“…For obstructive indications, evidence exists that intracapsular techniques are not inferior in terms of resolution of obstruction and quality of life 6 . For recurrent acute tonsillitis there is less evidence 15 …”
Objectives
To identify paediatric intracapsular Coblation tonsillectomy procedures from routine administrative data in England, and determine their safety.
Design
Retrospective observational cohort study of four ENT centres using routine data from Hospital Episode Statistics (HES).
Setting
Acute NHS trusts in England conducting exclusively intracapsular Coblation tonsillectomy.
Participants
Children (≤16 years old) undergoing bilateral intracapsular Coblation tonsillectomy.
Main outcome measures
Number of procedures, readmissions for pain, readmissions for bleeding and requirement for additional surgery for regrowth.
Results
A total of 5525 procedures were identified. The median patient age was 4 (IQR 2–5). In‐hospital complications occurred in 1%, with 0.1% returning to theatre for arrest of primary tonsil bleeding. Almost half of the procedures were conducted as a day‐case (44%), with only a small proportion staying in hospital more than one night (7%). Within 28 days, 1.2% of patients were readmitted with bleeding, 0.7% with infection and 0.3% with pain; 0.2% of patients required return to theatre for control of secondary haemorrhage. Longitudinal follow‐up has found that revision tonsil surgery is 0.3% at 1 year (n = 4498), 1.1% at 2 years (n = 2938), 1.7% at 3 years (n = 1781), 1.9% at 4 years (n = 905) and 2.2% at 5 years (n = 305).
Conclusions
Intracapsular coblation tonsillectomy safety outcomes in this study show primary and secondary bleeding rates and emergency return to theatre rates are lower than all tonsillectomy techniques reported in the National Prospective Tonsillectomy Audit and also lower than previously published Hospital Episode Statistics analysis of tonsillectomy procedures.
“…For obstructive indications, evidence exists that intracapsular techniques are not inferior in terms of resolution of obstruction and quality of life 6 . For recurrent acute tonsillitis there is less evidence 15 …”
Objectives
To identify paediatric intracapsular Coblation tonsillectomy procedures from routine administrative data in England, and determine their safety.
Design
Retrospective observational cohort study of four ENT centres using routine data from Hospital Episode Statistics (HES).
Setting
Acute NHS trusts in England conducting exclusively intracapsular Coblation tonsillectomy.
Participants
Children (≤16 years old) undergoing bilateral intracapsular Coblation tonsillectomy.
Main outcome measures
Number of procedures, readmissions for pain, readmissions for bleeding and requirement for additional surgery for regrowth.
Results
A total of 5525 procedures were identified. The median patient age was 4 (IQR 2–5). In‐hospital complications occurred in 1%, with 0.1% returning to theatre for arrest of primary tonsil bleeding. Almost half of the procedures were conducted as a day‐case (44%), with only a small proportion staying in hospital more than one night (7%). Within 28 days, 1.2% of patients were readmitted with bleeding, 0.7% with infection and 0.3% with pain; 0.2% of patients required return to theatre for control of secondary haemorrhage. Longitudinal follow‐up has found that revision tonsil surgery is 0.3% at 1 year (n = 4498), 1.1% at 2 years (n = 2938), 1.7% at 3 years (n = 1781), 1.9% at 4 years (n = 905) and 2.2% at 5 years (n = 305).
Conclusions
Intracapsular coblation tonsillectomy safety outcomes in this study show primary and secondary bleeding rates and emergency return to theatre rates are lower than all tonsillectomy techniques reported in the National Prospective Tonsillectomy Audit and also lower than previously published Hospital Episode Statistics analysis of tonsillectomy procedures.
