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Table of Contents
ORGINAL ARTICLE
Year : 2009  |  Volume : 11  |  Issue : 1  |  Page : 12-15

Coblation Versus Cold Steel Dissection Tonsillectomy


1 Consultant and Head of the Department, E.N.T. Department, Dubai Hospital, United Arab Emirates
2 Senior Specialist Registrar, E.N.T. Department, Dubai Hospital, United Arab Emirates
3 Specialist Registrar, E.N.T. Department, Dubai Hospital, United Arab Emirates

Date of Web Publication7-Jan-2020

Correspondence Address:
Hussein Abdul Rehman Facharzt
Consultant and Head of ENT Department, Dubai Hospital, P O Box 7272, Dubai
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.275319

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  Abstract 


Objectives: To evaluate the benefits of coblation against blunt dissection (cold steel) tonsillectomy with bipolar diathermy haemostasis. Comparison was done regarding postoperative bleeding, pain and healing of tonsillar fossae.
Materials and Methods: In this prospective study, a comparison between 100 coblation tonsillectomies with 100 blunt dissection tonsillectomies was done.
Results: Favorable outcome was demonstrated regarding the postoperative pain and healing of tonsillar fossae with no significant changes noted in the postoperative bleeding rate when using the coblation technique.
Conclusion: Coblation tonsillectomy is a safe procedure with less postoperative pain and better healing of tonsillar fossae than blunt dissection tonsil- lectomy but the cost of the disposable hand pieces should be considered.

Keywords: coblation, tonsillectomy, blunt, dissection, diathermy


How to cite this article:
Rehman Facharzt HA, Jaffar FA, Mustafa K, Y Mohamed HA. Coblation Versus Cold Steel Dissection Tonsillectomy. Saudi J Otorhinolaryngol Head Neck Surg 2009;11:12-5

How to cite this URL:
Rehman Facharzt HA, Jaffar FA, Mustafa K, Y Mohamed HA. Coblation Versus Cold Steel Dissection Tonsillectomy. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2009 [cited 2022 Dec 4];11:12-5. Available from: https://www.sjohns.org/text.asp?2009/11/1/12/275319




  Introduction: Top


Tonsillectomy is one of the most commonly performed surgical procedures in the head and neck region. Multiple surgical techniques have been described and diverse instruments have evolved for this purpose [1]. Over the past decades, the described techniques included blunt dissection, guillotine excision, cryosurgery, monopolar and bipolar dissection, bipolar scissor dissection, ultrasonic scalpel tonsillectomy, laser dissection and the latest addition of coblation tonsillectomy [2],[3],[4]. All these techniques have advantages and disadvantages and debate about the optimal surgical technique for tonsillectomy continues in the literature [5]. Multiple parameters are described to compare the different surgical techniques and these include operative blood loss, operative time, postoperative pain, primary hemorrhage [within the first 24 hours], secondary hemorrhage [more than 24 hours] [6],[7],[8],[9], and return to normal diet and activities .

Coblation [cold ablation] is a new technique. Recently the use of this technique in the treatment of snoring, nasal congestion and sleep apnea has received considerable research interest [10],[11]. The system involves passing a radio frequency bipolar electrical current, at a much lower frequency than standard bipolar diathermy, through a medium of normal saline which results in the production of plasma field of sodium ions. These ions are able to breakdown intercellular bonds and in effect vaporize tissue at a temperature of only 40-700 Celsius compared to standard electrosurgery where a temperature of 400-6000 Celsius is reached [12]. The presence of irrigating saline helps to limit the amount of heat delivered to surrounding structures and hence reduces the amount of postoperative pain experienced by the patient. Coblation is a bipolar system and therefore requires no ground pads.

The standard technique used for tonsillectomy in our department is blunt dissection with bipolar diathermy haemostasis .Aim of the study was to compare our standard technique with a new technique [coblation tonsillectomy] regarding postoperative pain, bleeding and healing of tonsillar fossae.


