Conventional Electrocautery Research Articles

Silicone stents, the rigid bronchoscope, and the standard of care in central airway stenosis

Central airway stenoses often represent a therapeutic challenge and require a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. While surgery is often the preferred definitive modality, advances in bronchoscopic techniques have led to substantial improvements in patient symptoms and long-term quality of life using minimally invasive techniques generally safe when performed by experienced proceduralists. Endobronchial laser therapy, cryotherapy, conventional electrocautery, or argon plasma coagulation and photodynamic therapy have been used successfully. A variety of stents, silicone or self-expandable (covered or non-covered metallic stents), have been used though little significant progress has been achieved since the description of the dedicated airway silicone stents first described by Jean-Francois Dumon in the 1980s. Rigid bronchoscopy remains the method of choice for the treatment of both benign and malignant central airway obstruction, but significant technological advances allow for effective treatments using the flexible bronchoscope. Metallic non-covered stents are generally not recommended, except in selected patients with poor short-term prognosis.

Bipolar Sealing in Revision Total Hip Arthroplasty for Infection: Efficacy and Cost Analysis

Saline-coupled bipolar sealing has shown mixed results in primary arthroplasty. However, this technology has not been studied in infected revision total hip arthroplasty (THA), where morbidity is higher and conventional methods of blood management, such as cell salvage, often cannot be used. This case-matched study of 76 consecutive revision THA for infection included an experimental bipolar sealing group and a control group of conventional electrocautery. Groups were matched for gender, body mass index, American Society of Anesthesiologists classification, and surgery type. Total blood loss, intraoperative blood loss, and perioperative hemoglobin drop were significantly less in the experimental group. In addition, operative time was significantly shorter in the experimental group, which translated into gross savings approximately equal to the cost of the device. The decreases in total blood loss and perioperative hemoglobin decline, along with financial savings, may support the use of bipolar sealing in infected revision THA.

Does En-bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen?

Aims:Detrusor muscle in initial transurethral resection of the bladder tumor (TURBT) may not be found in up to 50% of the cases. This study was done to assess the safety, feasibility and yield of detrusor muscle on en- bloc TURBT using a conventional electrocautery loop.Materials and Methods:Patients with bladder tumor of size 2-4 cm, from September 2007 to August 2010, who had en-bloc TURBT, were compared with patients who had conventional resection for the presence of detrusor muscle in the biopsy specimen on an initial resection. Tumor size was calculated on ultrasonography or contrast enhanced computerized tomography scan. Tumor with pedunculated base, more than 4 cm in size and tumor with hydroureteronephrosis were excluded. Conventional electrocautery loop was bent to 45° and periphery of the tumor was marked first and then the whole tumor was resected en bloc. The free-lying tumor was then cut into two or three pieces in the bladder for retrieval. Statistical analysis was done using SPSS software Version 13.Statistical Analysis Used:Statistical analysis was done using Pearson chi square test and P value of <.05 was considered significant.Results:A total of 25 patients in the control arm (with conventional TURBT) were compared with 21 patients who had en-bloc TURBT. En-bloc TURBT did not result in bladder perforation as vision was clear due to better hemostasis. Twenty of 21 (94.4%) patients had detrusor muscle but only 15 of 25 (60%) patients in the control arm had detrusor muscle on histopathological examination (P.001)Conclusions:En-bloc TURBT is safe and gives well-controlled resection of the whole tumor due to better visualization. Yield of detrusor muscle present in the specimen is significantly better with en-bloc TURBT.

Analysis of keratinocytes Proliferation During Repair of Surgical Incisions Performed by Conventional Scapel, Electro Cautery, CO2 and Diode Laser

Analysis of keratinocytes Proliferation During Repair of Surgical Incisions Performed by Conventional Scapel, Electro Cautery, CO2 and Diode Laser

Prospective Randomized Comparison of Cold Snare Polypectomy and Conventional Polypectomy for Small Colorectal Polyps

Background and Aim: The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms. Methods: Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group). The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding. Results: Eighty patients were randomized: cold group, n = 40 (101 polyps) and conventional group, n = 40 (104 polyps). The patients’ demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. conventional polypectomy (18 vs. 25 min, p < 0.0001). Complete polyp retrieval rates were identical [96% (97/101) vs. 96% (100/104)]. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy (i.e. 20%; 8/40) than with cold polypectomy (i.e. 2.5%; 1/40; p = 0.029). Conclusion: Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms. The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps.

Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting; an electron microscopic evaluation

Use of the radial artery (RA) as a conduit in coronary artery bypass grafting (CABG) has become increasingly popular in recent years. The aim of this prospective randomized study is to determine how the endothelial wall and blood flow of RA are differently affected with the usages of ultrasonic scalpel and conventional electrocautery in addition to effects of hypothermia and storage solutions. Histopathologic study was achieved by electron microscope to evaluate endothelium of the grafts. Between 2008 and 2009, 182 patients with coronary artery diseases were operated for coronary artery revascularization. The radial arteries were harvested for 40 of these patients and divided into two groups depending on the use of the ultrasonic cautery (UC) (n=20) and the high-frequency electrocautery (EC) (n=20). Patients were divided into two subgroups according to the storage media of the graft. RA was preserved in situ at room temperature (Group 1) and normothermic organ bath (NOB) (Group 2). Harvesting time, use of hemostatic clips, frequency of spasm, in situ free flow, temperature and endothelial damage were compared between the two groups. Statistical analysis was performed using one-way ANOVA, Friedman and unpaired t tests. In all groups, blood flows were significantly decreased as parallel to the local temperatures. Second and third phase flows were similar in group EC1 and UC1 (p>0.05). Free flow was increased in group UC+NOB when comparing with only EC group (60.4±9.83 ml/min and 40.8±7.50 ml/min, p<0.001), whereas the graft preparing time "t2" was shorter in group EC than UC (10.9±2.42 min and 15.2±1.31 min, p<0.01). Nonetheless scoring of the groups in terms of endothelial cell structure and mitochondrial morphological changes did not show any significant difference. If endothelial integrity of the RA can be preserved along with the application of systemic temperature (NOB), regardless of harvesting technique, it provides better flow rates.

VIO soft-coagulation system for major pulmonary resections: results in 68 patients with primary lung cancer

The VIO soft-coagulation system is a new device for tissue coagulation in which the output voltage is automatically regulated. We evaluated the safety and efficacy of this system for major pulmonary resection of lung cancer. We used bipolar VIO soft-coagulation for major pulmonary resection in 68 patients with primary lung cancer using the following three surgical procedures: (1) coagulation of the tissues around lobar vessels and bronchus; (2) fissure dissection; (3) lymph node dissection. The dissection in those steps was performed with both bipolar VIO soft-coagulation forceps and scissors. Results were analyzed with special reference to intraoperative complications, blood loss, and postoperative morbidity. The data in this study (VIO group) were compared with those of 78 lung cancer patients who underwent surgery using conventional electrocautery (CE group). The operations in this series included 60 lobectomies, 1 bilobectomy, 1 pneumonectomy, and 6 segmentectomies. With the VIO soft-coagulation system, coagulation of tissues around the lobar pulmonary vessels without injury to the pulmonary vessels or bronchus was effective. The mean blood loss in the VIO group was 90.6 g (range 5-595 g), which was significantly lower than that in the CE group (mean 141.0 g, range 5-700 g) (P = 0.014). Postoperative morbidity rates in the VIO and the CE group were 11.7% and 17.9%, respectively. The VIO soft-coagulation system is safe and feasible for major pulmonary resections in patients with lung cancer.

The Aquamantys System—An Alternative To Reduce Blood Loss in Primary Total Hip Arthroplasty?

