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Tonsillectomy

Coblation Tonsillectomy

Coblation^® Tonsillectomy can greatly improve your patients' postoperative experience. The device used in this procedure is the EVac Xtra, PROcise XP, or the PROcise EZ Plasma Wand. The procedure is performed in a dry field and the Wand(s) can be used to either totally remove the tonsils via dissection for a tonsillectomy or to perform a partial intracapsular tonsillectomy.

Studies published in peer-reviewed journals have shown Coblation Tonsillectomy to have the following patient benefits in comparison to conventional electrocautery tonsillectomy:

• Significantly less pain and less frequent use of narcotics
• Significantly faster return to normal diet (2.4 days vs. 7.6 days on average)
• Less incidence of postoperative nausea and throat swelling
• Less depth of thermal adjacent tissue necrosis
• Less postoperative dehydration

References

• Glade RS, Pearson SE, Zalzal GH, Choi SS. Coblation adenotonsillectomy: an improvement over electrocautery technique? Otolaryngol Head Neck Surg. 2006 May; 134(5):852-5
• Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN. Pediatric total tonsillectomy using coblation electrosurgery compared to conventional electrosurgery: A prospective, controlled single-blind study. Otolaryngology, Head and Neck Surgery. 2004; 130 (6): 666-675.
• Temple RH, Timms MS. Paediatric Coblation Tonsillectomy. International Journal of Pediatric Otorhinolaryngology, 2001; 61: 195-198.
• Chinpairoj S, Feldman M, et al. A comparison of monopolar
  electrosurgery to a new multipolar electrosurgical system in a rat model. Laryngoscope 2001; 111; 213-217.

Clinical Information

The following is a partial list of published journal articles and white papers, and presented abstracts on Coblation^® Tonsillectomy.

1. Glade RS, Pearson SE, Zalzal GH, Choi SS. Coblation adenotonsillectomy: an improvement over electrocautery technique? Otolaryngol Head Neck Surg. 2006 May; 134 (5): 852-5.

   This paper compares postoperative complication rates of Coblation and electrocautery adenotonsillectomies. The authors found that Coblation tonsillectomy had similar rates of primary and secondary hemorrhage when compared with electrocautery tonsillectomy but a lower incidence of postoperative dehydration. Also, Coblation adenoidectomy caused less postoperative neck pain than curette/cautery adenoidectomy without significant advantage over cautery adenoidectomy.

2. Parsons S, Cordes S, Comer, B. Comparison of Post-tonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery. Otolaryngol Head Neck Surg. 2006; 134: 106-113.

   The objective of this study was to compare postoperative tonsillectomy pain between the Harmonic Scalpel (HS), Coblator, and Electrocautery. A prospective, randomized trial was performed enrolling 134 patients, who were randomized to receive a tonsillectomy with 1 of the 3 devices.

   The three groups did not differ statistically with regards to age, gender, indication for surgery, and return rate of the pain diary, estimated blood loss, and delayed postoperative bleeding. Statistically significant differences in pain scores were found between Coblation and electrocautery and between Coblation and HS with Coblation patients having lower pain scores. Coblation patients showed a trend toward quicker return to normal diet.

3. Clark MP, Smithard A, Jervis P. How we do it: Coblation tonsillectomy complication rates from a single ENT department compared with the National Prospective Tonsillectomy Audit. Clin Otolaryngol. 2006 Apr; 31 (2): 156-9.

   The purpose of the study was to conduct an audit to analyze the rebleed rates following Coblation tonsillectomy and compare the outcomes to the UK National Prospective Tonsillectomy Audit.

   A retrospective audit of 391 Coblation tonsillectomies showed that the authors postoperative bleed rates and return to operating room rates were similar to the National Prospective Tonsillectomy Audit rates for cold steel and ties data.

4. Lee KC, Dolitsky J, White A, Younis RT, Mansfield E, Hinchcliffe A. Surgical advances in tonsillectomy: Round table discussion. ENT Journal. September 2004.

   Participants discussed clinical pearls, advantages, and disadvantages of using the harmonic scalpel, the powered tissue microdebrider, and the Coblation devices for both total and subtotal tonsillectomy.

5. Divi V, Benninger M. Postoperative tonsillectomy bleed: Coblation versus Non-coblation. Laryngoscope. 2004; 115: 31-33.

