Abstract
This study aimed to compare the outcomes of coblation versus bipolar diathermy in pediatric patients undergoing tonsillectomy. A systematic review and meta-analysis were performed per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. An electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Primary outcome measures were intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage, and post-operative pain. Secondary outcome measures included a return to a normal diet, effects on the tonsillar bed, operation time, and administration of analgesia. Fixed and random-effects models were used for the analysis. Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.27, P = 0.005) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. The coblation group improved analgesia administration, diet and tonsillar tissue recovery, and thermal damage for secondary outcomes. No significant difference was reported in terms of operation time. In conclusion, coblation is comparable to a bipolar technique for pediatric patients undergoing tonsillectomy. It improves postoperative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.
Highlights
BackgroundTonsillectomy is one of the oldest surgical operations in medicine and is one of the most common operations of otolaryngologists [1,2]
There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.27, P = 0.005) and post-operative pain
Temple et al [13] conducted a single-center prospective Randomized Controlled Trials (RCTs) that included 38 pediatric patients listed for a routine tonsillectomy with chronic tonsillitis or obstructive tonsils history
Summary
Tonsillectomy is one of the oldest surgical operations in medicine and is one of the most common operations of otolaryngologists [1,2]. Several techniques are used to perform tonsillectomies, including blunt dissection, guillotine, bipolar diathermy dissection, laser dissection, and the more recent coblation method [4]. Despite the range of available techniques, post-operative pain, primary or reactionary hemorrhage, and post-operative infection associated with the hemorrhage continue to present as the main post-tonsillectomy complications [5]. Coblation (cold ablation) is a relatively new tonsillectomy technique that has earned increased popularity due to the decreased post-operative pain and reduced intraoperative bleeding that comes with its use [6]. The use of coblation eliminates the risk of causing thermal damage that comes with heat and minimizes necrosis of surrounding healthy tissue, resulting in minimal pain and faster recovery [8,9]
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