Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

Abstract

ObjectivesCoblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies.MethodsEighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked.ResultsPostoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups.ConclusionOnly cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.

The utility of common surgical instruments for pediatric adenotonsillectomy

“…Postoperative adenotonsillectomy hemorrhage is a feared complication and has a reported occurrence ranging from 2.7% to 15.9% . Postoperative hemorrhage has also been examined in many studies comparing monopolar cautery and radiofrequency ablation, but few to none have included PlasmaBlade analysis . Hong and colleagues compared monopolar cautery to radiofrequency ablation regarding primary and secondary hemorrhage rates and reported no significant difference .…”

“…However, one study suggested increased postoperative pain secondary to the high continuous thermal energy (400°C to 600°C) used for dissection . Regarding the rate of postoperative hemorrhage, studies are largely contradictory without clear consensus . Furthermore, some suggest monopolar cautery dissection increases operative time when compared to cold dissection …”

“…4 Regarding the rate of postoperative hemorrhage, studies are largely contradictory without clear consensus. 5 Furthermore, some suggest monopolar cautery dissection increases operative time when compared to cold dissection. 3 Alternatively, bipolar radiofrequency ablation (coblation) significantly limits thermal heat to 40 C to 70 C through the use of irrigating saline and its bipolar component, providing a theoretical decrease in collateral tissue damage.…”

Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience

“…In most of the literature we consulted this rate is between 1% and 5%. 11,12 According to the aforementioned study by Blakley, we are within a range in our hospital which, although not optimal, is acceptable (between 5% and 13.9%). 10 The data provided by the National Prospective Tonsillectomy Audit, show that the rate of haemorrhage varies considerably according to the surgical technique used.…”

“…12 In the study performed by Gallaher et al which compared the onset of postoperative bleeding in 4776 patients, after dissection techniques using electrocautery, coblator and microdebrider, a haemorrhage rate of 1.7% was observed; the most frequent being after electrocautery (1.9%). 1 Comparing dissection by electrocautery and cold dissection, it can be concluded from the study performed by Lee et al 13 that, out of 337 patients, the postoperative bleed rate in adults operated using electrocautery was 12%, compared with those operated using cold dissection (5.5%).…”