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

Abstract

Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English‐language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta‐analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5‐5.9; p < .0001), 4.1 (95% CI 2.7‐5.4; p < .0001), 3.5 (95% CI 1.7‐5.4; p = .0002) and 2.8 (95% CI 1.6‐4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16‐0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19‐1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.

Intracapsular tonsillectomy: setting a new standard

“…Intracapsular tonsillectomy was associated with significantly decreased duration of pain and analgesia use, a quicker return to normal diet and activity, and a decreased rate of posttonsillectomy hemorrhage. Efficacy measures between the two techniques for the management of OSA were equivalent, though a lack of long term follow up was noted [5 ▪▪ ]…”

“…Using this classification, a recent meta-analysis evaluated outcomes of ICT vs. ECT performed with plasma ablation [5 ▪▪ ]. Intracapsular tonsillectomy was associated with significantly decreased duration of pain and analgesia use, a quicker return to normal diet and activity, and a decreased rate of posttonsillectomy hemorrhage.…”

When Should We Recommend Intracapsular Tonsillectomy in Pediatric Patients?

“…Retrospective reviews and comparative studies between intracapsular and total tonsillectomy have demonstrated multiple short‐term benefits of intracapsular tonsillectomy including decreased risk of postoperative bleeding and improved pain control. This is thought to be due to the preservation of the pharyngeal musculature and formation of a biological dressing over the capsule 1 . In a study by Soaper et al, short‐term and long‐term outcomes were compared between intracapsular and extracapsular tonsillectomy, with a mean follow‐up time of 8.2 years.…”

“…A recent meta‐analysis showed that patients who underwent intracapsular tonsillectomy had lower absolute pain scores and a faster return to normal diet and activity level compared to those who underwent extracapsular tonsillectomy 1 . There are numerous short‐ and long‐term studies supporting the benefits of intracapsular tonsillectomy, but there is a paucity of information regarding the efficacy in special populations, such as syndromic patients.…”

Impact of Low-Temperature Plasma Radiofrequency Tonsillectomy on Pain, Inflammatory Markers, and Sleep Quality in Adults with Chronic Tonsillitis

“…Traditional surgery was often considered a thorough method for complete removal of tonsillar tissue, but it was associated with a prolonged postoperative recovery period, significant pain, and a higher risk of complications [8]. In contrast, although low-temperature plasma radiofrequency tonsillectomy may not achieve complete excision, it features smaller incisions, shorter postoperative recovery, reduced pain, and a lower risk of complications [9]. Although low-temperature plasma radiofrequency tonsillectomy for CT has been clinically recognized for its effectiveness, previous studies primarily focused on the clinical effects of this procedure and lacked a comprehensive view of patient outcomes [10,11].…”