To evaluate the effectiveness of the Bipolar Sealer 6.0-VT (BPS 6.0-VT) (Tissue Link Medical, Inc, Dover, NH) in reducing blood loss compared with a conventional electrocautery (Erbe ICC 350) (Erbe ICC 350 (ERBE Elektromedizin GmbH, Tübingen, Germany). A prospective randomized trial of 105 patients with primary total hip arthroplasty (Erbe ICC 350: 50 patients; BPS 6.0-VT: 55 patients). On the basis of the calculation of the preoperative blood volume the total and postoperative blood loss were calculated. No statistically significant difference could be shown for total intraoperative and postoperative blood loss (group A 1846 mL; group B 1740 mL) ( t test). Due to the lack of reduction of blood loss and the high costs of the BPS 6.0-VT, its use is not recommended in primary total hip arthroplasty.

MP-06.09: Ultrasound Assessment of Treatment Cavity Size after Greenlight Laser Prostatectomy vs. TURP

Greenlight laser prostatectomy is rapidly gaining status as an effective alternative to TURP in the management of Benign Prostatic Hyperplasia. We sought to evaluate the size of treatment cavity produced after this form of therapy in comparison to that apparent after conventional electrocautery TURP.

Lasers in percutaneous renal procedures

Since the invention of lasers in 1960, they have been increasingly used in medicine. In this review paper, the types of lasers used in urology, in addition to their applications to percutaneous renal surgery will be reviewed. Specifically, use of lasers in the percutaneous management of renal stones, upper tract transitional cell carcinoma and stricture will be reviewed. Pubmed was searched for citations since 1966. The following terms were used: "lasers", "calculi", "endopyelotomy", and "transitional cell carcinoma". Due to its minimal depth of penetration, holmium laser has proven to be safe and efficacious. It is currently the primary energy source for flexible instrumentation, and also has demonstrated efficacy in percutaneous lithotripsy (faster than ultrasonic lithotripsy and safer than electrohydraulic lithotripsy). Holmium laser been used for antegrade endopyelotomy and percutaneous resection of upper tract transitional cell carcinoma. Holmium laser is safer than other lasers and has become the gold standard for laser lithotripsy for flexible instrumentation. It has been used successfully in the percutaneous management of renal stones, ureteropelvic junction obstruction, and upper tract transitional cell carcinoma. Holmium laser is an alternative energy source to conventional lithotripters and electrocautery for endopyelotomy and resection of upper tract transitional cell carcinoma.

Lymphorrea incidences after modified radical mastectomy with auto cut versus spray mode electro coagulation

e11571 Background: Lymphorrea is one of the most common side effects subsequent to mastectomy. It is a predicting factor for seroma, which are usually painless; however, lymphorrea is also linked to wound infection, wound healing complications and lymphedema. Electrocautery is a significant risk factor for lymphorrea and seroma. Two electrocautery methods—auto cut and spray mode electro coagulation—were compared in this prospective randomized study. Methods: 68 patients with operable breast cancer intended for modified radical mastectomy with axillary lymph node dissection or sentinel node biopsy were randomized into two groups by their date of birth. The patients in the first group were operated by using high frequency coagulation with auto cut, the members of the second group in spray mode. All wounds were drained by two self-regulating suction drainages. The drainages were removed as soon as the drain volume decreased to less than 30 ml/24 hours. Results: The mean drain volume amounted to 276 ml (range 20- 1,200 ml) in the auto cut group and 546 ml (range 100 -1,600ml) in the spray mode group. This difference is highly significant (significance level &lt;0.01, t= -2.9987; p=0.003896). The incidence of seroma formation was 5% in the auto cut group and 23.5% in the spray mode group. Patients who were treated with spray mode electrocautery in average had to be hospitalized two days longer. Conclusions: The lower need for instrument changes makes the spray mode electro coagulation more comfortable for the surgeon. Nonetheless the conventional electrocautery should be preferred to operate radical mastectomy in order to decrease the morbidity risk for patients. No significant financial relationships to disclose.

