Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

Alsaif, Abdulmalik; Alazemi, Mohammad; Kahlar, Narvair; Karam, Mohammad; Abul, Ahmad; Al-Naseem, Abdulrahman; Muhanna, Abdulredha Al; Aldrees, Turki

doi:10.1177/0145561321994995

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…Similar to previous studies, 2 , 14 , 16 in the present study the mean operation time was significantly shorter in the monopolar compared to coblation group. Noordzij et al 14 reported that the mean times to remove a single tonsil with coblation and electrocautery were 8.22 and 6.33 min, respectively ( p = .01).…”

Section: Discussionsupporting

confidence: 91%

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A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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Objective: The aim of this study was to compare intraoperative blood loss, postoperative pain, post-tonsillectomy hemorrhage (PTH), and medical costs associated with extracapsular tonsillectomy between coblation and monopolar electrocautery in children. Materials and methods:This study included 293 patients aged 6-15 years planned to undergo extracapsular tonsillectomy. Data on estimated blood loss, postoperative pain score, operation time, PTH, and the cost of disposable equipment were collected.Results: Coblation extracapsular tonsillectomy was associated with significantly lower mean pain scores than monopolar technique on postoperative days 1 (p <.001) and 2 (p = 0.02). However, the pain score was similar between the groups at all other time points. The monopolar group had a significantly shorter operation time compared to the coblation group (11.09 ± 7.53 vs. 17.12 ± 4.29 min, p <.001).Intraoperative estimated blood loss was not significantly different between the groups (p = .43).The cost of extracapsular tonsillectomy was significantly lower in the monopolar compared to the coblation group (US$ 28.18 vs. US$ 430.48, p <.001). PTH occurred in 17 patients (5.80%) and required a second surgery. Secondary PTH occurred in 6.16% (9/146) and 0.68% (1/147) of patients in the coblation and monopolar groups, respectively (p <.001). The PTH was significantly higher in the tonsillitis compared to in the tonsillar hypertrophy (12.37% vs. 2.55%, p = .002), However, the difference of PTH was not significant among mean pain scores subgroups. Of the 17 patients with PTH, the lower pole, middle portion, and upper pole were involved in 15 (88.24%), 2 (11.76%), and 0 cases, respectively.Conclusions: Coblation and novel monopolar electrocautery extracapsular tonsillectomy are associated with similar postoperative pain scores except on postoperative days 1 and 2. However, monopolar technique offers significant advantages over coblation method with less operative time, decreased secondary PTH, and cost.Level of Evidence: NA.

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Section: Discussionsupporting

confidence: 91%

“…These studies included a small sample. In contrast, other studies have reported no advantage 15 , 16 or disadvantage of coblation. 17 , 18 Álvarez Palacios et al 17 compared postoperative pain after cold, monopolar‐bipolar, and coblation dissection techniques.…”

Section: Discussionmentioning

confidence: 71%

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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“…In recent years, surgical instruments of tonsillectomy have improved from the cold knife approach to electrocoagulation and the currently popular coblation method. However, postoperative bleeding still occurs in a certain proportion with approximately 1.4-11.9% [4][5][6].The factors in uencing intraoperative and postoperative bleeding have been widely discussed. Some scholars believe that being obese, having a small mouth, and experiencing recurrent tonsillitis increases the likelihood of bleeding, whereas tonsillar hypertrophy reduces bleeding, particularly in younger patients [15].…”

Section: Discussionmentioning

confidence: 99%

Coblation revolving tonsillectomy with outside-in dissection: A modified tonsillectomy

Lou

et al. 2023

Preprint

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Objective This study introduces a modified tonsillectomy procedure and evaluates the occurrence of intraoperative and postoperative hemorrhage using the new method. Methods Modified tonsillectomy, defined as coblation revolving tonsillectomy with outside-in dissection, was performed on 104 patients. Results This study enrolled 104 patients (62 males and 42 females), the average age was 23.6 ± 6.8 (range: 16–31) years. The reasons for the procedure were as follows: 58 (55.8%) due to tonsillar hypertrophy, 39 (37.5%) for recurrent tonsillitis, and 7 (6.7%) because of the presence of a benign tumor. The average operation time of bilateral surgery was 13.2 ± 1.9 min. No intraoperative bleeding was encountered in the tonsillar fossa in any of the patients. Pain intensity was 4.1 ± 1.6 on postoperative days 0, 3.9 ± 2.1 on postoperative days 1, and 2.8 ± 1.1 on postoperative days 2. No postoperative hemorrhage which required any additional intervention occurred. Also, no postoperative other complications were encountered. Conclusions Coblation revolving tonsillectomy with outside-in dissection may be effective and safe technique for reducing intraoperative and postoperative hemorrhage.

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“…Due to its potentially serious nature, post‐tonsillectomy haemorrhage (PTH) is a commonly reported outcome 3–5 . Studies have identified surgical indication, technique and surgeon experience as potential factors associated with PTH 6–11 …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Studies have identified surgical indication, technique and surgeon experience as potential factors associated with PTH. [6][7][8][9][10][11] Instrumentation used for tonsillectomy can be classified as either 'hot' or 'cold' techniques. 11,12 'Hot' techniques involve the use of instrumentation to apply thermal energy to dissect the tonsils (e.g.…”

mentioning

confidence: 99%

BiZact™ tonsillectomy: Predictive factors for post‐tonsillectomy haemorrhage from a 1717 case series

Mao

Woods

Athanasiadis

et al. 2023

Clinical Otolaryngology

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Objective: To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. Setting: Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. Data collected: patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH.Results: One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001).Conclusions: BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.

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Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

Cited by 5 publications

References 28 publications

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Coblation revolving tonsillectomy with outside-in dissection: A modified tonsillectomy

BiZact™ tonsillectomy: Predictive factors for post‐tonsillectomy haemorrhage from a 1717 case series

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