Introduction: The optical microscopy was initially used in the pharynx in 1994, specifically for the tonsils. The ultracision cautery was first used in ENT practice for microscopic tonsillectomy in 1999, with good results. Such cautery is characterized for having a vibrating mechanical energy in the range of 55.5 kHz, promoting cut and coagulation depending on the power range, the kind of sharpener, tissue traction and sharpener pressure. Objective: To associate the optical microscopy and the ultracision cautery for tonsillectomies, using the benefits of image magnification and lower tissue aggressiveness. Material and methods: This preliminary study enrolled 26 patients with indication to perform tonsillectomy. The surgeries were performed under optical microscopy, using the ultracision cautery as the main surgical instrument. The parameters analyzed were: time of procedure, trans and postoperative bleeding, postoperative pain, and time for cicatrisation. Results: There was a good control of the surgery itself, the bleeding and the pain. Conclusion: The criterious association of such methods (optical microscopy and ultracision cautery) allowed a good preservation of the tissues and contributed for the good results achieved in this preliminary study.