Coblation Tonsillectomy Research Articles

Coblation versus dissection tonsillectomy in children

Background and objective: Tonsillectomy is the surgical procedure of removing the tonsils. Various methods of tonsillectomy have been practiced aimed at decreasing or eliminating intraoperative and postoperative morbidity. This study was conducted to determine the different outcomes of tonsillectomy surgery in both coblation and dissection techniques. Methods: A prospective control study was conducted with a total sample size of 66 patients. Each patient underwent tonsillectomy by using ArthroCare Coblator on the right side and dissection method on the left side. Children between the age of 3-12 years old were selected with indications of recurrent tonsillitis and/or kissing tonsil causing snoring and/or sleep apnea. Children with peritonsillar abscess, malignancy, bleeding disorder were excluded. Operative time and blood loss, postoperative pain, bleeding and healing process were compared between two methods. Operations performed by the same surgeon. Results: The intraoperative time was significantly shorter (P <0.001) and intraoperative blood loss was significantly lesser (P <00.01) in coblation as compared to dissection tonsillectomy, while there were no significant differences in the postoperative pain scores on 1st, 2nd, 7th and 14th postoperative days. There was a significant healing process in tonsillar fossa in favor of coblation rather than dissection. No primary or secondary postoperative bleeding was reported. Conclusion: Coblation tonsillectomy is a safe procedure with significantly less intraoperative time and less blood loss and better surgical wound healing with similar postoperative pain in comparison with dissection tonsillectomy.

The clinical efficacy of coblation tonsillectomy and conventional tonsillectomy in China: A Meta analysis

Objective:To systematically review the clinical efficacy of coblation tonsillectomy and conventional tonsillectomy in China. Method:Randomized controlled trials (RCT) of coblation tonsillectomy and conventional tonsillectomy were searched and retrieved through online databases (PubMed, Cumulative Index to Nursing and Allied Health, EMBASE, Cochrane Library, CBM, CNKI, VIP, WanFang, SUMsearch and Google search engine) and related literatures were reviewed up to 30 April, 2017. Two investigators independently screened literatures,extracted data and evaluated the risk of bias assessment tools for RCT using the Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions. Then, Meta analysis was performed using RevMan 5.3 software provided by the Cochrane Collaboration. Result:A total of 32 RCTs involving 3 197 tonsillectomy patients were included. The results of meta-analysis showed that: the operation time (MD=-17.03, 95%CI -19.78 to -14.28, P＜0.00 001), intraoperative blood loss (MD=-27.00, 95%CI -30.44 to -23.56, P＜0.00 001), postoperative pain in 24 hours (MD=-2.00, 95%CI -2.65 to -1.35, P＜0.00 001), time needed to regain the normal diet (MD=-2.01, 95%CI -2.60 to -1.42, P＜0.00001), formation time of white membrane (MD=-2.44, 95%CI -3.96 to -0.93, P=0.002) of patients in the coblation tonsillectomy group were all significantly lower than the conventional tonsillectomy group; while the exfoliation time of white membrane (MD=2.02, 95%CI 0.65 to 3.39, P=0.004) in the coblation tonsillectomy group was significantly longer than the conventional tonsillectomy group. Conclusion:Current evidence shows that, compared with the conventional tonsillectomy group, the coblation tonsillectomy group can significantly shorten the operation time, decrease intraoperative blood loss, alleviate postoperative pain degree during 24 hours, regain the normal diet early and form white membrane early, but delaye the exfoliation time of white membrane. Due to the limited kinds of literature and quality of the included studies, the above conclusions still need to be verified by carrying out more large scale samples and high quality randomized controlled trials (RCTs) studies.

The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques.

Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients. A total of 137 patients, aged 2-50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected. Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001). Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.

Coblation Versus Conventional Tonsillectomy: A Double Blind Randomized Controlled Trial.

Post tonsillectomy bleeding and pain are two main problems following traditional tonsillectomy. Coblation therapy (controlled ablation) was first used in tonsillectomy in 2001. A great amount of literature debated around its use with controversial opinions regarding its benefits, efficacy, and cost. This is a prospective double-blind randomized controlled study that compares between coblation tonsillectomy and conventional tonsillectomy as regard operative time, operative blood loss, time needed to return back to the normal activity and diet, and incidence of postoperative hemorrhage whether primary or secondary. The study included 1004 patients with mean age of 10.4years (range from 4 to 35years). The first group (coblation tonsillectomy group) included 507 patients, age ranging from 4 to 35years with mean age 15.1year. This group included 277 female (54.6%) and 230 male (45.4%). The second group (conventional tonsillectomy group) included 497 patients, age ranging from 4 to 24years and mean age 14.7years. This group included 274 female (55.1%) and 223 male (44.9%). Coblation tonsillectomy offers significant advantages over dissection method with less operative time, decreased intraoperative blood loss, early restoration of daily activities and normal diet. However coblation tonsillectomy is associated with a higher incidence of secondary hemorrhage.

