Ultrasonically activated scalpel was developed to concomitantly achieve cutting and coagulation, and thereby has a potential to reduce bleeding. We introduced this instrument (Harmonic Scalpel(R), Johnson and Johnson Medical Co., Cincinnati, OH, USA) for adenoidectomy in 14 patients under direct visualization by endoscope. After the patient was intubated, a sandbag was placed under the shoulders and Davis mouth gag was inserted. Small rubber catheters were introduced to retract the soft palate

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... nd a 4-mm 70° rigid endoscope was used transorally to visualize the nasopharynx. The adenoid tissue was initially shaved mostly using a KATANA blade. Thereafter, the residual tissue, especially the choanal adenoid and peritubal tonsil, was removed with a ball coagulator. Finally the nasopharyngeal wound was smoothed for complete hemostasis using the latter blade. The mean blood loss was 31.6g (range 0-70g) and the mean surgical duration was 37.6 minutes (range 19-57 minutes). Neither postoperative hemorrhage nor regrowth of adenoid tissue was encountered. There were no other complications such as otitis media, hemotympanum and local infection observed. We concluded that ultrasonically activated instrument combined with endoscopic visualization facilitated a more adequate adenoidectomy.