Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies.
ABSTRACT Coblation tonsillectomy is a relatively recently introduced surgical technique which attempts to bridge the gap between 'hot' and 'cold' tonsillectomy methods.
To compare coblation tonsillectomy with three commonly used surgical techniques: cold dissection-ligation, monopolar electrocautery and CO2 laser.
A prospective, randomised, double-blinded clinical trial was undertaken of 60 adult patients divided into three equal study groups. Patients in each group were randomly assigned to have one tonsil removed with coblation and the second with one of the other three tonsillectomy techniques. Ten randomly selected tonsils resected by each method were sent for histopathological evaluation.
Coblation was significantly faster to perform than laser and produced significantly less intra-operative blood loss than both the dissection-ligation and laser techniques. Subjective visual analogue scale comparisons showed a non-significant pain score difference between coblation and dissection-ligation on most post-operative days. Coblation produced consistently highly significantly (p < 0.001) less pain, compared with electrocautery up to the 12th post-operative day and laser up to the 10th post-operative day. There was no significant difference in tonsillar fossa healing, comparing coblation to both dissection-ligation and laser techniques. Monopolar electrocautery produced significantly slower healing than coblation after 7 post-operative days, with no significant difference after 15 post-operative days. Histopathological evaluation showed that coblation inflicted significantly less thermal tissue injury than either electrocautery (p = 0.001) or laser (p = 0.003).
In adult patients, coblation tonsillectomy offers some significant advantages in terms of post-operative pain and healing, compared with other tonsillectomy techniques.
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ABSTRACT: After the surgical procedure of tonsillectomy, hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using the coblation technique. 24 prospective, randomized, and controlled studies were included in the meta-analysis. Data of 796 patients who had undergone coblation tonsillectomy were analyzed. Hemorrhages occurred in 33 patients: 2 classified as primary and 26 as secondary hemorrhages. 5 could not be classified into either group. Overall, the total hemorrhage rate for the coblation procedure was 4.1% with a 95% confidence interval from 2.8 to 5.5%. The overall hemorrhage rate of 4.1% found in this meta-analysis shows that coblation is a safe and effective technique for tonsillectomies with a secondary bleeding rate similar to what is reported for comparable techniques such as bipolar diathermia.Archives of Oto-Rhino-Laryngology 03/2011; 268(6):807-16. · 1.29 Impact Factor