  Materials and Methods: Top


This prospective study was conducted over 8-month period in which two hundred pediatric patients participated. All patients were children on the waiting list for routine elective tonsillectomy with history of chronic tonsillitis or obstructive tonsils. Approval of the hospital ethical committee was obtained. During the booking procedure for surgery, the nature of each technique was explained to parents, consent was signed and the child listed for surgery considering the parents’ choice. They were listed into 2 groups. Group [1] consisted of 100 patients who underwent the standard technique used in the hospital [blunt dissection tonsillectomy with bipolar diathermy for haemostasis]. The remaining 100 patients group [2], had coblation tonsillectomy. Postoperative follow up was done by a surgeon who was not involved in the surgery. The majority of patients also underwent adenoidectomy performed using adenoid curette during the same surgical procedure. Coblation tonsillectomy was performed using an Arthrocare Evac70 Arthro Wand [ArthroCare. Sunnyvale, California] [Figure 1]. Patients with history of bleeding disorder, quinsy, acute tonsillitis within the past 3 weeks or other past medical history were excluded from the study. Surgeons were filled in to allow collection of information regarding patient age, gender, and method of dissection (blunt dissection/coblation) and that of haemostasis (diathermy/coblation). All patients were discharged home on the second day after surgery and treated with therapeutic doses of paracetamol as analgesic and amoxycillin/clavulinic acid as prophylactic antibiotic. Parents were given a daily questionnaire to fill in for 10 days post operatively. The questionnaire included information regarding the severity of pain assessed by visual analogue pain score [on a scale of 1-10], any postoperative bleeding, and return to normal diet as well as any other symptoms. They were followed up in the outpatient department on the 10th postoperative day and were adviced to attend the emergency department if there was any postoperative bleeding. Throat examination findings were recorded and the questionnaire collected. Comparison of rate of postoperative bleeding, pain score for each day and the examination finding from the throat was done and the results were statistically analyzed using student’s t-test. Statistical significance was accepted for P value less than 0.05.
Figure 1: End result of coblation tonsillectomy

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  Results Top


One hundred children (52 females and 48 males) with mean age of 6.3 ± 3.7 underwent coblation tonsillectomy and the same number (56 females and 44 males) with mean age of 6.1 ± 3.5 underwent blunt dissection tonsillectomy with bipolar diathermy for haemostasis. Rate of primary bleeding was 3% (3 cases) in the coblation group with 1% (1case) returned to operating theater. In the blunt dissection group, the rate of primary bleeding was 2% (2 cases) with 1% (1 case) returning to the operating theater. These values in primary bleeding showed no significant difference between coblation and blunt dissection groups.

Rate of secondary bleeding was 6% (6cases) in the coblation group with 2% (2cases) returning to operating theater; while the rate of secondary bleeding in blunt dissection group was 11% (11cases) with 3% (3cases) returning to operating theater. These values showed no significant difference between coblation and blunt dissection group (P value= 0.206). Comparison of post operative bleeding is shown in [Figure 2]. Regarding postoperative pain, both groups showed an initial rise in mean pain score with day 1 being the most painful in coblation group and day 5 in blunt dissection group. In the coblation group there was a more rapid return to low pain score than blunt dissection group. The difference in daily mean pain score was statistically significant (P value was less than 0.0001). Comparison of daily mean pain score is shown in [Figure 3]. Throat examination at 10th postoperative day revealed complete healing of tonsillar fossae in 87% (87cases) of coblation group. Complete healing of tonsillar fossae was found in 13% (13cases) of blunt dissection group. This difference in healing of tonsillar fossae for both groups was statistically significant (P value =0.0000). Healing of tonsillar fossae is shown in [Table 1].
Figure 2: Comparison of post-operative bleeding

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Figure 3: Comparison of daily mean pain score.

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Table 1: Comparison of healing in tonsillr Fossae

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  Discussion: Top


Coblation technique was first developed by ArthroCare (Sunnyvale, California) and was originally designed for cartilage repair during arthroscopic surgery [12]. It is a newly introduced technique in the field of otolaryngology, used for a number of different procedures including sleep surgery [13], turbinate reduction [14], & tonsillectomy [3]. Coblation tonsillectomy was evaluated by a number of studies. Timms & Temple [15] demonstrated that patients who had coblation tonsillectomy complained of less postoperative pain & had more rapid healing of tonsillar fossae when compared with a routine bipolar technique and this is consistent with our results. Divi & Benninger [16] found no significant difference in postoperative bleeding with the coblation technique versus non-coblation one; this is consistent with our results. On the other hand, Bellosa et al [17] demonstrated reduced incidence of postoperative bleeding for coblation tonsillectomy. Any postoperative bleeding is significant but those requiring operative intervention are more serious. In the present study there was no difference in return to theatre due to bleeding between the two groups and this demonstrates the relative safety of coblation when compared with routinely used blunt dissection tonsillectomy. Chinpairoj et al [18] made a study on rats and compared tongue incision using coblation with electro-cautery. They have shown that coblation dissection has advantages over electrocautery in terms of minimal tissue damage and faster healing in the first 2 weeks following the incision.

