Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T17:07:52.080Z Has data issue: false hasContentIssue false
  • English
  • Français

Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies

Published online by Cambridge University Press:  26 November 2007

E A Magdy ,
S Elwany ,
A S El-Daly ,
M Abdel-Hadi  and
M A Morshedy
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Coblation tonsillectomy is a relatively recently introduced surgical technique which attempts to bridge the gap between ‘hot’ and ‘cold’ tonsillectomy methods.

Aim:

To compare coblation tonsillectomy with three commonly used surgical techniques: cold dissection–ligation, monopolar electrocautery and CO2 laser.

Materials and methods:

A prospective, randomised, double-blinded clinical trial was undertaken of 60 adult patients divided into three equal study groups. Patients in each group were randomly assigned to have one tonsil removed with coblation and the second with one of the other three tonsillectomy techniques. Ten randomly selected tonsils resected by each method were sent for histopathological evaluation.

Results:

Coblation was significantly faster to perform than laser and produced significantly less intra-operative blood loss than both the dissection–ligation and laser techniques. Subjective visual analogue scale comparisons showed a non-significant pain score difference between coblation and dissection–ligation on most post-operative days. Coblation produced consistently highly significantly (p < 0.001) less pain, compared with electrocautery up to the 12th post-operative day and laser up to the 10th post-operative day. There was no significant difference in tonsillar fossa healing, comparing coblation to both dissection–ligation and laser techniques. Monopolar electrocautery produced significantly slower healing than coblation after 7 post-operative days, with no significant difference after 15 post-operative days. Histopathological evaluation showed that coblation inflicted significantly less thermal tissue injury than either electrocautery (p = 0.001) or laser (p = 0.003).

Conclusions:

In adult patients, coblation tonsillectomy offers some significant advantages in terms of post-operative pain and healing, compared with other tonsillectomy techniques.

