to 600 °C) applied directly to the tonsillar area. Yet electrocautery remains one of the most frequently utilized tools due to its hemostatic effects through vessel coagulation at the time of dissection. Still, a recent large meta-analysis reported the rates of primary post-tonsillectomy hemorrhage (bleeding within the first 24 hours) at 2.4% and secondary post-tonsillectomy hemorrhage (beyond 24 hours) at 2.6%, suggesting that bleeding after tonsillectomy remains a relatively common occurrence. The search for a methodology that improves post-operative pain without increasing the risk of post-operative hemorrhage remains an active area of research.
Coblation, which creates an ionized plasma layer by passing a bipolar radio-frequency current through a medium of saline, offers another approach. The saline irrigation results in much less heat when compared to monopolar cautery, measuring approximately 40°C to 70°C. Coblation can be used in both subcapsular and intracapsular fashion. Subcapsular tonsillectomy with coblation has demonstrated a minimal decrease in pain, and may result in slightly higher rates of post-operative hemorrhage.
It has been pointed out that bipolar cautery could result in lower thermal injury and reduced blood loss, however tonsillectomy using traditional bipolar forceps leads to longer operative times. One group found that the use of BiClamp, a bipolar vascular sealing device originally designed for thyroidectomy, provided decreased operative times and less intraoperative bleeding compared to electrocautery. They noted, however, instances of posterior pillar perforation, which they attributed to curvature of the device that was designed for thyroid surgery, making dissection of the superior pole more difficult. Medtronic has now developed a similar device designed for use in tonsillectomy with a curved jaw meant to follow the contour of the tonsillar bed. In its marketing material for the recently developed BiZact , Medtronic describes a bipolar device that continuously measures the impedance of clamped tissue, adjusting energy levels in real-time and automatically stopping energy delivery when a seal is established. Their literature suggests the device permanently seals vessels up to 3mm with less thermal damage, resulting in less intraoperative blood loss, more efficient procedures, and possibly less pain.
In a pilot study of 186 patients, intraoperative blood loss was shown to be <1ml of blood loss in 71 cases (38.2%) and between 1 and 10ml of blood loss in 81 cases (43.5%). Post-operative hemorrhage rate of 4.3% is similar to rates described by other studies. BiZact tonsillectomy allows for a shortened operative time with a median time of 5.1 minutes. Other studies have shown other techniques to have a time duration of 21.6 minutes (electrocautery), 20.20 minutes (coblator), and 16.14 minutes (microdebrider).
In off label use of the device at our institution, data from surgeons using the device showed that surgeons perceived a relative improvement in following compared to standard tonsillectomy:
- Less perceived thermal heat transfer to surrounding soft tissues
- Left perceived blood loss
- Superior ease of obtaining timely hemostasis
- Faster operative time
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ronald Vilela, M.D
- Phone Number: 832-822-3268
- Email: rjvilela@texaschildrens.org
Study Contact Backup
- Name: Grace Shebha Anand, MPH
- Phone Number: 8328221980
- Email: gxanand@texaschildrens.org
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- Recruiting
- Texas Children's Hospital
-
Sub-Investigator:
- Daniel Chelius, MD
-
Sub-Investigator:
- Shraddha Mukerji, MD
-
Sub-Investigator:
- Carol Yi-Chun Liu, MD
-
Sub-Investigator:
- Matthew D Chelius, MD
-
Sub-Investigator:
- Sonal Saraiya, MD
-
Sub-Investigator:
- Jeff Carter
-
Sub-Investigator:
- Alexis Moisiuc
-
Contact:
- Ronald Vilela, MD
- Phone Number: 832-822-3268
-
Contact:
- Grace Anand, MPH
- Phone Number: 8328221980
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Tonsil hypertrophy with sleep disordered breathing
- Recurrent tonsillitis or pharyngitis
- Tonsil asymmetry or neoplasm
- Tonsil stones
- Must be able to take ibuprofen
Exclusion Criteria:
- Bleeding disorders such as von Willebrand's disease or hemophilia
- Down's Syndrome or other craniofacial syndromes
- Revision tonsillectomy cases
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: BiZact
A bipolar electrosurgical device that employs radiofrequency(RF) energy and pressure to ligate vessels interposed between its jaws which can then be transected using the built in knife deployed by the device trigger
|
It has been described as describes a bipolar device that continuously measures impedance of clamped tissue, adjusting energy levels in real time and automatically stopping energy delivery when a seal is established.
Their literature suggests the device permanently seals vessels up to 3mm with less thermal damage, resulting in less intraoperative blood loss, more efficient procedures, and possibly less pain
|
Active Comparator: Standard of care
In electrocautery tonsillectomy (or diathermy) electric current from a radiofrequency generator is passed through the tissue between two electrodes.
The resulting high temperature (400º-600ºC) cuts the tissue and simultaneously seals the blood vessels
|
This method would involve removal of tonsils using electrocautery technique
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Emergency room visits
Time Frame: 2 months
|
Emergency room visits following tonsillectomy commonly involve poorly controlled pain, dehydration, and post-tonsillectomy hemorrhage.
The investigators will tabulate the number of ER visits related to post-operative factors by reviewing charts of tonsillectomy patients two months post-operatively.
|
2 months
|
Intra-operative blood loss
Time Frame: Duration of surgery
|
Intra-operative blood loss will be recorded in milliliters for all patients undergoing tonsillectomy using the BiZact device.
Additionally, each surgeon using the Bi-zact device will maintain records of intra-operative blood loss in milliliters for tonsillectomies utilizing standard electrocautery for tonsillectomy.
|
Duration of surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post-tonsillectomy hemorrhage
Time Frame: 2 months
|
Post-tonsillectomy hemorrhage is a known complication of tonsillectomy.
