Coblation Tonsillectomy: A Review of Five-Year Experience in Basrah

Abstract

Background: Tonsillectomy is a very common surgery in children and it is the most routinely performed surgical operation worldwide. It is indicated for recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, suspicion of malignant diseases, and tonsillar hypertrophy causing obstructive sleep apnea. Various techniques can be employed for tonsillectomy, including cold dissection, electrocautery, bipolar diathermy dissection, radiofrequency, coblation, laser, and harmonic scalpel. Coblation is one of the most recent techniques used for tonsillectomy, which can ablate tissue by generating a field of ionized sodium molecules using a bipolar radiofrequency energy, which ablates and coagulates soft tissue into an ionized plasma layer, creating sufficient energy to break molecular bonds which result in molecular dissociation. Aim: To evaluate the efficacy of the coblation technique in decreasing the complications associated with tonsillectomy. Methods: A prospective study was conducted at Al-Moosawi Private Hospital in Basrah over a period of five years, between April 2018 to April 2023. A total of 466 patients (266 male and 240 female), aged 4 to 54 years, were included. All patients underwent coblation tonsillectomy either due to recurrent tonsillitis or tonsillar hypertrophy causing obstructive sleep apnea, or both. Several operative and postoperative parameters were evaluated, including operative time, hospital stay, postoperative bleeding, postoperative pain, and time to resume a normal diet. Results: The surgery was most commonly indicated due to recurrent tonsillitis in 411 patients (88%), while only 5 patients (1%) underwent surgery for tonsillar hypertrophy causing obstructive sleep apnea. The operative time ranged from 6 to 15 minutes in the majority of patients, constituting 413 (88.6%). Of the patients, 396 patients (85%) stayed in hospital for 6 hours postoperatively, while 44 patients (9.5%) stayed for 12 hours, and only 26 patients (5.5%) required an overnight stay. Among the 466 patients, only 8 (1.7%) patients experienced postoperative bleeding. The bleeding was primary in 3 (0.65%) and secondary in 5 (1.05%) patients. The mean VAS in the first postoperative day was 2.5±1.4, increasing to 4±1.4 on the third postoperative day, and decreasing to 3.5±1.7 by the 7th postoperative day. Most patients (311, or 66.7%) resumed a normal diet on the first postoperative day, while only 12 (2.5%) delayed resuming their diet to the seventh postoperative day. Conclusions: Based on our findings and clinical outcomes, the coblation technique is an effective, reliable, and safe method for tonsillectomy, with negligible complications. We recommend its wider adoption among otolaryngologists and pediatric ENT surgeons.