Bleeding after tonsillectomy

Oropharyngeal hemorrhage after tonsillectomy is one of the most common postprocedural ENT emergencies that require immediate attention. Management choices depend on the severity of bleeding, underlying platelet or coagulation disorders, and the patient’s maturity and age. Treatment range from simple observation to an emergent need to both secure the airway and stop the hemorrhage. The workup of the hemorrhagic patient will be discussed from the preoperative to postoperative time period. Surgical techniques in response to various acuity will be discussed to fully elucidate options to control the hemorrhage.

Coblation versus other surgical techniques for tonsillectomy.

Coblation versus other surgical techniques for tonsillectomy.

Coblation versus Traditional Tonsillectomy: A Double Blind Randomized Controlled Trial

Coblation versus Traditional Tonsillectomy: A Double Blind Randomized Controlled Trial

Coblation tonsillectomy: a systematic review and descriptive analysis.

Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates.

Comparison Between Coblation Assisted Tonsillectomy Versus Conventional Tonsillectomy Regarding the Postoperative Pain and Bleeding

Background: The tonsillectomy is one of the most common surgical procedure in the world. Common complications are postoperative pain and bleeding. Coblation tonsillectomy is recent method of these surgical procedure and there are few publications in the literature and published information which are focused on the specific aspects of this surgical techniques or early postoperative complications. This study compare coblation and traditional tonsillectomy techniques in view of their advantages and complications. methods: In our prospective study type we include 60 children and adolescents, divided equally:30 conventional tonsillectomy versus 30 surgically treated with Coblation II system Arthrocare (Smith and Nephew). We compared the postoperative pain and intraoperative bleeding in the patients underwent surgery within conventional method versus coblation assisted tonsillectomy. To measure the pain we used visual-analogue scale of Wong-Baker with face expressions (0 no hurt; 10-hurts worst). We follow-up the level of pain in the day 1,2 and 7 after the surgery Estimated blood loss for coblation tonsillectomy was calculated by deducting the total amount of blood in suction jar with estimate saline used for the surgery. Results: Average age of participants surgically treated with conventional method group are 6,87±3,01. In the group where we used coblation method the average age of participant were 8.16±4,74. We found statistically significant differences (p-value<0.0001) in these parameters in both surgical techniques: the pain is less weak in intensity in the patients treated with the Coblation method in all the three days. In regard of intraoperative bleeding we found statistically significant difference between both methods (p-value -9.3132*10-10). The average bleeding in the conventional method is 97,5 ml ±12,12 ml, comparing with the coblastion-assisted tonsillectomy the average intraoperative bleeding is 27,1 ml ±14,28 ml. Conclusions: This study revealed a significantly less intraoperative or postoperative complications and morbidity in coblation tonsillectomy in comparison with traditional method. Coblation was associated with less pain and quick return to normal diet and daily activity. These findings addressed coblation tonsillectomy as an advanced method.

Coblation tonsillectomy under surgical microscopy: A retrospective study.

ObjectiveA retrospective study to compare surgical parameters and postoperative pain in patients undergoing coblation tonsillectomy with or without microscopic guidance.MethodsData regarding duration of surgery and hospital stay, intraoperative blood loss, incidence of haemorrhage and postoperative pain scores were retrieved from the medical records of adult patients undergoing coblation tonsillectomy under direct vision or with microscopic guidance.ResultsThe incidence of secondary haemorrhage (>24 h postoperatively) was significantly lower and the duration of hospital stay was significantly shorter in the microscope group (n = 92) than the direct vision group (n = 76). Pain scores both at rest and while swallowing reached ≤3 (no significant impact on quality-of-life) significantly faster in the microscope group than the direct vision group.ConclusionsMicroscope-assisted coblation tonsillectomy decreases the duration of hospital stay and the incidence of postoperative secondary haemorrhage, and results in an early improvement in postoperative pain scores.

Bleeding following coblation tonsillectomy: a 10-year, single-surgeon audit and modified grading system.