The investigators will tabulate the incidence of post-tonsillectomy hemorrhage by reviewing emergency room visits in the post-operative period and through follow-up questionnaires at the first post-operative clinic visit.
|
2 months
|
Pain level
Time Frame: 14 days
|
Patients will be asked to maintain a pain diary.
The investigators will ask the parent or caretaker to document the Wong-Baker FACES Pain Rating Scale twice a day for fourteen days.
|
14 days
|
Pain medication documentation
Time Frame: 5 days
|
Post-operative pain protocol at Texas Children's Hospital includes scheduled weight-based doses of ibuprofen every 6 hours for 5 days, acetaminophen every 4-6 hours as needed, and a one-time dose of dexamethasone as needed to be given on post-operative day 3, 4, or 5 for breakthrough pain.
Patients are also instructed to use ibuprofen as needed for pain after the first 5 days.
Participants will be instructed to maintain accurate records of use of acetaminophen and dexamethasone use, and use of ibuprofen beyond 5 days post-operatively
|
5 days
|
Operating time
Time Frame: Duration of procedure
|
Operative time in minutes will be recorded for all patients undergoing tonsillectomy using the BiZact device.
Additionally, each surgeon using the BiZact device will maintain records of operative time using standard electrocautery for tonsillectomy
|
Duration of procedure
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- De Luca Canto G, Pacheco-Pereira C, Aydinoz S, Bhattacharjee R, Tan HL, Kheirandish-Gozal L, Flores-Mir C, Gozal D. Adenotonsillectomy Complications: A Meta-analysis. Pediatrics. 2015 Oct;136(4):702-18. doi: 10.1542/peds.2015-1283. Epub 2015 Sep 21.
- Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jan;144(1 Suppl):S1-30. doi: 10.1177/0194599810389949.
- Hall MJ, Schwartzman A, Zhang J, Liu X. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. Natl Health Stat Report. 2017 Feb;(102):1-15.
- Nunez DA, Provan J, Crawford M. Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial. Arch Otolaryngol Head Neck Surg. 2000 Jul;126(7):837-41. doi: 10.1001/archotol.126.7.837.
- Jones DT, Kenna MA, Guidi J, Huang L, Johnston PR, Licameli GR. Comparison of postoperative pain in pediatric patients undergoing coblation tonsillectomy versus cautery tonsillectomy. Otolaryngol Head Neck Surg. 2011 Jun;144(6):972-7. doi: 10.1177/0194599811400369. Epub 2011 Apr 4.
- Heidemann CH, Wallen M, Aakesson M, Skov P, Kjeldsen AD, Godballe C. Post-tonsillectomy hemorrhage: assessment of risk factors with special attention to introduction of coblation technique. Eur Arch Otorhinolaryngol. 2009 Jul;266(7):1011-5. doi: 10.1007/s00405-008-0834-2. Epub 2008 Oct 25.
- Lee SW, Jeon SS, Lee JD, Lee JY, Kim SC, Koh YW. A comparison of postoperative pain and complications in tonsillectomy using BiClamp forceps and electrocautery tonsillectomy. Otolaryngol Head Neck Surg. 2008 Aug;139(2):228-34. doi: 10.1016/j.otohns.2008.04.004.
- Medtronic Brief: More efficient tonsillectomies. Boulder Colorado, 2017. Retrieved from http://www.medtronic.com/content/dam/covidien/library/us/en/product/vessel-sealing/bizact-tonsillectomy-device-product-information-kit.pdf, 9/23/18.
- Rosenfeld RM, Green RP. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol. 1990 Mar;99(3 Pt 1):187-91.
- Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol. 2000 May 30;52(3):239-46. doi: 10.1016/s0165-5876(00)00293-7.
- Krishnan G, Stepan L, Du C, Padhye V, Bassiouni A, Dharmawardana N, Ooi EH, Krishnan S. Tonsillectomy using the BiZact: A pilot study in 186 children and adults. Clin Otolaryngol. 2019 May;44(3):392-396. doi: 10.1111/coa.13273. Epub 2019 Feb 4. No abstract available.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H-44399
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Hemorrhage
-
Region StockholmRecruitingRetinal Hemorrhage, Bilateral | Retinal Hemorrhage, Left Eye | Retinal Hemorrhage, Right EyeSweden
-
Al Hadi HospitalCompletedDiabetic Vitreous HemorrhageKuwait
-
Massachusetts Eye and Ear InfirmaryCompletedPost-operative HemorrhageUnited States
-
Panhandle Eye Group, LLPRecruitingDiabetic Vitreous HemorrhageMexico
-
Weill Medical College of Cornell UniversityThe Edward Grayson Fund for Retinal ResearchUnknownSubretinal Hemorrhage and Exudative MaculopathyUnited States
-
Tel-Aviv Sourasky Medical CenterIsrael Defense ForcesRecruiting
-
Ain Shams Maternity HospitalUnknownPost Operative HemorrhageEgypt
-
Asan Medical CenterUnknownPost Vitrectomy State | Recurrent Diabetic Vitreous HemorrhageKorea, Republic of
-
Assistance Publique - Hôpitaux de ParisTerminatedHemorrhage; Complicating DeliveryFrance
-
University of Sao PauloUnknownHemorrhage | RecurrentBrazil
Clinical Trials on BiZact
-
Line Schiøtt NissenAalborg University Hospital; Sygehus Lillebaelt; Sonderborg Hospital; Hospital...RecruitingTonsillectomyDenmark
-
Medtronic - MITGCompleted