Keywords

TonsillectomyCoblationPost-Operative ComplicationsPost-Operative Pain
Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 3 , March 2008 , pp. 282 - 290
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Younis, RT, Lazar, RH. History and current practice of tonsillectomy. Laryngoscope 2002;112(suppl 100):3–5CrossRefGoogle ScholarPubMed
2 Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–1310.1016/j.otohns.2005.09.027CrossRefGoogle ScholarPubMed
3 Sorin, A, Bent, JP, April, MM, Ward, RF. Complications of microdebrider-assisted powered intracapsular tonsillectomy and adenoidectomy. Laryngoscope 2004;114:297–300CrossRefGoogle ScholarPubMed
4 Karatzias, GT, Lachanas, VA, Papouliakos, SM, Sandris, VG. Tonsillectomy using the thermal welding system. ORL J Otorhinolaryngol Relat Spec 2005;67:225–910.1159/000088925CrossRefGoogle ScholarPubMed
5 Glade, RS, Pearson, SE, Zalzal, GH, Choi, SS. Coblation adenotonsillectomy: an improvement over electrocautery technique? Otolaryngol Head Neck Surg 2006;134:852–510.1016/j.otohns.2005.11.005CrossRefGoogle ScholarPubMed
6 Timms, MS, Temple, RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:450–2CrossRefGoogle ScholarPubMed
7 Chinpairoj, S, Feldman, MD, Saunders, JC, Thaler, ER. A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model. Laryngoscope 2001;111:213–710.1097/00005537-200102000-00005CrossRefGoogle ScholarPubMed
8 Noordzij, JP, Affleck, BD. Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients. Laryngoscope 2006;116:1303–910.1097/01.mlg.0000225944.00189.e9CrossRefGoogle ScholarPubMed
9 Oko, MO, Ganly, I, Loughran, S, Clement, WA, Young, D, Geddes, NK. A prospective randomized single-blind trial comparing ultrasonic scalpel tonsillectomy with tonsillectomy by blunt dissection in a pediatric age group. Otolaryngol Head Neck Surg 2005;133:579–8410.1016/j.otohns.2005.08.002CrossRefGoogle Scholar
10 Schloss, MD, Tan, AK, Schloss, B, Tewfik, TL. Outpatient tonsillectomy and adenoidectomy: complications and recommendations. Int J Pediatr Otorhinolaryngol 1994;30:115–2210.1016/0165-5876(94)90194-5CrossRefGoogle ScholarPubMed
11 Liboon, J, Funkhouser, W, Terris, DJ. A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg 1997;116:379–8510.1016/S0194-5998(97)70277-8Google ScholarPubMed
12 Hultcrantz, E, Linder, A, Markstrom, A. Tonsillectomy or tonsillotomy? – A randomized study comparing postoperative pain and long-term effects. Int J Pediatr Otorhinolaryngol 1999;51:171–610.1016/S0165-5876(99)00274-8CrossRefGoogle ScholarPubMed
13 Unkel, C, Lehnerdt, G, Schmitz, KJ, Jahnke, K. Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: a retrospective review. Int J Pediatr Otorhinolaryngol 2005;69:1615–20CrossRefGoogle ScholarPubMed
14 Hall, DJ, Littlefield, PD, Birkmire-Peters, DP, Holtel, MR. Radiofrequency ablation versus electrocautery in tonsillectomy. Otolaryngol Head Neck Surg 2004;130:300–510.1016/j.otohns.2003.09.024CrossRefGoogle ScholarPubMed
15 Wexler, DB. Recovery after tonsillectomy: electrodissection vs sharp dissection techniques. Otolaryngol Head Neck Surg 1996;114:576–8110.1016/S0194-5998(96)70249-8CrossRefGoogle ScholarPubMed
16 Temple, RH, Timms, MS. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195–810.1016/S0165-5876(01)00553-5CrossRefGoogle ScholarPubMed
17 Shah, UK, Galinkin, J, Chiavacci, R, Briggs, M. Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Arch Otolaryngol Head Neck Surg 2002;128:672–610.1001/archotol.128.6.672CrossRefGoogle ScholarPubMed
18 Stoker, KE, Don, DM, Kang, DR, Haupert, MS, Magit, A, Madgy, DN. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg 2004;130:666–7510.1016/j.otohns.2004.02.012CrossRefGoogle ScholarPubMed
19 Chang, KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005;132:273–8010.1016/j.otohns.2004.11.002CrossRefGoogle ScholarPubMed
20 Tan, AK, Hsu, PP, Eng, SP, Ng, YH, Lu, PK, Tan, SM et al. Coblation vs electrocautery tonsillectomy: postoperative recovery in adults. Otolaryngol Head Neck Surg 2006;135:699–703Google ScholarPubMed
21 Back, L, Paloheimo, M, Ylikoski, J. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study. Arch Otolaryngol Head Neck Surg 2001;127:1106–1210.1001/archotol.127.9.1106CrossRefGoogle ScholarPubMed
22 Philpott, CM, Wild, DC, Mehta, D, Daniel, M, Banerjee, AR. A double-blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post-operative symptoms. Clin Otolaryngol 2005;30:143–810.1111/j.1365-2273.2004.00953.xCrossRefGoogle ScholarPubMed
23 Noon, AP, Hargreaves, S. Increased post-operative haemorrhage seen in adult coblation tonsillectomy. J Laryngol Otol 2003;117:704–610.1258/002221503322334521CrossRefGoogle ScholarPubMed
24 Lowe, D, van der Meulen, J. National Prospective Tonsillectomy Audit. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;364:697–702Google Scholar
25 Windfuhr, JP, Deck, JC, Remmert, S. Hemorrhage following coblation tonsillectomy. Ann Otol Rhinol Laryngol 2005;114:749–5610.1177/000348940511401003CrossRefGoogle ScholarPubMed
26 Lee, KC, Altenau, MM, Barnes, DR, Bernstein, JM, Bikhazi, NB, Brettscheider, FA et al. Incidence of complications for subtotal ionized field ablation of the tonsils. Otolaryngol Head Neck Surg 2002;127:531–8CrossRefGoogle ScholarPubMed
27 Belloso, A, Chidambaram, A, Morar, P, Timms, MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:2010–3CrossRefGoogle ScholarPubMed
28 Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–310.1097/01.mlg.0000150682.62517.0eCrossRefGoogle ScholarPubMed