Use Of Coblation Research Articles

Treatment of Oral Lymphangiomas by Coblation.

Lymphangioma is a malformation of superficial lymphatic vessels. Tongue lymphangiomas are relatively uncommon. Multiple treatment modalities have been reported, with variable treatment responses. Most of the traditional treatment modalities have a high recurrence rate. We describe the use of coblation in the management of lymphangioma circumscriptum of the dorsum of tongue in two patients. Radiofrequency ablation of oral lymphangiomas showed early postoperative oral intake and minimal postoperative pain. There was no recurrence of disease on 1 year follow up. Improved wound healing, early postoperative oral intake and minimal postoperative pain, make radiofrequency ablation a highly valuable treatment modality for oral lymphangiomas and may be recommended as the treatment of choice.

Coblator adenoidectomy in pediatric patients: a state-of-the-art review.

Adenoid hypertrophy is one of the main causes of nasal obstruction in 'children. Adenoid hypertrophy can be approached either with nasal corticosteroids, or surgically when medical treatment fails. Different adenoidectomy techniques have been proposed to reduce morbidity and surgical risks, with a consequent marked increase in the use of new surgical procedures in recent years, with a progressive increase in the use of coblation. This state-of-the-art review aims to systematically review the current literature on the role of coblation in adenoidectomy. The selection criteria included children submitted to adenoidectomy with coblator vs other techniques. 11 research questions were defined. 4 databases were explored by four authors: PubMed (Medline), the Cochrane Library, EMBASE and SciELO. The level of evidence and quality of the selected articles were assessed according to assessed according to the Quality Assessment Checklist of the National Institute for Health and Clinical Excellence. 20 studies met the inclusion criteria: 2 metanalysis, 12 randomized clinical trial, 2 non-randomized clinical trial, 1 prospective cohort study, and 3 retrospective cohort study. It encompassed a total population of 8375 participants. Regarding the different surgical techniques, 18 studies (excluding metanalysis) performed coblation (n = 1550), 6 microdebridement (n = 883), 15 curettage (n = 4016), and 1 suction coagulation (n = 1926). Coblator adenoidectomy appears to offer better adenoid control compared to curettage, with a possible, although not confirmed lower rate of revision surgery. Similarly, this greater resection of adenoid tissue seems to be related to a greater reduction of nasal obstruction. The advantages of this technique are mainly less surgical bleeding-although it is not clear this is a clinically relevant difference, and less postoperative pain compared to cold curettage. The difference in pain is small, as adenoidectomy is not a painful surgery in general. There is little evidence on the control of OME and comparison with other techniques such as microdebrider adenoidectomy.

Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes.

Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients' symptoms, postoperative bleeding, crusting, and pain scores. This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group (n = 45), and submucous resection group (n = 45). The outcomes of both techniques were analyzed and compared. Both techniques were equally in alleviating patients' symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting.

Coblation-assisted excision of hypopharyngeal venous malformation: a case report

BackgroundAdult hypopharyngeal venous malformations are rare. Unlike hemangiomas, venous malformations require surgical excision wherever feasible. We describe the case of a hypopharyngeal venous malformation and use of coblation to achieve complete excision.Case presentationA 28-year-old male presented to the emergency department with sudden-onset hematemesis, and melena for 3 days. Examination revealed a broad-based reddish polypoidal lesion (mulberry like) arising from the left aryepiglottic fold and medial wall of the pyriform sinus. Contrast-enhanced magnetic resonance scan and angiogram of the neck was done, which revealed an intensely enhancing vascular lesion. He underwent a selective embolization of the feeder vessels achieving 80% reduction in the post run blush. We excised the lesion in toto using coblation considering its superior hemostatic control and maneuverability.ConclusionThe use of coblation is a relatively safe and easy technique to learn and perform in management of vascular tumor of hypopharynx and upper airway. When appropriately performed, it provides a bloodless field and causes minimal damage to surrounding tissue. However, knowledge of external approaches is mandatory for management of complications.

