Comparison between Tonsillectomy by Coblation, Bipolar and Surgical Dissection

Abstract

Abstract Background Tonsillectomy is one of the most common paediatric surgical procedures performed worldwide. Although it is one of the most widely performed procedures in otorhinolaryngology, none of the commonly used techniques for tonsillectomy is considered optimal till now. Objective To compare coblation, bipolar diathermy, and surgical dissection approaches for tonsillectomy in terms of operative time, surgical blood loss, postoperative pain and the incidence of postoperative complications. Methods A systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. Guidelines and an electronic search of information was conducted to identify studies that compare between coblation, cold dissection and bipolar diathermy techniques. Results This study showed that bipolar diathermy tonsillectomy was the lowest risk of primary bleeding followed by coblation then cold dissection tonsillectomy but with insignificant difference. Coblation technique was the highest secondary bleeding risk followed by cold dissection and the lowest risk was figured in bipolar diathermy procedure also the difference did not reach statistical significance. Coblation tonsillectomy was the best technique regarding blood loss and operative time with significant difference in the comparison with cold dissection and insignificant in the comparison with bipolar diathermy. Because of using a different postoperative pain measures in the studies we could not pool its data, but the majority of studies showed that coblation technique was better as regard postoperative pain than cold dissection and bipolar diathermy. While there was no significant difference between cold dissection and bipolar diathermy in the most studies Conclusion Overall, bipolar diathermy procedure for tonsillectomy was considered the best technique regarding primary and secondary bleeding outcomes, but the difference did not reach statistical significance. Coblation procedure for tonsillectomy was considered the best technique regarding intraoperative blood loss with significant difference except in comparison between bipolar diathermy and coblation the difference was not significant. Coblation technique also considered the best one regarding operative time with significant difference in direct comparison between coblation and cold, and insignificant in other comparisons. By systematic review on 21 studies coblation technique shows less postoperative pain than cold dissection and bipolar diathermy in the majority of studies comparing coblation with every technique. And there was no significant difference between studies compared cold dissection with bipolar diathermy regarding postoperative pain.