Coblation Versus Conventional Tonsillectomy: A Double Blind Randomized Controlled Trial

No Difference in Pain or Febrile Episodes With the Use of Post-Operative Antibiotics in Paediatric Coblation Intracapsular Tonsillectomy for Sleep-Disordered Breathing or Recurrent Tonsillitis: A Prospective Randomised Trial

OBJECTIVE

Coblation technology is gaining wide acceptance and use as a contemporary surgical technique for tonsil surgeries due to less post-operative morbidity compared to the more traditional total tonsillectomy. Previous articles examined the role of post-operative antibiotics for traditional total tonsillectomy; however, this is the first study which explores the role of post-operative prophylactic antibiotic treatment among children undergoing coblation intracapsular tonsillectomy.

METHODS

A prospective randomised study included 100 children (aged 1-16) who were divided into two subgroups: with and without post-operative antibiotics. Post-operative follow-up of patients included assessment for 7 days of pain levels, fever, return to diet, bleeding and halitosis. In addition, the children's caregivers completed the Parents'-Postoperative-Pain-Measure (PPP-M) questionnaire on Days 1 and 7.

RESULTS

The (+) antibiotic subgroup had substantially less halitosis on Days 2-6 after surgery. Prophylactic antibiotic treatment did not yield any differences between the two subgroups in the incidence of fever, return to regular diet or drinking, pain as measured by the Wong Baker Faces Pain scale, or pain as reported by the parents on the PPP-M questionnaire.

CONCLUSIONS

This prospective study highlights that routine prophylactic post-operative antibiotic use has a limited clinical benefit in paediatric intracapsular tonsillectomy. Improvement in halitosis was significant with antibiotic treatment; however, various other clinical parameters did not differ between the two subgroups, so the routine use of post-operative antibiotics in the above setting is discouraged.

Intracapsular tonsillectomy improves children's postoperative behavior measures

BACKGROUND

Tonsillectomy represents one of the most frequently performed surgical interventions in pediatric otolaryngology (Bohr and Shermetaro, 2023) [1]. The selection of surgical technique plays a crucial role in determining multiple aspects of postoperative recovery, including pain management, healing trajectory, and behavioral adaptation (Karam et al., 2022; Lin et al., 2024). This investigation sought to evaluate the differential impacts of coblation intracapsular tonsillectomy (CIT) versus traditional cold dissection total tonsillectomy (TT) on postoperative behavioral patterns in pediatric patients.

OBJECTIVE

This study aimed to conduct a comprehensive comparison of postoperative behavioral outcomes between pediatric patients undergoing CIT versus TT procedures.

METHODS

The investigation prospectively enrolled 163 pediatric patients, aged 2-15 years, scheduled for tonsillectomy. Subjects underwent either CIT or TT procedures according to standardized protocols. Postoperative assessment utilized two validated instruments: the Parental Postoperative Pain Management (PPPM) questionnaire and the Wong-Baker Faces Pain Scale. Parents completed these assessments daily from postoperative day (POD) 1 through 7.

RESULTS

Analysis revealed consistently superior behavioral outcomes in the CIT group compared to the TT cohort. Initial evaluations on POD 1 demonstrated advantages for the CIT technique across all measured parameters, with two reaching statistical significance. By POD 7, the behavioral differences between groups had become more pronounced, with seven parameters showing statistically significant advantages in the CIT group. Composite behavioral scores similarly demonstrated significant superiority in the CIT cohort.

CONCLUSIONS

The postoperative period following tonsillectomy presents substantial challenges for pediatric patients and their families, characterized by notable behavioral modifications. Our findings demonstrate that CIT procedures are associated with markedly improved behavioral outcomes compared to conventional TT approaches. These results provide compelling evidence supporting the preferential use of CIT when considering the behavioral impact of tonsillectomy in pediatric populations. This data contributes valuable insights to inform surgical decision-making in pediatric tonsillectomy cases.

