Mitchell Austin, M.D., a pediatric otolaryngologist at Nemours Children's Clinic in Orlando, Florida.
How does this new technology work?
Dr. Austin: The technology from Gyrus ACMI uses electricity to seal blood
vessels, but at a much lower temperature than traditional tonsillectomy
What are the dangers of operating at a higher temperature?
Dr. Austin: They're equally the same, whether the temperature you use it at is
high or low. It's just prolonged pain and dehydration that we're trying to fight as
otolaryngologists in our tonsillectomy patients.
How big is the difference this makes in a child's recovery?
Dr. Austin: I think it's statistically significant that in most research centers, lower
temperature technologies in tonsillectomy reduce pain and shorten the need for
pain medicine usage, and usually return the child back to a more active state
earlier and back to eating earlier. I would say that it probably reduces the time it
takes for them to be able to eat in half, so they're eating in a week instead of two
weeks. They're taking probably maybe 5 or 7 days less of stronger pain narcotic
medications, and their activity level is higher, and their moms feel better that their
child is in less pain, requiring less pain medicine.
So it significantly shortens the amount of time patients need to be on pain
Dr. Austin: Absolutely. That's one of the metrics we look at.
Do patients who undergo this procedure go home the day of surgery?
Dr. Austin: Most do.
Is that a change?
Dr. Austin: Most do. Children under the age of 2, or children who have
syndromic problems or cardiac problems, usually have to be admitted overnight
to be monitored. Children who are having problems with a breathing disorder,
sleep disorder, breathing, snoring or mild obstructive sleep apnea can go home
the same day -- chronic tonsillitis as well -- so outpatient surgery is probably
about 95 to 98 percent of the cases across the United States.
How big of a difference does this procedure make as far as the burn area?
Dr. Austin: The temperature that the newer technologies work at, that the Gyrus
ACMI works at, are around 90 to 100 degrees centigrade, which is close to
boiling water; but the traditional tonsillectomy using an electrical cautery device
can be up as high as 400 degrees, and that's been tested using infrared
technology that NASA uses when they look at the shuttle engines and measure
how much energy and heat is being produced, and they actually have infrared
measurements of that.
Is it like the difference between a second- and third-degree burn?
Dr. Austin: It's almost. A third-degree is almost par to an electrical cautery
tonsillectomy, and a very high-degree, second-degree burn can be done with
some of the lower heat technology techniques, I think.
What is it that's actually generating this heat, and is it different than the
Dr. Austin: The newer technologies use something called plasma, which is an
ion that breaks apart, and the ions create a heat at a very localized fixed point.
The heat generated by a Bovie or an electrical cautery device is electrons, and
electrons produce a lot of lateral thermal spread. In other words, where the tip of
the Bovie or the electrocautery touches, we may see a few centimeters or a few
millimeters of distance of heat travel along the sides of the throat muscles while
we're dissecting, whereas when we use the PK technology through Gyrus, we're
seeing a millimeter of spread or less.
It's lesser depth of burn versus a deeper burn, is what we're trying to avoid.
We're trying to avoid a deep burn because of the blood vessels in our mouths,
which are associated with that, and the fact that the muscles hurt a lot -- and we
swallow about 6 times a minute, so if your throat really hurts and you're
swallowing 6 times a minute, and the pain is less, then you probably will swallow
better if the pain is less, and you'll get dehydrated less often, and that's what
we're seeing in the research behind a lot of these technologies.
Does it cut down on any other risks associated with the surgery as
opposed to traditional?
Dr. Austin: It does. Electrocautery requiring a pad can be used with a patient
with a cochlear implant or a pacemaker. A pacemaker has to be turned off.
That's the older technique that's very well established and very safe, but we can't
use them on patients who have a vagal stimulator -- anything electrically charged
in the patient like a defibrillator, whereas when we use a localized PK technology
device, they don't have to turn those machines off, and they can have the
surgery while those machines are still working. There's also less chance of burn
scatter and fire. There's a concern of fire that we have a lot in surgery, and when
we're working at a lower temperature, we have a less of a chance of causing an
ignition source in the mouth; because we're dealing with an intubated person,
and the oxygen is being used at time, and sometimes oxygen can form in
pockets in our body and in our throat, mouth and nose, and those areas can be
sources of ignition, and people have had fires underneath drapes and stuff, so
this machine that they use is less hot and has lower temperatures.
How many tonsillectomies do you perform using this technology?
Dr. Austin: I'd have to say that I do a lot of the surgeries where I can. Some of
the new hospitals require a committee to get the technology onboard, and we're
waiting for them to get the technology onboard,. So where I have that technology
at that hospital, I use that technology, the lower heat technology. Where I don't, I
tend to use the traditional Bovie cautery or scanner tonsillectomy cautery.
What's holding up its approval?
Dr. Austin: Problematically, I think we are developing so much technology that
the front-loading of the costs of new technology increases the cost per case, and
hospitals are very wary now of how much the cost per case is being done. What
we want to do is make sure that the recovery is not also increasing the cost of
medicine so that if we have a technology that costs, say, $100 more per case but
has less admissions to the ER, or less dehydration and less pain and a more
comfortable child and a more satisfied child, I think that's not only a consumer
wish, but I also think it's a wish that we have as doctors -- not sending our child
to the ER in the middle of the night to get $700 or $800 or $1,000 worth of fluid
and emergency room fees, whereas they're right now in the middle of taking care
of very sick people in the emergency room, so we're causing more damage than
good. We don't like to do that. We like to try to get our kids to better and have
Why do you prefer this technology?
Dr. Austin: I like it because the newer technology has been thought out by
people who are engineers whoe really are devoted to trying to perfect this device,
and I've met them personally, and they're open to M.D.-to-engineer discussions,
and you don't get that very often. The engineers want to hear back from us. They
want to have quality assurance measurements made from how well can we make
this for you, doctor, and how can we help your patients better, and they really
believe in their product. When you have that in a company, I think it's refreshing.
When did you first do this procedure?
Dr. Austin: I did that about three and a half years ago.
What were your first impressions?
Dr. Austin: It was as easy to use as the other technologies, so the learning
curve wasn't too hard, and I thought that it was a bit concerning that I might have
a problem post-operatively to just control the problem as well as I like it to do --
Did it seal the blood vessels the way that I wanted it to, and it did, so I didn't feel
a very big difference after 15 or 16 years of training other residents. I didn't feel
like it was going to be very difficult for them to pick up as long as they knew the
basics of surgery. So if you keep the basics of surgery in front of you, I think it's a
very easy machine to work with.
So procedure time is about the same?
Dr. Austin: Procedure time is about the same
The real benefit is shorter recovery time?
Dr. Austin: The perk is less pain and recovery time and a happier patient, and
less phone calls, and that's what we want, so the parents don't worry.
How does this machine operate at a 300 degree lower temperature?
Dr. Austin: Different technology. It's an electrical phenomenon. We're using
electrons, and in electrocautery surgery, which has been standard, we still use
that type of technology today. The difference is the engineering.
END OF INTERVIEW
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