The use of argon beam coagulation in pressure sore reconstruction

Pressure sores are a significant source of physical and financial burden for debilitated patients. When conservative measures fail, surgical reconstruction with myocutaneous flaps may be the last hope for cure and/or improved quality of life in these patients. Adequate haemostasis is an integral component of these reconstructive procedures, as bleeding and haematoma formation can lead to increased morbidity. This study was designed to investigate the use of argon beam coagulation in patients undergoing bony debridement and subsequent pressure sore reconstruction with myocutaneous flaps. The clinical records of 34 patients undergoing pressure sore reconstruction with the use of argon beam coagulation from 2004 to 2006 at an academic institution were reviewed and outcomes were assessed. Reconstruction was performed by a single surgeon on 34 patients (31 men, three women; mean age 41+/-15 years), with a total of 41 pressure sores. Thirteen (32.5%) patients had evidence of osteomyelitis preoperatively and five (12.5%) had previous coccygectomies secondary to infection. Twenty-six (65%) of the pressure sores were treated with hamstring V-Y musculocutaneous flaps, 10 (25%) with gluteal flaps, and four (10%) with tensor fascia lata flaps. Overall, suture line dehiscence occurred in six (15%) cases, flap failure and pressure sore recurrence occurred in six (15%) cases, an abscess developed in one (2.5%) case, and a sinus tract with a superficial wound developed in one (2.5%) case. There were no complications related to haemostasis, including excessive bleeding or haematoma formation. Argon beam coagulation is an efficacious tool for achieving adequate haemostasis during pressure sore reconstruction, particularly when significant bony debridement is involved. The use of argon beam coagulation does not result in an increased complication or recurrence rate when compared with conventional electrocautery methods.

Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral

To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior left atrial wall using electrocautery in mitral valve surgery. From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean age of the patients was 59 years, and 60.8% were female. The left atrium mean diameter was 50.3 +/- 5.09 mm and the left ventricular ejection fraction was 53.6 +/- 11.03%. The mean time of extracorporeal circulation was 52.5 +/- 13.3 min; aortic clamping, 35.6 +/- 12.9 min; atrial ablation, 3.05 +/- 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 +/- 3.5 mm; left ventricular ejection fraction was 59.2 +/- 3.48%; In addition, left atrial contraction was present in 68.8% of the patients. The surgical treatment of the atrial fibrillation with electrocautery in mitral valve surgery was capable to determine the reversion of this arrhythmia in a significant number of patients during short- and middle-term clinical follow-up without mortality and fewer complications.

Mechanism of Blood Coagulation by Non-Thermal Atmospheric Pressure Dielectric Barrier Discharge Plasma.

Introduction: Non-thermal atmospheric pressure dielectric barrier discharge plasma (cold plasma due to its non-thermal nature) has emerged as a promising new tool in medicine due to its ability to coagulate blood rapidly, sterilize tissue without thermal damage and induce apoptosis in malignant tissue. The potential clinical applicability of non-thermal plasma lies in its use in controlling intra-operative microvascular bleeding in organs and in endoscopy. Non-thermal plasma can also be used to treat superficial wounds in trauma through hemostasis while simultaneously inducing surface sterilization. We have previously demonstrated that non-thermal plasma hastens blood coagulation on cut tissue surfaces and accelerates clot formation in whole blood five times faster than natural coagulation. A series of experiments were undertaken to investigate the mechanism of coagulation by non-thermal plasma.Methods/Results: We initially postulated that changes in pH and/or extracellular Ca2+ as a possible mechanism for non-thermal plasma mediated coagulation. Our studies however showed no significant changes in pH or Ca2+ in treated blood. Thermal energy triggered coagulation as seen in conventional electrocautery as well as electric field effects were eliminated as other possible mechanisms. The role of reactive oxygen species (ROS) in coagulation was studied, as non-thermal plasma is known to produce ROS in water. ROS production in blood was blocked with sodium pyruvate, an ROS scavenger, and the results showed no effect on non-thermal plasma induced coagulation. Specific effects of non-thermal plasma on citrated blood samples revealed extremely rapid coagulation with surface gel formation, while clotting studies (PT, aPTT) performed on the plasma beneath the gel revealed consumption of coagulation factors. Examination of the clot formed by non-thermal plasma using Scanning Electron Microscopy (SEM) showed platelet activation with pseudopodia formation, aggregation, and fibrin formation. The effects of non-thermal plasma on fibrinogen solution treated at physiologic pH showed a change in opacity suggesting clot formation. Dynamic Light Scattering (DLS) was used to measure particle size distributions of treated and untreated fibrinogen solutions. Treated fibrinogen exhibited a multi-modal distribution of sizes with the largest size corresponding to the size of fibrin-like structures. This suggests that non-thermal plasma may coagulate blood by the conversion of fibrinogen to fibrin. Evaluation of albumin, our control protein given its non-involvement in coagulation, showed no changes upon exposure to non-thermal plasma.Conclusion: Non-thermal plasma likely promotes coagulation by enhancing the physiologic coagulation process through direct activation of fibrinogen as well as platelet activation and aggregation. Future research will further evaluate the mechanisms of non-thermal plasma induced platelet activation and effects on other proteins in the coagulation cascade. This will lead to newer insights into the physiological aspects of coagulation and clinical utility of non-thermal plasma in medicine.

