Coblation<sup>®</sup> intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long‐term follow‐up

Hoey, Andrew W; Foden, Neil; Andreou, Sonia; Noonan, Frances P.; Chowdhury, Anupananda; Greig, Samuel R.; Sproson, Eleanor; Allin, David; Amin, Nikul; Wouters, K.M.A.; Jonas, Nico; Tweedie, D.J.

doi:10.1111/coa.12849

Cited by 39 publications

(52 citation statements)

References 11 publications

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“…Systematic reviews in 2012 and 2015 showed significant improvements in time to return to normal diet and reduction in postoperative readmissions for dehydration and bleeding . The disadvantages are the risk of symptomatic tonsil regrowth (rates between 2 and 13%) and recurrent tonsillitis, both of which may lead to the need for revision surgery.…”

Section: What Does a Tonsillectomy Involve?mentioning

confidence: 99%

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Current perspectives on the role of tonsillectomy

Greig

2017

J Paediatrics Child Health

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Tonsillectomy is one of the most common paediatric surgical procedures performed in Australasia. The aim of this paper is to provide an up-to-date review of the indications for the procedure (and the evidence base for each of these indications), as well as describe the surgical technique and perioperative management and risks for a non-surgical audience. The primary indications for tonsillectomy are obstructive sleep apnoea (OSA) (where it is most commonly performed in association with adenoidectomy) and recurrent pharyngotonsillitis. There is now high-quality evidence that tonsillectomy improves objective measures of OSA on sleep studies, as well as quality of life and child behaviour. The impact of surgery on cognitive function is less well delineated. For recurrent pharyngotonsillitis, tonsillectomy has a modest impact on recurrent sore throat symptoms - clinicians should ensure an appropriate pre-operative observation period and adequately discuss the potential benefits with parents prior to surgery. Traditional approaches to tonsillectomy involve surgically dissecting the entire tonsil from the underlying pharyngeal muscle. Subtotal tonsillectomy (intracapsular tonsillectomy or tonsillotomy) is described for OSA and may reduce perioperative morbidity. Children younger than 3 years and those with moderate to severe OSA or significant comorbidities should be admitted for overnight observation. Simple analgesia is adequate for most patients postoperatively. Codeine is contraindicated due to reports of postoperative death due to respiratory suppression. Overall, tonsillectomy is a well-tolerated procedure, with pain and postoperative haemorrhage (2-4%) being the most common complications. Haemorrhage can be life threatening; however, the mortality rate remains very small at approximately 1:30 000.

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Section: What Does a Tonsillectomy Involve?mentioning

confidence: 99%

“…Tonsil capsule preserved, with variable amount of denatured tonsil tissue remaining, and no exposed pharyngeal muscle …”

Section: What Does a Tonsillectomy Involve?mentioning

confidence: 99%

Current perspectives on the role of tonsillectomy

Greig

2017

J Paediatrics Child Health

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“…18 A 'long-term prospective study' on 500 paediatric patients undergoing coblation subtotal tonsil reduction tonsillotomy revealed only 2.4% underwent revision tonsil surgery but on closer examination, the mean follow-up was only 7.4 months. 23 While our study was not designed to identify tonsil regrowth or the need for revision surgery, the use of an electronic medical record allows us to look beyond the cut-off period utilized for our primary goals. As of May 2020, an identical figure of 2.4% (n = 8) of our subtotal tonsil reduction cohort have undergone completion tonsillectomy, all for recurrent tonsillitis in the tonsil remnant.…”

Section: Discussionmentioning

confidence: 99%

Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10‐year consecutive, single surgeon series

Attard

Carney

2020

ANZ Journal of Surgery

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Background: Subtotal tonsil surgery (tonsillotomy) remains a controversial procedure. We aimed to document bleeding rates and return to normal activity for total versus subtotal tonsil surgery in the paediatric population. Methods: A 10-year cohort of 608 children from a single-surgeon series was analysed. Bleeding events were classified using the Flinders modification of the Stammberger criteria. Return to normal activity was defined as normal diet and return to childcare/school. Results: A total of 8.3% of tonsil procedures and a subtotal of 1.8% of procedures had some kind of bleeding episode (P < 0.01; odds ratio 3.2; 95% confidence interval (CI) 1.3-7.6). When bloodstained sputum (type A bleed) was excluded, this dropped to 2.5% versus 0.3%, respectively (P < 0.05; odds ratio 8.5; 95% CI 1.2-96.0). Return to normal activities occurred at a mean of 11.1 (95% CI 9.7-12.5) versus 4.6 (95% CI 4.0-5.3) days, respectively (P < 0.0001). Conclusion: In this 10-year single surgeon series, subtotal tonsillectomy or 'tonsillotomy' was associated with a significant reduction in both prevalence and severity of bleeding, in addition to a more rapid return to normal activities when compared to total tonsillectomy.

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“…Si se utilizan elementos generadores de calor como el cauterio monopolar, se produce una agresión tisular con la corriente generada de aproximadamente 400 a 600 °C que prolonga bastante el tiempo de cicatrización. Cuando se utiliza la radiofrecuencia, la temperatura es ostensiblemente menor en un rango de 40-50 °C, lo que provoca una menor lesión y, por ende, una recuperación más temprana (5).…”

Section: Introductionunclassified

Recubrimiento del lecho amigdalino en amigdalectomia intracapsular. Reporte de técnica quirúrgica

Pérez¹

2020

Acta otorrinolaringol cir cabeza cuello

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Resumen: El recubrimiento del lecho amigdalino se trata de un procedimiento coadyuvante y sencillo ya descrito por varios autores con diferencias en la técnica que nos ocupa unos cuantos minutos más en la cirugía amigdalina tradicional pero que representa en la experiencia de muchos, un aporte para la pronta cicatrización y recuperación de los pacientes sometidos a esta cirugía que se realiza desde tiempos inmemoriales pero que encarna un posoperatorio particularmente molesto por cuenta del dolor en los días siguientes. Es nuestro reto y responsabilidad el alivio del dolor posoperatorio y la prevención de las complicaciones principalmente relacionadas con sangrado. La intención de este artículo es proponer en nuestra práctica diaria cuando realizamos amigdalectomias, una técnica complementaria que mejorará las condiciones de un periodo posoperatorio con menor dolor y una más rápida recuperación. Se busca el recubrimiento de la zona operada con el remanente de la mucosa de la capsula amigdalina protegiendo la musculatura del lecho.

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Coblation^® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long‐term follow‐up

Abstract: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Cited by 39 publications

References 11 publications

Current perspectives on the role of tonsillectomy

Current perspectives on the role of tonsillectomy

Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10‐year consecutive, single surgeon series

Recubrimiento del lecho amigdalino en amigdalectomia intracapsular. Reporte de técnica quirúrgica

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Coblation® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long‐term follow‐up

Abstract: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Cited by 39 publications

References 11 publications

Current perspectives on the role of tonsillectomy

Current perspectives on the role of tonsillectomy

Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10‐year consecutive, single surgeon series

Recubrimiento del lecho amigdalino en amigdalectomia intracapsular. Reporte de técnica quirúrgica

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Coblation^® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long‐term follow‐up