DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20164814

A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children

Nithya V., Angshuman Dutta, Sabarigirish K.

Abstract


Background: The aim of the present study was to compare intraoperative blood loss, operative duration and postoperative pain between coblation-assisted adenotonsillectomy and cold dissection adenotonsillectomy in children.

Methods: A prospective, randomized, single-blind trial of pediatric patients aged 7 to 13 years undergoing adenotonsillectomy was conducted. Patients were randomized to undergo either cold dissection or coblation-assisted adenotonsillectomy. Measured intraoperative parameters included surgical duration and intraoperative blood loss. Measured postoperative parameters included a daily pain rating using the visual analog scale on the postoperative evening, postoperative day 1 and day 7. Intraoperative and postoperative measures were statistically compared between the two groups.  

Results: Sixty children were randomized and included in the study. 30 patients underwent cold dissection adenotonsillectomy and 30 coblation-assisted adenotonsillectomy. Mean age was 8.7 years in the coblation group and 9.1 years in the cold dissection group. Intraoperative blood loss was lower for the coblation assisted adenotonsillectomy group versus the cold dissection adenotonsillectomy group which was proved statistically (mean bleeding was 16.67 in coblation group and 58.67 in cold dissection group and p value <0.0001).There was statistically no significant difference in the mean pain scores in the 2 groups in the postoperative evening and on postoperative day 1. The mean pain scores on postoperative day 7 were found to be 3.4 in the coblation group and 2.47 in the cold dissection group with a significant p value of 0.0087. The average duration of surgery in the coblation group was 55.6 minutes as against 34.1 minutes in the cold dissection group. The p- value was found to be less than 0.0001 which makes the difference statistically significant.

Conclusions: This study found that the intraoperative blood loss was significantly less in Coblation adenotonsillectomy than in cold dissection adenotonsillectomy. The duration of surgery in Coblation assisted adenotonsillectomy is significantly greater than the duration of surgery in cold dissectionadenotonsillectomy. While the postoperative pain scores are similar with coblation and cold dissection adenotonsillectomy in the early postoperative period, it is significantly more with coblation in the late postoperative period.


Keywords


Adenotonsillectomy, Coblation

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References


Mcneill RA. A history of tonsillectomy: Two millenia of trauma, haemorrhage and controversy. Ulster Med J. 1960;29(1):59–63.

Temple RH, Timms MS. Paediatric Coblation tonsillectomy. Int J Pediatr Otorhinolaryngol. 2001;61:195-8.

Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomized controlled study. J LaryngolOtol. 2002;116:450-2.

Belloso A, Chidambaram A, Morar P, Timms MS. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope. 2003;113 (11):2010-3.

Shah UK, Dunham B. Coblation for Tonsillectomy: An evidence based review. ORL J Otorhinolaryngol & rel Specialities. 2007;69(6):349–57.

Divi V, Benninger M. Postoperative Tonsillectomy bleed: Coblation versus Non Coblation. Laryngoscope. 2005;115:31–33.

Magdy EA, Elwany S, el-Daly AS, Abdel-Hadi M, Moreshedy MA. Coblation Tonsillectomy: A prospective, double blind, randomized, Clinical and Histopathological comparision with Dissection – Ligation, Monopolar Electrocautery and Laser Tonsillectomies. J Laryngol Otol. 2008;122(3):282–90.

Javed F, Sadri M, Uddin J, Mortimore S, Parker D. A completed audit cycle on post-tonsillectomy haemorrhage rate: Coblation versus standard tonsillectomy. Acta Otolaryngol. 2007;127:300-4.

Noon AP, Hargreaves S. Increased post-operative haemorrhage seen in adult Coblation tonsillectomy. J LaryngolOtol. 2003;117:704-6.

Sung-Moon H, Jae-GuCho, Sung Won C, Heung-Man L, Jeong-Soo W. Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults. Clin Exp Otorhinolaryngol. 2013;6(2):90-3.

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;32:261–7.

Singh R, Anand TS, Garg P, Kulshreshtha P. A Prospective, Randomized, Double-Blind Study of Coblation versus Dissection Tonsillectomy in Adult Patients. Indian J Otolaryngol Head Neck Surg. 2012;64(3):290–4.

Parker D, Howe L, Unsworth V, Hilliam R. A randomized controlled trial to compare postoperative pain in children undergoing tonsillectomy using cold steel dissection with bipolar haemostasis versus coblation technique. Clin Otolaryngol. 2009;34(3):225-31.

Burton MJ, Doree C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev. 2007;(3):CD004619.

Omrani MR, Barati B, Omidifar N, Okhovvat AR, Hashemi SAG. Coblation versus traditional tonsillectomy: A double blind randomized controlled trial. J Res Med Sci. 2012;17(1):45–50.

Shapiro NL, Bhattacharyya N. Cold Dissection Versus Coblation-Assisted Adenotonsillectomy in Children. Laryngoscope. 2007;117:406–10.