Endoscopic-Assisted Tonsillectomy With Preemptive Hemostasis and Low-Output Bipolar Energy: A Strategy to Reduce Postoperative Hemorrhage.

Introduction Tonsillectomy is a common surgical procedure in otolaryngology; however, postoperative hemorrhage remains a serious complication. Although novel hemostatic devices have been introduced, no definitive preventive strategy has been established. This study evaluated a standardized surgical approach combining preemptive hemostasis, reduced energy device output, and endoscopic assistance to minimize postoperative complications. Methods This single-center, non-randomized, observational cohort study included 137 patients aged 15 years or older who underwent extracapsular tonsillectomy between April 2018 and March 2025. Patients were grouped based on the time period of treatment: those who underwent conventional tonsillectomy between 2018 and 2021 comprised the Conventional Group (n = 85), and those who underwent a standardized procedure incorporating preemptive hemostasis and low-output energy devices between 2022 and 2025 comprised the Standardized Group (n = 52). Perioperative outcomes, postoperative hemorrhage rates, pain control, and hospital stay length were compared between groups using the Mann-Whitney U test and Fisher's exact test (p < 0.05 was considered significant). Results The Standardized Group showed a significantly lower postoperative hemorrhage rate (0% vs. 9.5%, p = 0.0236) and less intraoperative blood loss (0.42 ± 1.01 mL vs. 8.31 ± 26.7 mL, p = 0.0031) compared to the Conventional Group. Although operative time was longer (83.5 ± 33.3 min vs. 56.5 ± 23.8 min, p < 0.001), the Standardized Group had a shorter hospital stay (8.86 ± 1.24 days vs. 10.1 ± 1.15 days, p < 0.001) and required fewer rescue analgesic interventions (p = 0.0178). Conclusion The combination of preemptive hemostasis, reduced energy output, and endoscopic supervision significantly improved surgical outcomes, reduced complications, and enhanced the educational experience for junior surgeons. This protocol represents a standardized, cost-effective technique that enhances safety and surgical training.