Coblation tonsillectomy can be controversial. This study assessed post-tonsillectomy haemorrhage outcomes for patients operated on by a single experienced coblation-trained ENT surgeon. A retrospective audit of coblation tonsillectomies was performed using the Flinders modification of Stammberger criteria for post-tonsillectomy haemorrhage. Case note review, interview and database interrogation were utilised to obtain the dataset. Haemorrhage results were compared to reports in the current literature. Of those who underwent coblation tonsillectomy, 3.4 per cent were readmitted to hospital with haemorrhage and 1.3 per cent returned to the operating theatre (0.4 per cent primary haemorrhage and 0.9 per cent secondary haemorrhage). Younger children had a lower risk of returning to the operating theatre than older children or adults (0.3 per cent under the age of 12 years vs 2.0 per cent aged 12 years or older). Coblation can be a safe method for tonsillectomy with low complication rates when performed by an experienced ENT surgeon. The Flinders modification of the Stammberger criteria for post-tonsillectomy haemorrhage provides a simple system for data comparison.

Intracapsular Tonsillectomy for Keratosis Pharyngeous: Postoperative Recovery and Surgical Efficacy

Objectives: (1) Compare the postoperative recovery of patients undergoing intracapsular tonsillectomy to subcapsular tonsillectomy for keratosis pharyngeous. (2) Determine the surgical efficacy of intracapsular tonsillectomy in preventing recurrent symptoms in patients with keratosis pharyngis. Methods: A prospective, single-blinded, randomized controlled trial of adult patients ages 18 years or older diagnosed with keratosis pharyngis between December 2010 and February 2013 was performed. Patients were randomized to receive either intracapsular or subcapsular tonsillectomy with the coblator. Postoperative pain scores and amount of pain medication taken were recorded daily for 2 weeks postoperatively. A 6-month follow-up questionnaire was used to assess the efficacy of the procedure based on persistent symptoms. Results: Twenty-two patients completed the study, with 11 in each group. There was a statistically significant difference in the amount of pain medication consumed on postoperative days 8, 9, and 10, with the intracapsular group consuming less medication ( P = .0293, .0146, .035). There was also a statistically significant difference in the recurrence of tonsilloliths at the 6-month follow-up point ( P = .0291). Patients who had an intracapsular tonsillectomy had a significantly higher recurrence rate than those patients who had a subcapsular tonsillectomy. Conclusions: In adult patients undergoing tonsillectomy for keratosis pharyngis, an intracapsular, coblation tonsillectomy resulted in lower consumption of pain medication than subcapsular tonsillectomy. However, intracapsular coblation tonsillectomy resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication usage in the intracapsular cohort may be offset by the increased likelihood that symptoms will recur.

Coblation Tonsillectomy our experience

Tonsillectomy happens to be the commonly performed surgery these days. Like any other surgical procedure this surgical procedure has also undergone tremendous technological changes. One such evolving change happens to be coblation tonsillectomy. Coblation technology is actually an offshoot of radiofrequency surgery. This technique involves passing radiofrequency energy through a conductive medium like isotonic sodium chloride or potassium chloride solution. This produces a plasma field which is composed of sodium and hydroxyl ions which ablates tissue. This tissue ablation takes place at (60-70° C) which is much lower than that achieved during other electro surgical techniques (400 – 600° C). This article attempts to discuss the use of this technology to perform tonsillectomy with special emphasis on sharing our experience with the system. This study involves critical appraisal of 25 coblation tonsillectomy surgeries performed at Stanley Medical college during the year 2013.

Coblation tonsillectomy in children

Coblation tonsillectomy in children

Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children.We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight.

Coblation Tonsillectomy Versus Blunt Dissectomy Tonsillectomy in Children

Tonsillectomy is one of the most common surgical procedure performed world wide by the ENT Surgeons.Various methods of tonsillectomy have been practiced over the century aimed at reducing or eliminating intraoperative and postoperative morbidity. Coblation tonsillectomy is a recently introduced surgical technique. Tonsillectomy over blunt dissection tonsillectomy in respect of operative time, intraoperative blood loss, postoperative pain, rate of healing of tonsillar fossa and other postoperative complications. This prospective randomized study was done at Maleka Nursing Home, Bogra and Bangladesh ENT Hospital, Dhaka for 36 months from 1st January 2008 to 31December 2010. 200 children were divided into two groups of equal number. In one group, the tonsillectomy performed by Coblation method and in the other group the tonsillectomy Age ranged from 3-12 years with mean age 5.6 in coblation group and 4-14 years with mean age 7.2 in dissection group. Number of male patients were slightly more than female with male female ratio was 3:2 in coblation group and 3.7:2 in dissection group. Operative time and amount of blood loss is significantly reduced in the coblation group (10-25 min, mean 12 min in coblation group, 18-35 min, mean 25 min in dissection group. Tonsillectomy by using coblation have shown less intraoperative bleeding (5ml-100 ml, mean 15 ml compared with 50-230 ml, mean 65 ml in dissection method).During post operative follow-up on day 8, children of coblation group experienced mild to moderate pain with maximum pain on day 2 and no pain on day 8. On the other hand dissection group experienced moderate to severe pain with maximum pain on day 4 and little or no pain on day 8.Children of coblation group returned to normal diet on day 3 and children of dissection group on day 8.On 8th post operative day, coblation group showed smooth healing without any granulation tissue in tonsillar fossa whereas granulation tissue is observed in dissection group. No major complications were noted in any group except one secondary haemorrhage in dissection group. Coblation tonsillectectomy offers less operative time, minimum blood loss, less post operative pain,early return to normal diet and rapid healing of tonsillar fossa. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13681 AKMMC J 2013: 4(1): 25-29

Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

ObjectivesCoblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies.MethodsEighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked.ResultsPostoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups.ConclusionOnly cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.

Comparison of Tonsillectomy by Conventional Dissection, Electrocautery, Laser, and Coblation

Received September 25, 2013 Revised October 7, 2013 Accepted October 7, 2013 Address for correspondence Dong Jin Choi, MD Department of OtolayngologyHead and Neck Surgery, Kwangju Hospital of Christian, 37 Yangnim-ro, Nam-gu, Gwangju 503-715, Korea Tel +82-62-650-5095 Fax +82-62-650-5090 E-mail kircheys@naver.com Background and ObjectivesZZTonsillectomy remains to be an ordinary operative process in otorhinolaryngology. The aim of this study is to evaluate four current tonsillectomy techniques, conventional dissection, electrocautery tonsillectomy, laser tonsillectomy, coblation tonsillectomy, comparing operation time, postoperative pain, postoperative otalgia and postoperative hemorrhage. Subjects and MethodZZFrom March 2012 to December 2012, a total of 61 patients between the ages of 10 years and 58 years scheduled for tonsillectomy were randomly assigned to conventional dissection, electrocautery, laser, coblation groups. All tonsillectomies were performed under general anesthesia. ResultsZZCoblation tonsillectomy technique produced the shortest total surgical time, averaging 19.1 minutes. Electrocautery was the most painful method and postoperative pain was less in laser and coblation, but there was no statistically significant difference between the two. The incidence of primary and secondary hemorrhage was statistically insignificant between the surgical methods. ConclusionZZThis study found that coblation tonsillectomy led to statistically shorter surgical time. However, the four techniques showed no statistically significant difference in the postoperative pain, postoperative otalgia and hemorrhage. Coblation tonsillectomy and laser tonsillectomy are found to be both useful in patients who are sensitive to postoperative pain. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:773-7

The surgical technique for coblation tonsillectomy and its clinical benefits

The surgical technique for coblation tonsillectomy and its clinical benefits

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

To examine the incidence of haemorrhage following tonsillectomy, to explore the usefulness of antibiotic in preventing postoperative haemorrhage and to examine if the haemorrhage depended on the level of expertise of the surgeon. A retrospective review analysing tonsillectomy method, the rate secondary haemorrhage, the grade of operating surgeon. A χ(2) analysis was used to determine the statistical difference between the haemorrhage rates of different tonsillectomy methods. One thousand three hundred and thirty-six tonsillectomies were performed during this period by four different methods: 615 by cold steel dissection, 582 by Coblation, 32 by bipolar dissection and 107 by Helica thermal coagulation. 621 tonsillectomies were performed by Consultant grade and middle grades performed 693 operations. 124 patients (9.3%) were readmitted with haemorrhage. The secondary haemorrhage requiring surgery for controlling bleeding for cold steel dissection method was 1.5% compared to 6.7% for coblation method (P<0.01%), 6.3% for bipolar dissection and 1.9% for Helica thermal coagulation method. Overall consultants had a post tonsillectomy haemorrhage rate of 5.5% and middle grades had a rate of 3.7%. 86.5% of the patients were already on routine prophylactic oral antibiotics at the time of presentation with haemorrhage needing surgical arrest and 13.5% were not on antibiotics (P<0.05%). There was statistically significant difference in secondary haemorrhage rate between coblation and cold steel dissection methods. Coblation tonsillectomies had an increased need for operative intervention to control secondary haemorrhage. Routine use of antibiotic and expertise of operating surgeon had no bearing on secondary haemorrhage rate.