A Comparative Study Between Coblation-Assisted Tonsillectomy and Conventional Dissection and Snare Tonsillectomy

Background Tonsillitis is a vastly prevalent disease, accounting for the majority of outpatient visits. The dissection and snare method has been the predominant approach for tonsillectomy for centuries. Coblation-assisted tonsillectomy offers advantages such as faster healing, shorter surgery duration, minimal blood loss, and fewer postoperative complications. Therefore, a study was conducted to evaluate the distinctions and compare the efficacy of traditional dissection and coblation-assisted tonsillectomy. Materials and methods Patients were divided into two groups: Group I was operated on using the conventional method, and Group II was operated on using the coblation method. Both groups were then assessed for intraoperative time, intraoperative bleeding, postoperative pain, and postoperative complications. Results Coblation-assisted tonsillectomy patients had a significantly shorter mean duration for the procedure and significantly lower blood loss in comparison to the conventional method. There were no statistically significant variations in the incidence of postoperative complications. Coblation-assisted tonsillectomy patients experienced considerably higher pain scores on various postoperative days. Conclusion Coblation-assisted tonsillectomy had the added advantage of reduced intraoperative blood loss, shorter surgical time, and faster recovery postoperatively. Coblation-assisted tonsillectomy can be considered an effective alternative to conventional methods. However, it's important to consider factors such as cost-effectiveness and surgeon experience. Further research involving larger sample sizes and longer follow-up periods could yield more insightful knowledge of the outcomes of these two tonsillectomy techniques.

Effect of Cold-Water Irrigation on the Coblation Site for Post-Tonsillectomy Pain: A Prospective Randomized Clinical Study

OBJECTIVE

To explore the effect of cold-water irrigation on post-tonsillectomy pain after coblation.

METHODS

Data from 61 adult patients who underwent coblation tonsillectomy in our hospital from January 2019 to December 2020 were collected, and the patients were randomly divided into the cold-water irrigation group (Group 1) and the room-temperature irrigation group (Group 2). Group 1 was irrigated with ice water mixed saline with the help of a pressure band, and Group 2 was irrigated with room-temperature saline. During the operation, we monitored the temperature of the operating cavity in real time. We recorded the postoperative pain for 11 consecutive days from the day and the 10th day after the operation.

RESULTS

The postoperative pain score was significantly lower than that in Group 2, except on the 2nd, 3rd and 7th and 8th days after the operation.

CONCLUSION

The perfusion of cold water during coblation tonsillectomy is helpful to reduce postoperative pain.

Coblation Versus Cold Dissection Tonsillectomy: A Comparative Study

Tonsillectomy is the most frequently performed surgery in the recent years. Many techniques have been advocated to improve surgical efficacy and decrease postoperative morbidity. Probably the most update was coblation tonsillectomy. This is a comparative study which was conducted on 50 patients (23 females and 27 males) who underwent tonsillectomy operations, 25 patients using cold steel dissection method whereas coblation technique was used for the rest 25 patients. Follow up was done at day 1, 3, 7 and 14 and the related parameters were calculated. The mean age of patients was 11.6 years with a mean of 2.2-40 years. There were 27 (54%) males out of 50 and 23 (46%) were females. Male to female ratio was 54%:46% ≈ 1.17:1. The current study revealed significant difference between coblation versus cold dissection tonsillectomy. Postoperative pain was significantly less at day 3 and day 7 using coblation technique. Moreover, there were less intraoperative bleeding, less time in days to return to normal diet and less time to return to normal activities. We believe that coblation tonsillectomy carries less morbidity than cold steel dissection, hence we recommend it to be applied at our hospital.

Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis

BACKGROUND

Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH.

OBJECTIVE

Investigate whether evaluation of coagulation function by preoperative TEG might help to predict PTH after tonsillectomy by coblation tonsillectomy (TE).

DESIGN

Post-hoc analysis of randomized controlled study.

SETTING

Otolaryngology Department between January 2017 and August 2019.

PATIENTS AND METHODS

This post-hoc analysis included adults who underwent coblation TE for benign tonsillar disorders. Routine blood tests and TEG were performed preoperatively. The TEG parameters evaluated included coagulation reaction time (R) and maximum thrombus amplitude (MA).