A Novel Use of Coblation in the Treatment of Tracheal Tumors.

Radiofrequency coblation is a new method of electrosurgical intervention. Most recently, its use has been reported in the treatment of laryngotracheal pathology. However, studies on coblation for tracheal tumors have not been reported. In this article, we described a novel use of coblation technology, in which a new type of airway-specific wand was used to ablate tracheal benign or malignant tumors in 3 cases. The results suggest the possibility of usage of coablation in the treatment of tracheal tumors. More studies that are larger and have longer follow-up are needed to further evaluate the use of this technique in the treatment of tracheal tumors.

Trans-nasal Endoscopic Sphenopalatine Artery Ligation in Epistaxis: Coblation Versus Electrocauterization.

Epistaxis is one of the most common emergencies encountered by otorhinolaryngologist. Although anterior epistaxis is easy to manage but posterior epistaxis is usually refractory. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) is now a well established surgical technique for the management of refractory epistaxis. Electrocauterization and clipping are the most common methods used for ligation. Coblation is an upcoming tool with promising results in endoscopic skull base surgeries and tonsillectomies but has not been explored much in TESPAL. It was a randomised observational study.50 patients of refractory epistaxis were included in the study. The patients were divided into 2 groups. Group A underwent TESPAL using electrocauterization while Group B underwent TESPAL using coblation. The data was collected and analysed for various parameters like experience of the surgeon, time taken for surgery, episodes of rebleeding and postoperative crusting. Out of 50 cases in our study 27 were males and 23 were females. Most common age group was 60-70years (68%). Most common cause was hypertension (86%). Surgeons were happy 21/25 times in coblation group compared to 9/25 times in electrocauterization group. There were 4/25 rebleeding episodes in electrocauterization group compared to none in coblation group. Post-operative crusting was also less in coblation group compared to electrocauterization. Though electrocauterization is a well established method for TESPAL our experience with coblation in TESPAL has been extremely satisfying. We suggest our colleagues to conduct more research studies on use of coblation in TESPAL to reach a consensus.

Coblation® intracapsular tonsillectomy in children with recurrent tonsillitis: Initial experience

ObjectivesThe use of Coblation® intracapsular tonsillectomy for the treatment of sleep disordered breathing (SDB)/obstructive sleep apnoea (OSA) has an increasing evidence base. However, the results for tonsillitis as the predominant indication for surgery are not as clear. We present our initial results from 80 paediatric cases undergoing Coblation® intracapsular tonsillectomy for infective indications. MethodsProspective case series within the secondary care environment, January 2016–July 2018, all with completed follow-up. We utilised the validated T14 tonsil symptom questionnaire pre- and postoperatively and also collected data regarding postoperative complications. Results80 consecutive patients (age range 2–16 years and mean 7.2 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy) predominantly for infective reasons although some also had concomitant adenoidectomy for snoring/sleep disordered breathing were included.Mean follow-up was at 13 months postoperatively. 38 children had tonsillitis (with or without snoring) and 42 children had SDB in combination with tonsillitis. The mean over-all total T14 score was 32.7 preoperatively and 2.7 postoperatively (p < 0.0001). The mean infective score was 22.1 preoperatively and 1.5 postoperatively (p < 0.0001). The mean SDB score was 10.6 preoperatively and 1.5 postoperatively (p < 0.0001). There were no cases of haemorrhage, re-admission or regrowth noted. ConclusionCoblation® intracapsular tonsillectomy is a safe and effective technique for treating children with recurrent tonsillitis. Future studies should incorporate longer term follow-up.