   This study examined the incidence of postoperative bleeding after Coblation and Non-Coblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with Coblation.

   There was no statistical difference between bleeds rates for Coblation versus Non-Coblation tonsillectomy techniques. The postoperative Coblation bleed rates for the 3-month periods did not reveal an increasing or decreasing trend in the postoperative bleed rate.

6. Chan KH, Friedman NR, Allen GC, Yaremchuk K, Wirtschafter A, Bikhazi N, Bernstein JM, Kelley PE, Lee KC. Randomized, controlled, multisite study of intracapsular tonsillectomy using low-temperature plasma excision. Arch Otolaryngol Head Neck Surg. 2004; 130: 1303-1307.

   This study determined the efficacy of Coblation intracapsular tonsillectomy using Coblation for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively.

   Postoperative morbidity normally associated with traditional tonsillectomy was significantly reduced after Coblation intracapsular tonsillectomy. The residual tonsillar tissue associated with the Coblation technique was of no clinical consequence through one year postoperatively.

7. Hall DJ, Littlefield PD, Birkmire-Peters DP, Holtel MR. Radiofrequency ablation versus electrocautery in tonsillectomy. Otolaryngol Head Neck Surg. 2004; 130: 300-305.

   This study compared the safety, difficulty of removal, and postoperative pain profile of Coblation versus electrocautery tonsillectomy.

   Coblation was found to be a safe method to remove tonsils. There was significantly less pain reported with Coblation as compared to electrocautery tonsillectomy.

8. Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN. Pediatric total tonsillectomy using coblation electrosurgery compared to conventional electrosurgery: A prospective, controlled single-blind study. Otolaryngol Head Neck Surg. 2004; 130 (6): 666-675.

   This study compared the postoperative recovery of Coblation tonsillectomy versus electrocautery tonsillectomy.

   The results showed children who received Coblation experienced a better quality postoperative course.

9. Timms MS. Coblation tonsillectomy: A personal view. ENT News. 2004.

   The author shares his personal clinical experience using Coblation as a surgical tool for tonsillectomy over the last four years. He reported that Coblation resulted in reduced postoperative pain and fewer secondary bleeding events.

10. Patel J, Mandal S, Rachmanidou A. Paediatric coblation tonsillectomy versus dissection tonsillectomy: a comparative study of post-operative pain and complications. Int J Pediatr Otorhinolaryngol. 2004; 68 (5): 725.

    This paper evaluates the incidence of post-op complications, including pain following Coblation tonsillectomy versus the conventional sharp dissection/diathermy methods. The authors found that Coblation patients had significantly fewer rates of both primary and secondary bleeds and reduced rates of post-operative vomiting. There was a statistically significant reduction in reported pain levels found on day 3, in the Coblation group. The paper concluded that Coblation tonsillectomy offers significant advantages in the postoperative period, with rapid return to normal diet and a reduction in analgesic requirements following the surgery. It also concluded that Coblation is associated with less post-op pain and reduced rates of hemorrhage.

11. Belloso A, Chidambaram A, Morar P, Timms MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope. 2003; 113: 2010-2013.

    The authors compared Coblation tonsillectomy to blunt dissection tonsillectomy and attempted to identify the differences in primary and secondary hemorrhage rates.

    Coblation tonsillectomy was found to be associated with significantly lower incidence of delayed hemorrhage than conventional blunt dissection with bipolar diathermy hemostasis (sample size, n=1587).

12. Lee KC, Altenau MM, Barnes DR, Bernstein JM, Bikhazi NB, Brettscheider FA, Caplan CH, Ditkowsky WA, Ingber CF, Klausner LM, Moghaddassi MM. Incidence of complications for subtotal ionized field ablation of the tonsils. Otolaryngol Head Neck Surg. 2002; 127: 531-538.

    The authors reviewed the incidence of complications in patients who received Coblation subtotal tonsillectomy.

    Coblation subtotal tonsillectomy may offer an alternative to traditional subtotal tonsillectomy procedures with a decreased incidence of postoperative complications.

13. Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol. 2002; 116: 450-452.

    This study compared the postoperative outcomes in Coblation tonsillectomy versus bipolar dissection tonsillectomy.

    Significant benefits in postoperative pain levels and rates of healing were demonstrated following Coblation tonsillectomy.

14. Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol. 2001; 61: 195-198.