MAIN OUTCOME MEASURES

The main outcome was PTH during the 4-week postoperative period.

SAMPLE SIZE AND CHARACTERISTICS

284 RESULTS: The 19 patients (6.7%) that experienced PTH had a higher prevalence of diabetes mellitus, lower use of intraoperative suturing, fewer patients with grade I and II tonsillar enlargement, a higher white blood cell count, lower platelet count, lower fibrinogen level, lower R value, and a lower MA value than patients without PTH (all P<.05). Multivariate logistic regression revealed that diabetes mellitus (P<.053), fibrinogen level ≤2.735 g/L (P<.027), R≤6.55 min (P<.011) and MA≤59.15 mm (P<.012) were independently associated with PTH. A regression model incorporating these four factors predicted PTH with a sensitivity of 73.7% and specificity of 83.8%.

CONCLUSION

Preoperative evaluation of diabetes mellitus history, fibrinogen level, and TEG parameters might help to identify patients at higher risk of PTH after coblation TE.

LIMITATIONS

Single-center study with a small sample size; possibly underpowered statistically. TEG measurements might not accurately reflect coagulation function, and a validation cohort was unavailable.

CONFLICT OF INTEREST

None. CHINESE CLINICAL TRIAL REGISTRY NUMBER OF STUDY USED IN THIS ANALYSIS: ChiCTR2000032171. http://www.chictr.org.cn/showprojen.aspx?proj=52553.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

BACKGROUND

Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome. Postoperative hemorrhage of tonsillectomy is a life-threatening complication.

AIM

To identify the risk factors that may contribute to primary and secondary post-operative hemorrhage in pediatric tonsillectomy.

METHODS

The clinical data from 5015 children, 3443 males and 1572 females, aged 1.92-17.08 years, with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected. The variables including sex, age, time of onset, diagnosis, method of tonsillectomy, experience of surgeon, time when the surgery started and monthly average air temperature were abstracted. The patients with postoperative hemorrhage were classified into two groups, the primary bleeding group and the secondary bleeding group, and their characteristics were compared with those of the nonbleeding group separately. Statistical analysis was performed by chi-square test with SPSS 20.

RESULTS

Ninety-two patients had post-tonsillectomy hemorrhage, and the incidence rate of post-tonsillectomy hemorrhage was 1.83%. The mean age was 5.75 years. Cases of primary hemorrhage accounted for approximately 33.70% (31/92), and cases of secondary hemorrhage occurred in 66.30% (61/92). The rate of reoperation for bleeding was 0.92%, and the rate of rehospitalization for bleeding was 0.88% in all patients. Multiple hemostasis surgery was performed in 6.52% (3/46) of patients. The method of tonsillectomy (coblation tonsillectomy) and experience of the surgeon (junior surgeon with less than 5 years of experience) were significantly associated with primary hemorrhage (χ² = 5.830, P = 0.016, χ²= 6.621, P = 0.010, respectively). Age (over 6 years old) and time of onset (more than a 1-year history) were significantly associated with secondary hemorrhage (χ²= 15.242, P = 0.000, χ²=4.293, P = 0.038, respectively). There was no significant difference in sex, diagnosis, time when the surgery started or monthly average air temperature. There was a significant difference in the intervention measures between the primary bleeding group and the secondary bleeding group (χ²= 10.947, P = 0.001). The lower pole and middle portion were the common bleeding sites, followed by the upper pole and palatoglossal arch.

CONCLUSION

The incidence rate of post-tonsillectomy hemorrhage is low. Coblation tonsillectomy and less than 5 years’ experience of surgeon contribute to the tendency for primary hemorrhage. Age and time of onset are responsible for secondary hemorrhage.

Postoperative hemorrhage following coblation tonsillectomy with and without suture: A randomized study in Chinese adults

PURPOSE

Coblation tonsillectomy (TE) increases gradually in China. Hemorrhage is the main complication after tonsillectomy. The conclusions of the studies about suture after tonsillectomy are conflicting. To compare the post-tonsillectomy hemorrhage (PTH) rates in patients who underwent coblation with vs. without suture.

