Innovative Intracapsular Tonsillectomy: How we do it.

Abstract

OBJECTIVE: To present a new technique of intracapsular tonsillectomy using carbondioxide CO2 lasers, aiming to increase visibility by providing a better view of the tonsil and related structures in the obscure area by using the technique of rotating the operating table, 20°-30° instead of using a 30° endoscope. MATERIALS AND METHODS: From October 23, 2014 to October 23, 2015, 124 patients underwent an intracapsular tonsillectomy using a CO2 laser with the technique of rotating the operating table 20°-30° to have a clearer view of the tonsil tissue and the related structure. Absorbable suture material (3-0 vicryl) is also used to tie 6-8 areas of each side of the tonsillar capsule to prevent post-tonsillectomy bleeding. RESULTS: Rotating the operating table 20°-30° to the left and to the right while operating the intracapsular tonsillectomy using a CO2 laser helps the surgeons see the tonsillar tissue and the related structures in the obscure part clearer. That makes the intracapsular tonsillectomy using a CO2 laser safer and more precise due to improved ability to preserve healthy tonsillar tissue and vaporize the infected tonsillar tissue. Moreover, surgeons can also see the bleeding area (if any) and can precisely control the bleeding by using the electric cautery or suture ligation. CONCLUSION: Rotating the operating table 20°-30° in intracapsular tonsillectomy using a CO2 laser helps the surgeon not only to identify the upper, lower, and the side edges of the tonsillar capsule clearer but also makes the surgery safer and easier. Suture ligation of tonsillar capsule using 3-0 vicryl helps reduce the chance of post-tonsillectomy bleeding effectively.