Frontiers in surgery · 2026
Minimally invasive vs. traditional tonsillectomy techniques: a systematic review and meta-analysis of randomized controlled trials.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Zhou Yanan, Ming He, Liang Jiao, You Qingzhu
Аннотация
OBJECTIVE: To systematically evaluate both the effectiveness and safety of minimally invasive tonsillar surgical techniques for chronic tonsillitis.
METHODS: A comprehensive systematic literature search was performed across four English databases, including PubMed, Cochrane Library, Embase, and Web of Science, to identify randomized controlled trials (RCTs) that exclusively enrolled patients undergoing tonsillectomy only. All included studies compared minimally invasive tonsillectomy with cold dissection tonsillectomy for chronic tonsillitis, with publication dates up to December 25, 2025. Following a rigorous screening process, meta-analyses were carried out using Stata 17.0 and RevMan 5.2.1 software. The study protocol was registered in PROSPERO with registration number CRD420261292929.
RESULTS: A total of 16 randomized controlled trials comprising 1528 patients were included in this study. Compared with cold dissection, minimally invasive surgery tended to improved operative efficiency (MD = -10.48, 95% CI [-13.54, -7.42], P < 0.00001, I 2 = 96%) and intraoperative safety (MD = -66.83, 95% CI [-84.35, -49.30], P < 0.00001, I 2 = 100%). A series of sensitivity analyses confirmed the robustness of these significant effects. No statistically significant difference was found in early postoperative pain assessed by VAS on day 1 (MD = -0.02, 95% CI [-0.92, 0.87], P = 0.96, I 2 = 84%). The incidence of primary postoperative hemorrhage (OR = 0.54, 95% CI [0.17, 1.74], P = 0.31, I 2 = 0%) and secondary postoperative hemorrhage (OR = 1.06, 95% CI [0.67, 1.68], P = 0.80, I 2 = 0%) did not differ significantly between the two groups. GRADE analysis showed very low certainty for operative time, intraoperative blood loss and VAS, and low certainty for postoperative hemorrhage. All pooled findings need cautious interpretation.
CONCLUSION: Minimally invasive surgery may be associated with shorter operative time and reduced intraoperative bleeding, but these findings should be interpreted with caution due to unresolved heterogeneity, broad intervention grouping. Further research is needed to confirm these potential benefits and clarify the impact on postoperative hemorrhage.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420261292929.
METHODS: A comprehensive systematic literature search was performed across four English databases, including PubMed, Cochrane Library, Embase, and Web of Science, to identify randomized controlled trials (RCTs) that exclusively enrolled patients undergoing tonsillectomy only. All included studies compared minimally invasive tonsillectomy with cold dissection tonsillectomy for chronic tonsillitis, with publication dates up to December 25, 2025. Following a rigorous screening process, meta-analyses were carried out using Stata 17.0 and RevMan 5.2.1 software. The study protocol was registered in PROSPERO with registration number CRD420261292929.
RESULTS: A total of 16 randomized controlled trials comprising 1528 patients were included in this study. Compared with cold dissection, minimally invasive surgery tended to improved operative efficiency (MD = -10.48, 95% CI [-13.54, -7.42], P < 0.00001, I 2 = 96%) and intraoperative safety (MD = -66.83, 95% CI [-84.35, -49.30], P < 0.00001, I 2 = 100%). A series of sensitivity analyses confirmed the robustness of these significant effects. No statistically significant difference was found in early postoperative pain assessed by VAS on day 1 (MD = -0.02, 95% CI [-0.92, 0.87], P = 0.96, I 2 = 84%). The incidence of primary postoperative hemorrhage (OR = 0.54, 95% CI [0.17, 1.74], P = 0.31, I 2 = 0%) and secondary postoperative hemorrhage (OR = 1.06, 95% CI [0.67, 1.68], P = 0.80, I 2 = 0%) did not differ significantly between the two groups. GRADE analysis showed very low certainty for operative time, intraoperative blood loss and VAS, and low certainty for postoperative hemorrhage. All pooled findings need cautious interpretation.
CONCLUSION: Minimally invasive surgery may be associated with shorter operative time and reduced intraoperative bleeding, but these findings should be interpreted with caution due to unresolved heterogeneity, broad intervention grouping. Further research is needed to confirm these potential benefits and clarify the impact on postoperative hemorrhage.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420261292929.