Comparison between coblation tonsillectomy and dissection tonsillectomy

Tonsillectomy is one ofthe most frequently carried out surgical operations worldwide. Numeroussurgical techniques have been recorded and various devices have been developedsince Celsus performed the first tonsillectomy in 30 B.c.

The literaturedescribes a variety of tonsillectomy techniques. These include cryosurgery ,guillotine, dissection, suction diathermy, bipolar scissor dissection,monopolar and bipolar diathermy dissection, ultrasonic removal, radiofrequencyand laser surgery. Any enhancement of these techniques should result in areduction in operating time, a decrease in intraoperative and postoperativeblood loss, and a decrease in postoperative morbidity.

Cold dissectiontonsillectomy, also known as dissection tonsillectomy or cold knife techniquehas been the  standard procedure fordecades. Either the electrocautery or the ligation technique is used to achievethe surgical hemostasis. Recently, the new technology known as ‘Coblationtonsillectomy’ has come to light as a potentially appealing option for this procedure. In contrast to electrocautery which cuts tissue at 4000C, Coblation  involves passing a radiofrequency bipolarelectrical current through a medium of normal saline to create a plasma fieldof highly ionized particles, which in turn breakdown intercellular bonds andmelt tissue at about 700C.There are two methods fordoing a coblation tonsillectomy: (1) Subtotal, intracapsular ablation, whichmay leave some tonsil tissue intact, and (2) Total, subcapsular tonsillectomy,which involves separating the entire tonsil from the surrounding pharyngealmuscle and tonsillar capsule.

Despite tonsillectomybeing the most common and simple surgery, the surgeon is constantly concernedabout the high risk of complications, including intra and post-operative haemorrhage, which can even result in shock and death. Because the oropharynx and tonsilshave an abundant blood supply, tonsillectomy carries a very high risk ofheamorrahge. Following a tonsillectomy, morbidity is significant. It includesboth perioperative and postoperative bleeding as well as postoperative pain.Dehydration and extended hospital stay come from the patient’s inability toreturn to a regular diet due to postoperative pain and difficulty inswallowing.The postoperative pain that might result in decreasedoral intake, dehydration, and prolonged reduction in daily activities is themost significant morbidity following adult tonsillectomy. Additionally, painthat limits pharyngeal muscle movement may decrease tonsillar fossa clearancewhich may lead to infection, which may then result in bleeding. It isbelieved that the muscle fibers (palatoglossal, palatopharyngeal, and superiorpharyngeal constrictor muscle) and nerve endings (Vagus and glossopharyngealnerves) around the tonsillar bed are damaged and exposed during tonsillectomysurgery, which causes pain. Because of this, it is thought that surgical methods that carefully preserve the peritonsillar plane and prevent harmto the underlying tissues can reduce postoperative pain.

Our study aims tomeasure the efficacy of coblation method of tonsillectomy against dissectionmethod in terms of operative time, intraoperative blood loss, postoperativepain and postoperative  heamorhage.