As sealing and cutting technology for tonsillectomies has progressed over the years Charles A. Amenta III, M.D., an otolaryngologist with Advocate South Suburban Hospital in Chicago, has adopted new devices and leveraged new techniques in an effort to reduce tissue damage, pain and bleeding, including electrocautery, ultrasonic energy, laser and radiofrequency (RF), but each had its limitations.

"The ultrasonic energy technology was very slow and didn't provide any real benefit. Laser required a technician and various precautions but it wasn't hemostatic so I ended up using the cautery anyway. As for radiofrequency, I can't say I was ecstatic about it but it was definitely an improvement over cautery," said Dr. Amenta.

In June 2010, a Microline Surgical (formerly Starion Instruments) sales representative introduced Dr. Amenta to MiFusions® ENTceps®. Unlike conventional devices using monopolar, bipolar or ultrasonic energy as modes of operation, MiFusion ENTceps employs Thermal Fusion Technology (also known as Tissue Welding) to quickly and delicately seal and divide soft tissue, minimizing collateral tissue damage.

"I've taken out tonsils in six different ways and Thermal Fusion is by far the best way to do it because it's precise and atraumatic for the patients,' said Dr. Amenta. "I'm able to spare a lot of tissue using the technique because I just pinch and roll the tonsil out of the fossa. It's made me rethink just how much healthy tissue I can really save, still take out the complete tonsil and have a happier patient.'

Simple and Effective Performance
MiFusion ENTceps features a simple yet effective design. The tip of the instrument contains a heating element that is activated by squeezing the jaws closed and by using a Dual Control Footswitch. It is powered by Microline Surgical's Universal Power Supply (UPS), a compact, three-pound, reusable power source that can hang from an IV pole or sit on a tabletop, offering ease of set-up and use, which can reduce procedure and clean up time.

"ENTceps is just as easy to use as cautery but you don't have to ground the patient so it's easy for staff to set up,' said Dr. Amenta.

Safer, Satisfied Patients
The U.S. Food and Drug Administration (FDA) "strongly recommends against the use of codeine to manage pain in children after a tonsillectomy and/or adenoidectomy' because of the risk of fatality associated with its use in pediatric patients post-operativley.

While Dr. Amenta notes he's always strived to reduce pain and speed healing for his patients, the FDA's recent warnings about the use of codeine in children has escalated the issue and provided yet another reason for him to find ways to minimize tissue damage during tonsillectomy procedures.

"It used to be that surgeons compensated for pain by prescribing narcotics to tonsillectomy patients and Tylenol with codeine was the standard medication,' said Dr. Amenta. "We now have to find ways to inflict less damage so that patients can manage their pain with over the counter pain relievers.'
According to Dr. Amenta, MiFusion ENTceps has been a helpful technology in this effort. He's found patients suffer less post-operative pain, experience fewer hospitalizations for dehydration and place fewer phone calls to his office complaining of discomfort during the recovery period.

"I performed a Thermal Fusion tonsillectomy on a nine-year-old girl four days ago, instructed her family to treat her with Tylenol or ibuprofen and I've received no complaints from her in regards to pain,' said Dr. Amenta.

Dr. Amenta notes that he's performing the majority of tonsillectomies (80- 85 percent) on adult patients these days due to a shift in demographics in his geographic area. He points out that adult tonsillectomies tend to be more technically difficult and the patients typically experience a more painful recovery compared with children undergoing the same procedure. MiFusion ENTceps has improved this area of his practice as well. Out of the 60-70 adult patients on whom Dr. Amenta has performed Thermal Fusion tonsillectomies, only one patient went to the emergency room for dehydration and one other requested additional narcotics for pain.

"We used to get phone calls all of the time from patients telling us that they couldn't tolerate the pain but MiFusion ENTceps has made a huge difference,' said Dr. Amenta. "We are getting far fewer calls and just see the patients at their follow up appointments. When we do call them for routine matters they tell us that they're doing fine.'

More and more patients across the U.S. are seeking Thermal Fusion tonsillectomies as they learn about the positive results. After watching an online video by a Los Angeles man who had an excellent outcome following a MiFusion ENTceps procedure, an Indiana woman approached Dr. Amenta requesting that he use the device to remove her tonsils.

"I was the closest ENT to her area performing the procedure in this way so she crossed the border to get it done," said Dr. Amenta.