Guillotine for tonsils.
Tonsillectomy as a surgical operation has been used for 3000 years, with varying degrees of popularity over the centuries. It was first described in some books of “Hindu medicine” around 1000 BC. In the books on medicine of that period, this surgical intervention has always been associated with a high degree of risk of bleeding. According to many otolaryngologist surgeons, this problem is still relevant today, despite the development of laser coagulation, electric welding and other methods for hemostasis. In this connection, it was recommended to partially remove the palatine tonsil, since there was a fear that the removal of the palatine tonsil entirely would lead to the death of the patient.
In the 30s A.D. A. C. Celsius described the removal of the palatine tonsil as a whole, where he recommended exfoliation of the palatine tonsil with a finger, then at its base to cross with a scalpel. After removal for the purpose of hemostasis, he washed the wound with vinegar solution and lubricated the niche with a hemostatic agent.
Over the course of time, tools were gradually invented and introduced to reduce the risk of bleeding during and after surgery. So Galeni (121-201 AD) was the first to use a loop-like instrument to remove the tonsils. Later A. Pare (1564), when carrying out tonsillectomy, used an instrument that was designed to shorten the uvula of the soft palate and which, a century later, was modified by the surgeon Scultetus. This tool found widespread use only in the middle of the 18th century.
Prior to that, during tonsillectomy, the base of the amygdala was most often cut off with a scalpel, which increased bleeding and prevented the surgeon from completing the operation. Over the years, surgeons have tried to master various techniques to prevent such bleeding.
So, in the 15th century A. Pare proposed to preliminarily impose a ligature on the amygdala pedicle before cutting it off. In 1828, the American physicist P. Syng (developed a tonsillot), and M. McKenzie (1880) modified its handle. Thanks to this, it became possible to somewhat reduce the intensity of intraoperative bleeding. In the 20th century (1909), in his work G. E. Waugh describes the experience of 900 tonsillectomies, noting that the technique and instruments for carrying out extracapsular tonsillectomy are progressively modified.
In the 19th century, tonsillectomy was performed only under local anesthesia. Despite this, in order to prevent bleeding, the so-called “hot” instruments began to be gradually introduced into practice. One of the earliest “hot” instruments used in tonsillectomy was the galvanic scooter. The galvanic scooter, transmitting a galvanic current through a loop or an electrosurgical knife, generated heat, thereby performing hemostasis. Somewhat later, the literature describes the technique of performing tonsillectomy with the help of an electrocautery. Cauter directly performed both incision and coagulation. One of the disadvantages of using an electrocautery during tonsillectomy under local anesthesia was severe pain, which provoked a number of other problems. For example, against the background of high pain syndrome, blood pressure increased, which contributed to the occurrence of tissue bleeding and increased bleeding. There have been cases of adverse outcomes from the use of an electrocautery for tonsillectomy.
At the beginning of the 20th century, the introduction of the “cauter” led to the fact that there was a tendency for an increase in deaths from secondary delayed bleeding after tonsillectomy. Despite this, a number of authors continued to use “hot” tonsillectomy techniques. For example, G. Dillinger promoted the use of a new “hot” instrument for the so-called submucosal tonsillectomy. To do this, he used a metal needle, which was inserted into the lymphoid tissue of the palatine tonsil and connected the device to high-frequency electricity, which led to a local increase in temperature and heating of the lymphoid tissue. This technique was not widely used, as it was accompanied by massive intraoperative bleeding. Later, it was shown that high temperature leads to over coagulation and extensive damage to the mucous membrane of the oral cavity and pharynx.
All of the above led to the fact that for many years surgeons were forced to abandon the use of “hot” instruments during tonsillectomy. Their use was resumed only after the possibility of tonsillectomy under general anesthesia appeared and after the development of a number of instruments that we still use today. These include a tonsil clamp, a tonsil separator and a mouth speculum. In the middle of the 20th century, thanks to the availability of the above technical equipment, the use of endotracheal intubation, the development of non-flammable anesthetic consumables, tonsillectomy began to be actively performed under general anesthesia, while using “hot” instruments more safely.
As can be seen from the above, over the centuries, only the instruments and techniques for performing tonsillectomy have been improved. And, despite the postoperative complications (bleeding, etc.) the importance of the tonsils as an immune organ, none of the scientists, otolaryngologists, surgeons seriously studied and introduced conservative (non-surgical) methods of treating chronic tonsillitis.
But now everything has changed! Healthy Tonsils challenges the no-alternative paradigm of tonsillectomy. Tonsils can and should be treated! Our 40-year practice has proven this with tens of thousands of cured patients.
And if we, the whole world, carry out the treatment of tonsils using the “Healthy Tonsils” method, in twenty years the number of patients with this disease will decrease significantly! Well, the prevention of chronic tonsil disease will help avoid pandemics associated with acute respiratory viral infections. Since normally functioning tonsils are the best means of their prevention, and preserved tonsils will avoid a huge number of unnecessary sacrifices.