Intracapsular tonsillectomy versus extracapsular tonsillectomy: a safety comparison

Abstract

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.

A retrospective observational cohort study evaluating the postoperative outcomes of intracapsular coblation tonsillectomy in children

“…In a more recent retrospective study reviewing 730 patients, both adults and pediatrics, the postoperative bleeding was compared between ICT and ECT using the Coblator. Again, a significant decrease in the rate of bleeding was observed in the ICT group (0.3% vs. 2.1%; P = 0.025) 23 .…”

“…This is a significant improvement in the safety of tonsillar surgery. The relation of age to the risk of post-tonsillectomy bleeding is well known in the literature, showing a persistent higher incidence in adults compared to children 2 , whether undergoing ECT or ICT 23 . Looking solely at the pediatric age group, it was previously reported that the older the child, the higher the risk of postoperative bleeding; 1.9% for children < 5 yo, 3.0% for children 5-15 yo, and 4.9% for 16 yo and older 2 , but that was in patients who underwent ECT.…”

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

“…The included studies consisted of 3 RCTs using a with‐in patient design, 29 , 30 , 38 5 RCTs using a between‐patient design, 32 , 33 , 34 , 41 , 45 1 prospective cohort study, 40 and 8 retrospective cohort studies. 31 , 35 , 36 , 37 , 39 , 42 , 43 , 44 Across the 17 studies, a total of 1996 patients underwent CIT. The comparator arms included total tonsillectomy using plasma ablation (9 studies, 29 , 30 , 31 , 34 , 35 , 36 , 40 , 41 , 43 n = 1100), electrocautery (4 studies, 32 , 33 , 38 , 45 n = 155), cold steel (2 studies, 37 , 44 n = 77), electrocautery or plasma ablation (1 study, 42 n = 1800), any nonplasma ablation device (1 study, 35 n = 1216) and nondefined device (1 study, 39 n = 217).…”

“…Eleven studies included pediatric patients, 30 , 31 , 32 , 33 , 34 , 36 , 39 , 40 , 41 , 42 , 44 3 included both adults and pediatric populations, 37 , 43 , 45 2 studies included adult patients, 29 , 38 and 1 did not report on age. 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies.…”

“… 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies. 36 , 38 , 40 , 41 , 42 , 43 , 44 One study determined surgical procedure based on indication, with patients receiving CIT for obstructive indications without a history of recurrent tonsillitis and total tonsillectomy with a history of recurrent tonsillitis. 31 One study did not identify indication for surgery.…”