The cost of coblation machine may seem reasonable, but the cost of disposable hand pieces may put a major burden on a busy otolaryngology department conducting one of the commonest ENT procedures.


  Conclusion: Top


This study was conducted to evaluate the benefits of coblation tonsillectomy verses blunt dissection method. Significant benefits have been demonstrated regarding the postoperative pain and healing of tonsillar fossae without any significant changes regarding the postoperative bleeding using coblation tonsillectomy. Cost effectiveness of this new tool requires some attention in view of the costly disposable hand pieces.



 
  References Top

1.
Younis RT, Lazar RH. History and current practice of tonsillectomy. Laryngoscope 2002; 112:3-5.  Back to cited text no. 1
    
2.
Back L, Paloheimo M, Ylikoski J. Traditional tonsillectomy compared with bipolar radio frequency thermal ablation tonsillectomy: Apilot study. Arch Otolaryngol Head Neck Surg 2001; 127: 1106-12.  Back to cited text no. 2
    
3.
Temple RH, Timms MS. Pediatric coblation tonsillectomy. Int J Paediatr Otorhinolaryngol 2001; 61: 195-8.  Back to cited text no. 3
    
4.
Fenton RS, Long J. Ultrasonic tonsillectomy. J Otolaryngol 2000; 29: 384-50.  Back to cited text no. 4
    
5.
Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E.A. Comparison of micro bipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Paediatr Otorhinolaryngol 2000; 52: 239-46.  Back to cited text no. 5
    
6.
Blomgren K, Qvarnberg YH, Voltonin HJ. A prospective study on pros and cons of electro dissection tonsillectomy. Laryngoscope 2001; 111: 478-82.  Back to cited text no. 6
    
7.
Raut V, Bhat N, Kinsella J, Toner JG, Sinnathuray AR, Stevenson M. Bipolar scissors versus cold dissection tonsil-lectomy: A prospective randomized multiunit study. Laryngoscope 2001; 111: 2178-82.  Back to cited text no. 7
    
8.
Maddern BR. Electro surgery for tonsillectomy. Laryngoscope 2002; 112: 11-13.  Back to cited text no. 8
    
9.
Johnson LB, Elluru RG, Myer III CM. Complications of Aden tonsillectomy. Laryngoscope 2002; 112: 11-13.  Back to cited text no. 9
    
10.
Madani M. Radio frequency somnoplasty: A new treatment for snoring and sleep apnea. Int J. Oral Maxillofac. Surg 1999; 1: 108-9.  Back to cited text no. 10
    
11.
Nelson B, Powell MD. Laboratory and animal investigations, Radio frequency volumetric reduction of the tongue, Chest 1997; 111: 108-9.  Back to cited text no. 11
    
12.
Carroll M, Ladner K, Meyers A.Alternative Surgical Dissection Techniques. Otolaryngol Clin North America 2005; 38: 397-411.  Back to cited text no. 12
    
13.
Rombaux P, Hamoir M, Bertrand B, Aubert G, Liistro G, Rodenstein D. Postoperative pain and side effects after uvulopalatopharyngoplasty, Laser assisted uvulopalatoplasty, and radio frequency tissue volume reduction in primary snoring. Laryngoscope 2003; 113: 2169-73.  Back to cited text no. 13
    
14.
Back L, Hytonen M, Malmberg H. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: A long-term follow-up with subjective and objective assessment. Laryngoscope 2002; 112: 1806-12.  Back to cited text no. 14
    
15.
Timms MS, Temple RH. Coblation tonsillectomy. J Laryngo Otol 2002; 116: 450-52.  Back to cited text no. 15
    
16.
Belloso A, Chindambaram A, Morar P, Timms MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative haemorrhage. Laryngoscope 2003; 113: 20102013.  Back to cited text no. 16
    
17.
Divi V, Benninger M. Postoperative tonsillectomy bleeds: coblation versus non-coblation. Laryngoscope2005; 115: 31-33.  Back to cited text no. 17
    
18.
Belloso A, Chindambaram A, Morar P, Timms MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative haemorrhage. Laryngoscope 2003; 113: 20102013.  Back to cited text no. 18
    
19.
Chinpairoj S, Feldman MD, Saunders J, Thaler E. A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model. Laryngoscope 2001; 111: 213-17  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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