A Novel Resectoscope for Transurethral Resection of Bladder Tumors and the Prostate

Transurethral bladder tumor resection is associated with imperfect clinical staging and incomplete tumor removal. Transurethral prostate resection may be complicated by inadvertent damage to the urinary sphincter, bladder neck and trigone. We performed a multicenter pilot and feasibility study of a novel working element for resectoscopes designed to improve the efficacy and safety of transurethral endoscopic surgery. An innovative working element for resectoscopes was developed to convert the standard in/out linear/axial movement at the handgrip into a side-to-side, bidirectional, lateral rotating motion. The device is compatible with current optical technology and conventional electrocautery generators, and it has been granted marketing approval. It consists of variably sized cutting loops designed for transurethral resection of bladder tumors and the prostate. To date 80 patients with bladder cancer (38) or benign prostatic hyperplasia (42) have undergone surgery with this instrument at our 3 clinical sites. No safety concerns were evident. When used during transurethral bladder tumor resection, lateral resection at the base of the tumor enabled accurate depth of penetration into the bladder wall, which may decrease the risk of bladder perforation and improve pathological assessment of tumor invasion. During transurethral prostate resection this novel tool facilitated dissection of adenoma adjacent to the verumontanum and prostatovesical junction, which may decrease the risk of sphincteric damage and bladder neck injury. A novel resectoscope is currently under prospective clinical investigation to establish its surgical and pathological efficacy, ease of use and side effect profile. Current data suggest that the learning curve is mild, its use is safe and it provides distinct advantages when used for transurethral resection of bladder tumors and the prostate.

Effective Bone Hemostasis and Healing Using Radiofrequency and Conductive Fluid

Hemostasis in bone is difficult to achieve because of the mineral content. Current techniques often are ineffective, can have systemic effects, or leave residual material in the wound. Our hypotheses were that a wand device coupling radiofrequency energy with a cooling conductive saline solution, applied topically to bone, could produce superior hemostasis compared with conventional electrocautery or no treatment, and not impede bone healing. Immediate hemostasis and subsequent bone healing for 6 and 12 weeks were evaluated in an iliac crest ostectomy (cancellous bone) and a drilled tibia defect (cortical bone) sheep model. Outcome variables were amount and intensity of bleeding, serial radiography, quantitative computed tomography, histology and mechanical testing. Control of bleeding was nearly complete (93%) and greater with the radiofrequency/saline treatment compared with electrocautery (56%) or no treatment (0%) in cancellous bone and cortical bone. Electrocautery induced surface char (black carbon debris) that could be seen at 6 and 12 weeks. There were no differences in bone healing between the radiofrequency and electrocautery device applications or untreated bone. At 12 weeks, all healing tibiae defects were as strong as undrilled tibiae. This may be an effective method to produce rapid hemostasis in bone without char or healing complications.

