Comparison between dissection method and coblation technique in tonsillectomy
Keywords:Chronic tonsillitis, Tonsillectomy, Coblation tonsillectomy
Background: The objective of the present study was to compare the dissection method and coblation technique in tonsillectomy in patients of chronic tonsillitis.
Methods: This is prospective study in which 40 patients of chronic tonsillitis in age group of 5-12 years were selected in this study. Patients were blinded with regards to technique used to remove tonsils. 20 patients underwent tonsillectomy by cold dissection method and 20 with coblation method. In both techniques, duration of surgery and amount of blood loss were recorded and compared.
Results: In our study, the mean operative time from giving incision to achieving complete haemostasis for dissection method was 42.9 minutes and that for coblation technique was 34 minutes. The amount of blood lost on an average by dissection method was 51.8 ml, and by coblation technique was 22.3 ml. This difference was found to be statistically significant. Pain was evaluated by visual analogue scale. The data recorded from two groups was put to statistical analysis and ‘p’ value was calculated using independent t-test. The mean pain score for coblation technique averaged over 10 days was 2.72 and was 4.84 for dissection technique.
Conclusions: We can conclude that coblation tonsillectomy is an easy to learn safe procedure with significant advantages in terms improving the quality of post-operative recovery compared to that following the cold dissection technique. But cost effectiveness of dissection method outweighs benefits of coblation at present in Indian scenario.
Young JR, Bennett J. History of tonsillectomy. ENT News. 2004;13:34-5.
Feldmann H. 200 year history of tonsillectomy. Images from the history of otorhinolaryngology, highlighted by instruments from the collection of the German Medical History Museum in Ingolstadt. Laryngorhinootologie. 1997;76(12):751-60.
CELSUS (A.D. 10). De AMedicina, Cap. 7, Sect. 12.
Solares CA, Koempel JA, Hirose K, Abelson TI, Reilly JS, Cook SP, et al. Safety and efficacy of powered intracapsular tonsillectomy in children: A multi-center retrospective case series. Int J Pediatr Otorhinolaryngol. 2005;69:21-6.
Schmidt R, Herzog A, Cook S, O'Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg. 2007;133:925-8.
Maddern BR. Electrosurgery for tonsillectomy. The Laryngoscope. 2002;112(8):11-3.
New Methods in tonsillectomy- experiences with bipolar electrosurgical scissors. Available at: http://www.aro.org/archives/2000/5310.html. Accessed 27 October 2012.
Aremu SK. A Review of tonsillectomy techniques and technologies; 2012.
Sayin I, Cingi C. Recent medical devices for tonsillectomy. 2012;11-6.
Burton MJ, Doree C. Coblation versus other surgical techniques for tonsillectomy. Cochrane database of systematic reviews. 2007;(3):CD004619.
Younis RT, Lazar RH. History and current practice of tonsillectomy. The Laryngoscope. 2002;112(8):3-5.
Wang J, Liu D, Huang Z, Zhong J, Tan Z, Qiu S. Low-temperature coblation-assisted versus conventional dissection tonsillectomy in surgeries for children. J Clin Otorhinolaryngol Head Neck Surg. 2009;23(15):690-2.
Di Businco LR, Tirelli GC. Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures. Acta Otorhinolaryngol. 2008;28(2):67-72.
Mitic S, Tvinnereim M, Lie E, Saltyte BJ. A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol. 2007;32(4):261-7.
Polites N, Joniau S, Wabnitz D, Fassina R, Smythe C, Varley P, et al. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg. 2006;76(4):226-9.
Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol. 2002;116(6):450-2.
Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol. 2001;61(3):195-8.