Comparison of tonsillectomy by coblation and tonsillectomy by conventional method

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Operations on tonsils and adenoids are performed since many years. Tonsillectomy produces an open wound that heals by secondary intention. Tonsillectomy is still a very common surgical procedure. There are various modalities to perform surgery (diathermy, laser, harmonic scalpel, radiofrequency cautery, cryosurgery and coblation). Among these, dissection and snare method are commonly done by ENT surgeons.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We carried out the prospective cross-sectional study to compare intraoperative blood loss, time taken for the surgery, post-operative pain score, degree of slough formation and complications between these two methods. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average time for surgery on coblation side was less (15.1 min) than conventional side (36.04 min). For haemostasis on conventional side, all patients required bipolar cauterization while on coblation side only 8 patients (16%) required hemostasis. Average blood loss on coblation side (left) was 3.40ml while on conventional side (right) 25.57 ml. In my study, mean pain score on 1st day, 2&lt;sup&gt;nd&lt;/sup&gt; day, 5&lt;sup&gt;th&lt;/sup&gt; and 10&lt;sup&gt;th&lt;/sup&gt; day of surgery was 6.18, 4.10, 2.30 and 1.64 on conventional side and 4.36, 3.00, 1 and 0 on coblation side. In my study, only one patient had Secondary haemorrhage on conventional side on 7&lt;sup&gt;th&lt;/sup&gt; day.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The use of coblator reduces the time required for surgery, per-operative blood loss is very much less, chances of damage to surrounding structures are less, charring of tissue is less, post-operative severity of pain after 24 hours is very much less than that of dissection method. Slough formation was more on coblation side as compared to conventional side.&lt;/p&gt;

Coblation Assisted Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma- An Institutional Observational Study

Objective: The purpose of our case series is to highlight the role of coblation in endoscopic JNA excision in terms of blood loss, duration of surgery and hospital stay. This was a Retrospective study done at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha between January 2014 to June 2019 which includes 12 patients of JNA. Material and Method: The present case series was of 12 cases of JNA removal by endoscopic approach using coblation. Proper history taking and clinical examination was done in all cases. All patients were male between age group 5 to 20 years in the present series. In all patients preoperative CECT and MRI was done and staged according to Radkowski staging system. Out of 12 patients, 9 patients (Radkowski stage IB, IIA &amp; IIB) were operated without embolization &amp; 3 patients (Radkowski stage IIB &amp; IIIA) were embolized 24 hr before operation. Result: The present study suggests that coblation decreases the chances of intraoperative bleeding, provides clear surgical field thus reduces operative time. Coblation helps in debulking of tumor, preserving anatomical integrity, increases chance of complete removal and reduces the recurrence. Coblation decreases use of frequent and multiple instrumentation. So use of coblation in JNA removal (with or without preoperative embolization) gives advantage of safe and effective results. Conclusion: Hence, none of the 12 patients required post-operative blood transfusion and follow-up showed no complications in any of the cases.

Chemical Ablation of the Tissue in ENT Surgery

Various interventions require tissue ablation in ENT surgery. This can be achieved using a multitude of methods, but the tendency today is to use minimally invasive methods. The development of new technologies has allowed us to consider the use of coblation for tissue ablation, which is based on a chemical reaction, instead of a thermal or mechanical ablation. The technology proved to be extremely used in the field of ENT. Its indications range from functional surgery to benign or even malignant tumors and it can be used in the nose, pharynx and larynx, with probes of different length and angulation. This minimally invasive method of tissue ablation associates less scaring, a faster recovery and a lower postoperative discomfort. Although the time required for the intervention may be somewhat longer, the overall results are superior to the classical methods, considering it provides instant hemosthasis as well. We consider it to be a reliable method, fit for a wide range of indications.