“…A recent publication evaluating whether intracapsular tonsillectomy could also be considered for recurrent infection in addition to sleep-disordered breathing demonstrated that Coblation TM intracapsular tonsillectomy was a safe and effective technique for both indications in the paediatric population, in addition to lowered mean overall T14 questionnaire and infective scores over a 13-month post-operative follow-up period. 28 In their prospective study of 500 paediatric patients, Hoey and Foden also reported symptomatic improvements with intracapsular tonsillectomy for both obstructive and infective domains that were equivocal to figures published for extracapsular tonsillectomy. 11 Post-operative haemorrhage is a significant complication of traditional extracapsular tonsillectomyIntracapsular tonsillectomy has recently been revisited in an attempt to reduce complicationsThis study compared post-operative haemorrhage rate between extracapsular and intracapsular tonsillectomy proceduresA significant reduction in post-operative haemorrhage rate was observed when changing from extracapsular to intracapsular tonsillectomyThis study has demonstrated Coblation TM intracapsular tonsillectomy to be a safe and effective surgery for all ages and indications…”
Section: Discussionmentioning
confidence: 95%
“…A recent publication evaluating whether intracapsular tonsillectomy could also be considered for recurrent infection in addition to sleep-disordered breathing demonstrated that Coblation TM intracapsular tonsillectomy was a safe and effective technique for both indications in the paediatric population, in addition to lowered mean overall T14 questionnaire and infective scores over a 13-month post-operative follow-up period. 28 In their prospective study of 500 paediatric patients, Hoey and Foden also reported symptomatic improvements with intracapsular tonsillectomy for both obstructive and infective domains that were equivocal to figures published for extracapsular tonsillectomy. With regards to adults, a prospective randomised, controlled trial found extracapsular tonsillectomy and intracapsular tonsillectomy to be equally effective in reducing disease symptoms amongst patients with recurrent or chronic tonsillitis.…”
Objective
Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited.
Method
This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular (n = 379) and intracapsular tonsillectomy (n = 351) across all ages and indications using CoblationTM technology.
Results
A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 vs 0.3 per cent; p = 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage (p = 0.01).
Conclusion
CoblationTM intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.
“…Alguns autores consideram a tonsilotomia como TI, no entanto, há uma diferença: a TI se restringe a remoção até a cápsula, ao contrário da tonsilotomia que pode envolver uma quantidade mais variável de remoção do tecido. Já a tonsilectomia extracapsular remove completamente a tonsila palatina, deixando a musculatura faríngea nua e exposta (VARADHARAJAN K, et al, 2020;PYNNONEN M, et al, 2017).…”
Section: Técnicas Cirúrgicasunclassified
“…A coblação é uma eletrocirurgia de alta frequência, e vem aumentando seu destaque junto com a tonsilectomia intracapsular. Essa técnica tem vantagens, pois disseca o tecido em baixas temperaturas (40ºC a 70ºC em comparação com > 100ºC em eletrocirurgia), preservando a hemostasia (PYNNONEN M, et al, 2017;VARADHARAJAN K, et al, 2020).…”
Objetivo: Destacar o manejo de pacientes pediátricos envolvendo a tonsilectomia e adenoidectomia na otorrinolaringologia. Revisão bibliográfica: Os procedimentos cirúrgicos que envolvem a remoção das tonsilas palatinas e adenóide são frequentes na faixa etária pediátrica. Apesar de serem cirurgias distintas, muitas vezes são realizadas conjuntamente, denominando-se adenotonsilectomia. Dessa forma, suas duas principais indicações são: amigdalite recorrente e distúrbios respiratórios do sono, cujas causas são geradoras de baixo rendimento escolar, irritabilidade e retardo no crescimento infantil. As técnicas cirúrgicas empregadas diferenciam-se entre Tonsilectomia Intracapsular (TI) ou extracapsular, sendo a TI preferível por conta da diminuição de sangramento pós procedimento baseado em atualizações científicas. Dentre essas técnicas, o modo de execução envolve dissecção a frio, dissecção a quente, eletrocirurgia, ressonância molecular quântica e coblação. Considerações finais: A tonsilectomia em associação a adenoidectomia – adenotonsilectomia, caracteriza-se por um procedimento cirúrgico com finalidade de elevar a qualidade de vida da criança através da retirada dessas estruturas. Sendo assim, torna-se necessário investigar as hipertrofias tonsilar ou adenoideana e infecções recorrentes de garganta por conta de serem grandes potencializadoras de problemas de saúde na infância, e dessa forma indicar corretamente as técnicas cirúrgicas para essa população.
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