Coblation versus Conventional Electrocautery Tonsillectomy: Postoperative Pain and Recovery

Coblation versus Conventional Electrocautery Tonsillectomy: Postoperative Pain and Recovery

Randomized controlled trial of Coblation versus electrocautery tonsillectomy

To compare the postoperative recovery of patients receiving Coblation-assisted (Arthrocare, Sunnyvale, CA) intracapsular tonsillectomy with that of patients receiving traditional subcapsular electrocautery tonsillectomy. This was a prospective, randomized, double-blinded, controlled study. One hundred one children, aged 2 to 16 years, were randomized to Coblation or to conventional electrocautery tonsillectomy. Only patients with the operative indication of obstructive sleep apnea were entered into the study. Intracapsular tonsillectomy was performed on the Coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcome measures were assessed on days 1, 3, and 5 after surgery. These included child and parental rating of pain by using the Wong Faces pain scale, analgesic use, oral intake, and activity level. Patients, parents, and the nurse practitioner obtaining the outcome data were blinded to treatment arm. Treatment groups were similar in age, gender, and weight. Surgical time and estimated blood loss were similar. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percentage of normal activity level returned to >70% earlier and more frequently in Coblation patients. There was slightly decreased analgesic use on postoperative day 5 in the Coblation group. Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery after Coblation-assisted intracapsular tonsillectomy.

A Parallel Group Analysis of Tonsillectomy Using the Harmonic Scalpel vs Electrocautery

To evaluate efficiency and postoperative morbidity in tonsillectomy using the harmonic scalpel (HS) vs conventional electrocautery (EC). A retrospective medical chart review of all patients who underwent tonsillectomy at a single children's hospital during a 32-month period from January 2001 to August 2003. The charts of 605 patients who underwent tonsillectomy or adenotonsillectomy were reviewed. The patients were stratified into 2 groups based on the dissecting instrument used (HS vs EC). Each group consisted of 2 subcategories based on age (< or =7 years and >7 years). Data collected included age, sex, operative indication, operative time, postanesthetic recovery room time, pain scale scores, postoperative admissions, and postoperative morbidities. There were significant differences in mean age (P<.001), mean weight (P<.001), and indication for surgery (P<.001) between the 2 methods: HS patients were younger, weighed less, and more often had obstructive symptoms as their primary operative indication compared with the EC group. Average operative times were not significantly different between methods. No differences were noted with respect to recovery time (HS group, P = .10; EC group, P = .30), postoperative oxygen requirements (HS group, P = .07; EC group, P = .09), and postoperative pain scores (HS group, P = .31; EC group, P = .58). There was a significant difference in postoperative admissions between the 2 methods in patients 7 years or younger (P = .005). Finally, we noted a significant difference in postoperative bleeding between the HS (2/292) and EC (13/313) methods when the data were compared per age group (P = .006), but the overall bleeding rate was not statistically significant owing to the small number of total bleeding instances (15/605). Recent prospective studies indicate that the HS provides advantages over conventional EC with respect to postoperative pain and return to normal activity. This study shows that HS tonsillectomy was as efficient as the conventional EC method. In addition, there was evidence that the rate of postoperative bleeding was significantly reduced by using the HS vs conventional EC.

Randomized controlled trial of coblation vs electrocautery tonsillectomy

Objectives: To compare the postoperative recovery of patients receiving coblation-assisted intracapsular tonsillectomy to traditional electrocautery tonsillectomy. Methods: This was a prospective, randomized, double-blinded, controlled study. Eighty-three children, aged 2 to 17 years, were randomized to coblation or conventional electrocautery. Only patients with the operative indication of obstructive sleep apnea were entered into the study, and all received tonsillectomy and adenoidectomy by a single surgeon. Intracapsular tonsillectomy was performed on the coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcomes measures were assessed on days 1, 3, and 5 following surgery. These included child and parental rating of pain using the Wong Faces pain scale, analgesic use, oral intake, activity level, and presence/absence of nausea and/or vomiting. Patients, parents, and the nurse practitioner obtaining the outcomes data were blinded to treatment. Results: Treatment groups were similar in age, gender, and weight. Surgical time was similar and estimated blood loss slightly less in the coblation group. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percent of normal activity level returned to above 70% earlier and more frequently in coblation patients. There was decreased analgesic use in the coblation group. After controlling for codeine or hydrocodone intake, there was no difference in nausea and/or vomiting. Conclusions: Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery following coblation intracapsular tonsillectomy.