CO₂-Lasertonsillotomy Under Local Anesthesia in Adults

Abstract

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO 2 -lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO 2 -lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO 2 -lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

Time to Functional Recovery After Laser Tonsillotomy Performed Under Local Anesthesia vs Conventional Tonsillectomy With General Anesthesia Among Adults

“…Patients were advised to slowly reduce their gag reflex by touching their tongue base and tonsils with a tooth brush each time they brushed their teeth. This method has been previously shown to reduce the gag reflex intensity in most patients within 2 weeks …”

“…In case of bleeding, coagulation was accomplished by pulling the laser out of focus. A step-by-step video protocol of this intervention has been published previously …”

“…Partial removal of the tonsil, tonsillotomy, has been performed for 3000 years and is increasingly being reexplored to potentially decrease patient burden and risk . During tonsillotomy, only the cryptic lymphatic tissue is removed, and the tonsil capsule that contains larger nerves and blood vessels is left intact . This may lead to less postoperative pain and bleeding .…”

“…This may lead to less postoperative pain and bleeding . Tonsillotomy may be performed in adults using different instruments and techniques, including the use of carbon dioxide (CO 2 ) laser, diathermy, radiofrequency, microdebrider, coblation, bipolar electrosurgical device, and cold steel dissection …”

“…The CO 2 laser is the most used laser modality in tonsillotomy and is known for its good ablation and hemorrhage-controlling characteristics . An advantage of the CO 2 laser is its ability to perform tonsillotomy under local anesthesia without sedation . General anesthesia has additional effects on postoperative and functional recovery, and obviating the need for general anesthesia may provide additional recovery benefit over tonsillectomy .…”