A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis

Abstract

Objectives: To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. Design: A prospective, single blind, randomised controlled trial. Setting: ENT clinic, University Teaching Hospital. Participants: Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. Methods: Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. Main outcome measures: Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit.Results: The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. Conclusion: In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.Tonsillectomy continues to be one of the most common procedures performed by ENT surgeons in Norway as well as worldwide. The most commonly used techniques in Norway include blunt dissection, guillotine, bipolar diathermy haemostasis, bipolar diathermy scissors and laser. Despite the use of multiple analgesics, postoperative pain and postoperative morbidity remain the major side effects of the operation.Coblation tonsillectomy has not been used routinely in public hospitals in Norway up to now. Coblation (cold ablation) is a relatively new technique in soft tissue surgery. Recently, the use of this new technique in the treatment of snoring, nasal congestion and sleep apnoea has received considerable research interest.Coblation is a bipolar system that involves passing radiofrequency through a medium of normal saline, which results in the production of a plasma field of sodium ions. These ions are able to break down interc...

A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children

“…11 The authors found that intra-operative bleeding was significantly less in the coblation group and patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgesics over a 10-day period than patients undergoing dissection tonsillectomy.…”

Coblation tonsillectomy: is it inherently bloody?

“…The lower radiofrequency-generated energy employed by this technique means less tissue is damaged thus less inflammation and quicker wound healing which is translated to lesser postoperative pain, faster patient recovery, shorter hospital stay, and cheaper over-all cost of medical care. High quality studies, some in the form of randomised controlled trials (RCTs), have backed up these theoretical advantages of coblation surgery [2][3][4][7][8][9][10][11]. Chang et al [4] showed that it has lower early post-operative pain and likewise highlighted the ease of the procedure.…”

“…The advantages of coblation tonsillectomy over other techniques have been well reported, specifically the lower early phase post-operative pain and the ease of the procedure itself [2][3][4]. This surgical innovation has been practised in UK for almost a decade now.…”

A prospective multi-centre randomised controlled trial comparing PlasmaKnife with bipolar dissection tonsillectomy: Evaluating an emerging technology

“…The results showed an increased risk of secondary bleeding associated with ''hot'' techniques of dissection and haemostasis, although return to theatre rates were broadly similar [1,2]. Findings also included a higher secondary haemorrhage rate associated with coblation and single use instruments [1], but more recent work has found coblation, which is cold ablation, to be an excellent tool in terms of pain and secondary haemorrhage post-operatively [3][4][5][6][7]. The National Institute of Clinical Excellence commissioned a review of the safety and efficacy of monopolar and bipolar electrosurgery for tonsillectomy [8] and found that electrosurgery is associated with higher rates of secondary haemorrhage and return to theatre rates when compared to cold steel dissection and ties.…”