    This study compared the difference in postoperative pain, tonsillar fossae healing, and return to a normal diet by using Coblation compared to bipolar dissection tonsillectomy.

    The authors concluded that Coblation offers significant advantages in the postoperative period such as more rapid return to normal diet and drastic reduction in analgesic requirements when compared to conventional surgical techniques.

15. Arya AK. Double-Blind Randomized Controlled Study of Coblation Tonsillotomy versus Coblation Tonsillectomy on Postoperative Pain in Children. Clin Otolaryngol. 2005; 30: 226-229.

    The objective of this study was to compare the postoperative pain between tonsillectomy and intracapsular tonsillectomy with Coblation in children. There was no demonstrable difference between tonsillectomy techniques when measuring pain experienced by children in the 24-hour postoperative period.

16. Friedman M. LoSavio P. Ibrahim H. Ramakrishnan V. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope. 2003; 113: 882-887.

    The objective of this study was to evaluate the safety, morbidity, and efficacy of Coblation tonsil channeling (in the office), Coblation subtotal tonsillectomy, and cold dissection tonsillectomy. Nonrandomized retrospective review of 150 patients divided into three groups based on surgical technique: Coblation tonsil channeling, Coblation subtotal tonsillectomy, and cold dissection tonsillectomy.

    Both Coblation procedures were found to be safe, and no intra-operative or postoperative complications occurred. There was no postoperative bleeding in any cases. The advantages of Coblation tonsil reduction included less postoperative pain and earlier resumption of normal diet and normal activity levels.

17. National Prospective Tonsillectomy Audit: Tonsillectomy technique as a risk factor for postoperative hemorrhage. Lancet. 2004; 364: 697-702.

    The authors obtained data for the occurrence of complications after all tonsillectomies done since July 2003 in England and Northern Ireland. They recorded post-op bleeds and other complications taking place within 28 days of surgery that led to delayed discharge return to the operating room or readmission.

    The risk of postoperative hemorrhage after electrocautery tonsillectomy or cold steel with an electrosurgical hemostasis technique was significantly higher than that for patients who received tonsillectomy using cold steel alone (with pack and ties for haemorrhage). Postoperative hemorrhage rates in this cohort ranged between 1% for cold steel alone to 6% for monopolar diathermy forceps.

18. N Polites, S Joniau, D Wabnitz, R Fassina, C Smythe, P Varely, S Carney. Postoperative Pain following Coblation Tonsillectomy: Randomized clinical trial. ANZ J Surg. 2006; 76: 226–229.

    This study was designed to compare postoperative pain after tonsillectomy using Coblation and tonsillectomy using cold steel dissection with bipolar diathermy technique. Twenty adult patients underwent tonsillectomy, each having one randomly selected tonsil removed by dissection and the other removed by Coblation.

    Coblation tonsillectomy was significantly less painful than dissection tonsillectomy on day 1 and day 3. Coblation tonsillectomy caused significantly less pain during the first three post-op days, when compared with cold dissection tonsillectomy. No demonstrable benefit was shown on days 4–10. The beneficial effects of Coblation on early postoperative pain make it a potentially attractive technique for day-case tonsillectomy in adults with recurrent or chronic tonsillitis.

19. A Grobler, Carney S. Radiofrequency Coblation tonsillectomy. British J Hospital Medicine. 2006; 67 (6): 309-312.

    The authors of this paper reviewed the use and benefits of Coblation for tonsillectomy. Coblation tonsillectomy was found to cause less collateral tissue damage as a result of the low temperatures used compared with other electrosurgical methods. Lower post-op pain scores were also found with Coblation resulting in earlier return to normal activities with potential quality of life and economic benefits.

20. N Shapiro, N Bhattacharyya. Cold Knife Tonsillectomy versus Coblation Assisted Tonsillectomy in Children. This study compared intra- and post-op courses of 47 children undergoing either cold knife tonsillectomy (CKT) or Coblation tonsillectomy (CAT).

    The mean tonsillectomy and adenoidectomy operating time was shorter for Coblation. Intra-operative blood loss was also significantly less in CAT vs. CKT patients. The present study revealed that Coblation tonsillectomy and CKT are both safe and effective techniques for pediatric tonsillectomy, demonstrating excellent recovery rates with minimal complications, compared to electrocautery techniques.

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