The novel use of coblation whilst undertaking a challenging tracheostomy in a patient with anaplastic thyroid cancer

The novel use of coblation whilst undertaking a challenging tracheostomy in a patient with anaplastic thyroid cancer

Surgical Excision of Clivus Chordoma with the Use of Coblator—A Case Report

Chordomas are dysembryogenic tumors originating from the notochordal process [1] [2]. They are aggressive tumours with unique diagnostic and management challenges. Primary therapy is complete surgical removal of the tumour as much as possible. The likelihood of recurrence is high in spite of complete surgical resection. A 52-year-old female patient presented with complaints of decreased vision in right eye, nasal bleeding, nasal blockage and difficulties in swallowing. CT scan and nasal biopsy were performed which confirmed the diagnosis of clivus chordoma. The CT scan showed extension into nasopharynx, nasal cavity and oropharynx pushing onto the soft palate. Surgical excision of the mass was performed with coblator by both intraoral and intra nasal approach [3]. On follow-up, nasal endoscopy and CT were done; the patient was relieved of the symptoms and was clinically better.

Radiofrequency tonsillotomy in Sweden 2009–2012

The Swedish National Registry for Tonsil Surgery has been operational since 1997. All ENT clinics in Sweden are encouraged to submit data for all patients scheduled for tonsil surgery. Preoperatively, age, gender and indication are recorded. Postoperatively, method (tonsillectomy or tonsillotomy), technique, and perioperative complications are recorded. Postoperative bleedings, pain, infections, and symptom relief are assessed through questionnaires. An earlier report from this registry showed that tonsillotomy had become more common than tonsillectomy in children with tonsil-related upper airway obstruction. The aim of this study was to categorize which instruments were used for tonsillotomy in Sweden and to compare their outcome and complication rate. All children 2-18 years, reported to the registry from March 2009 until September 2012, who underwent tonsillotomy on the indication upper airway obstruction, were included in the study. 1,676 patients were identified. In 1,602 cases (96%), a radiofrequency instrument was used. The postoperative bleeding rate was low (1.2%) and the degree of symptom relief was high (95.1%). Three different radiofrequency instruments (ArthroCare Coblation(®), Ellman Surgitron(®), and Sutter CURIS(®)) were used in 96% of the patients. There were no significant differences in the number of postoperative bleedings, postoperative infections or symptom relief between the instruments. The only difference found was in the number of days on analgesics, where more days were registered after use of Coblation(®). In Sweden, radiofrequency tonsillotomy is the dominant surgical technique used for tonsil hypertrophy causing upper airway obstruction in children. There are no significant differences in outcome between the different radiofrequency instruments except for number of days on analgesics after surgery.

Use of Coblation in Resection of Juvenile Nasopharyngeal Angiofibroma

We present a series of 4 patients with juvenile nasopharyngeal angiofibroma (JNA) who underwent Coblation-assisted endoscopic resection after preoperative embolization, and discuss the use and advantages of endoscopic Coblation-assisted resection of JNA. Our limited case series suggests that Coblation may be used in the resection of JNA after embolization in a relatively safe, efficient, and effective manner. Coblation allows for decreased bleeding, less need for instrumentation, and improved visualization. There are limited published data in the literature to date on the use of Coblation in endoscopic JNA resection. We describe its use in a more extensive tumor than those previously reported. Further studies are needed to fully define the safety and utility of Coblation technology for this application.

Cordotomy by Coblation in Bilateral Vocal Fold Immobility

Objective: 1) Understand the presentation, etiology, and management of bilateral vocal fold immobility. 2) Understand the utility, technique, and advantage of endoscopic coblation vocal cordotomy for patients with bilateral vocal fold immobility. 3) Compare the use of the laryngeal coblator with the laser. Method: Case series using endoscopic coblation to perform vocal cordotomy in patients with bilateral vocal fold immobility is presented. Seven patients underwent suspension microlaryngoscopy with either initial or revision vocal cordotomy with or without partial arytenoidectomy. Routine follow-up was performed and wound healing was documented via distal chip videolaryngoscopy. Results: Seven patients underwent suspension microlaryngoscopy with vocal cordotomy as part of airway management for bilateral vocal fold immobility. The laryngeal coblator was used to perform a transverse cordotomy. The procedure was completed in approximately 5 minutes. No laser protection is required reducing operative set-up and procedure time versus the laser. Two patients had a prior tracheotomy. No patients required a tracheotomy with this procedure. Patients were seen between 1 day and 1 month postoperatively. Patients had minimal granulation tissue at the cordotomy site and appeared to have quicker healing. The glottic airway and stridor were improved in all patients. Conclusion: Initial outcomes of endoscopic coblation vocal cordotomy reveal this technique to be safe and efficient. Coblation increased the glottic airway with minimal granulation tissue and rapid healing. This represents the first described use of coblation for bilateral vocal fold immobility. Long-term data will be forthcoming.