MATERIALS AND METHODS

This was a randomized controlled study of adult patients who underwent coblation TE at our hospital between 01/2017 and 08/2019. The patients were randomized to TE with or without suture. The primary endpoint was the secondary PTH. The secondary endpoints included the primary PTH, grade of PTH, and incidence of PTH within 4 weeks post-TE.

RESULTS

There were no differences between the two groups regarding sex, age, disease course, and BMI (all P > 0.05). The occurrence of secondary PTH was lower in the suture group compared with the non-suture group (2.8% vs. 7.7%, P = 0.016). Compared with non-suture group, the incidence of PTH within 4 weeks (2.8% vs. 10.6%, P = 0.009) and the PTH degree (P = 0.02) were all significantly lower in the suture group.

CONCLUSION

Intraoperative suture reduces the secondary PTH in adult patients who underwent coblation tonsillectomy. The incidence of PTH within 4 weeks, PTH degree and pain might all improved for intraoperative suture.

Significantly reducing post-tonsillectomy hemorrhage requiring surgery by double-layer suture: A retrospective analysis

BACKGROUND

Although tonsillectomies carry a low-risk for adverse events, postoperative hemorrhage has been reported as the most common complication.

AIM

To compare the rates of postoperative secondary hemorrhage for tonsillectomy with or without double-layer suture.

MATERIAL AND METHODS

This is a retrospective study of 5087 patients who underwent coblation tonsillectomy with or without suture from 2006 to 2016. All cases had been followed up 3 weeks and severe secondary hemorrhage cases requiring operation were analyzed.

RESULTS

The severe secondary hemorrhage rate was statistically higher in group without suture (1.96%) as compared with the group with suture (1.08%). The surgery time (36.55 ± 7.45) was longer in patients with suture as compared to patients without suture (31.50 ± 6.23). In the age between 18 and 49 years group, the higher secondary hemorrhage rate (2.44%) was found in patients without suture. The rate of postoperative hemorrhage (0.96%) was significantly higher in patients without suture as compared with patients with suture (0.36%) on postoperative 5th day.

CONCLUSIONS

The risk of severe secondary hemorrhage is reduced in coblation tonsillectomy with suture. The rate of secondary hemorrhage is lower in patients with suture in 18 to 49 years old group and on the 5th day after surgery.

Cost benefit of coblation versus electrocautery adenotonsillectomy for pediatric patients

INTRODUCTION

Coblation and electrocautery are two common techniques used for adenotonsillectomy (T&A). Numerous studies have assessed surgical outcomes of coblation versus electrocautery and overall, postoperative complications are similar with the exception of a decrease in patient reported postoperative pain for coblation. Instrumentation required for coblation is significantly more expensive than that required for electrocautery. With minimal outcome differences, justification for the additional instrumentation costs is difficult. We performed this study to assess if there is a difference between operative & postoperative costs of electrocautery and coblation.

METHODS

300 patient medical records were reviewed from 2015 to 2017 with equal numbers of electrocautery and coblation surgeries. Outcome measures included finance information, duration and cost of OR and Phase I and Phase II post-anesthesia care unit (PACU), in-hospital pharmacy costs, and postoperative complications. Logistic regression was used for analysis.

RESULTS

The median patient age for each surgical technique was 6 years old. Electrocautery resulted in more time in the OR compared to coblation, (OR:1.11,95%CI:1.07-1.15, p < .001), with greater associated costs, p < .001. Electrocautery patients were under anesthesia longer and had a longer surgical duration, p < .001. These same patients had longer duration in Phase II PACU, p = .028, and were given pain medications an increased number of times, p < .001. Total costs including operative expense, physician charges, OR and anesthesia times, pharmacy, and instrument were significantly higher for electrocautery patients, p = .003. There were no differences in ED visits, post-tonsillectomy bleed, or additional surgery between techniques, p > .05.

CONCLUSION

T&A electrocautery technique was found to have increased overall indirect costs. Costs of instrumentation in addition to increased operative time, use of analgesics and post-operative care contribute to costs associated with electrocautery and coblation should be used when assessing surgical costs.