Unintentional RF Energy Transfer During Tonsillectomy: An In Vitro Investigation

Abstract

One-third of tonsillectomy patients experience post-operative taste disturbances (dysgeusia), yet the underlying cause is unknown. We hypothesize that unwanted radio-frequency (RF) energy couples to the metal-based mouth retractor during tonsillectomy and could be a possible cause of dysgeusia. To validate our hypothesis, in vitro studies are performed in a ground beef phantom with sensors measuring, first, the unwanted current coupled to the mouth retractor and, second, the unwanted temperature rise in the tissues that surround the retractor. The simulated surgery was performed using two separate surgical techniques: monopolar electrosurgery and coblation. Results indicate that unintentional RF energy transfer is indeed a real issue. During electrosurgery, peak-to-peak unwanted currents vary from 80.53 to 181.48 mA for typical power levels ranging from 10 to 30 W. Tissue temperature unintentionally increases by 1.3 °C and 1.8 °C, respectively. Coblation indicates smaller coupling effects, with peak-to-peak currents on the mouth retractor capped at 12.33 mA for a typical 7 W setting. Concurrently, tissue temperature is reduced by 0.73 °C, as attributed to the saline solution inherent to coblation. As the first of its kind, this study illuminates possible causes of post-tonsillectomy dysgeusia and intends to trigger future studies. The ultimate goal is safe and complication-free tonsillectomies.