Randomised comparative study of adenotonsillectomy by conventional and coblation method for children with obstructive sleep apnoea

IntroductionAdenotonsillectomy is one of the most common surgical procedures throughout the world for children in otolaryngology. One of the current indications for adenotonsillectomy is adenotonsillar hypertrophy causing Obstructive Sleep Apnoea (OSA). The choice of surgical tools and technique affects the outcome and morbidity due to adenotonsillectomy. Aim of the studyTo assess the efficacy and safety of coblation adenotonsillectomy as compared to dissection method. To evaluate the morbidity and to study complications associated with each procedure. Materials and methodsThis prospective and comparative study of dissection and coblation method of adenotonsillectomy was conducted in our institute, Madras ENT Research Foundation, Chennai over a period of 6 months. 50 cases of children with OSA age group between 5 and 12 years were randomly selected for each group and studied. Duration of surgical procedure, blood loss, post operative pain, post operative reactionary and secondary bleeding was noted and compared. Observation and resultsOperative time was more in dissection method compared to coblation technique. Blunt dissection tonsillectomy was associated with greater blood loss than coblation tonsillectomy. Post operative pain was more in dissection method and it was less in coblation technique. Post operative bleeding in both the techniques were found to be minimal. ConclusionWe conclude that the use of coblation for adenotonsillectomy may have several advantages over standard methods for the treatment of children with Obstructive Sleep Apnoea. It is highly efficacious, practical and safe with less morbidity and less complications.

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection

To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150min and the estimated blood losses were 150, 400, and 130mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.

Use of coblation in otolaryngology, head and neck surgery

Coblation is a relatively new, low-temperature electrosurgery technique that has established its place in various surgical fields. This article summarizes the published work on the use of coblation in the field of otorhinolaryngology.

Use of Coblation in Arthroscopic Surgery of the Temporomandibular Joint

To evaluate the effectiveness of Coblation in temporomandibular joint (TMJ) arthroscopic surgeries and to preliminarily evaluate the clinical effects. Arthroscopic Coblation, combined with disc suturing, was performed in 419 TMJs from July 2001 to March 2007 by use of the ArthroCare System 2000 radiofrequency machine (ArthroCare, Sunnyvale, CA). All patients had stage II to V internal derangement, according to the classification of Wilkes. Besides disc suturing, the technique of Coblation was used in procedures of adhesion ablation, anterior release, chondroplasty, and discoplasty. All patients were followed up for 3 months and evaluated based on immediate arthroscopic findings, by clinical examination, and by magnetic resonance imaging examination. During the TMJ arthroscopic surgeries, the adhesion, unhealthy disc, and cartilage were ablated completely. The surface of the cartilage and disc were smooth without cautery damage and hemorrhage. During the clinical follow-up period, 76.37% of TMJs (320/419) had excellent results and 16.47% (69/419) had good results. The success rate was 92.84%. Masseter muscle atrophy occurred in 4 patients, and 30 TMJs required second arthroscopic surgeries or open surgeries. The technique of Coblation has proved to be an effective and minimally invasive option for the treatment of TMJ internal derangement, with advantages such as offering a high degree of precision and control, causing little or no thermal damage to surrounding tissue, leaving smooth anatomic surfaces, and achieving hemostasis of smaller blood vessels.

Use of coblation in arthroscopic surgery of the temporomandibular joint

Use of coblation in arthroscopic surgery of the temporomandibular joint