Tonsillectomy Coblation vs Electrocautery Amy Stinson MS IV
Tonsillectomy: Coblation vs Electrocautery Amy Stinson MS IV KCUMB
Coblation vs EC n n Coblation passes a radiofrequency bipolar current through a saline medium which creates highly ionized particles that can “melt” the tissue at 40 -70°C 1, 2 EC uses thermal conduction and needs a temp of 400°C to cut and cauterize tissue 1, 2
Let’s Compare: n n n Time taken to remove tonsil Intra-operative blood loss Post-operative pain Post-operative hemorrhage Amount of healing at 2 weeks post-op
Tonsil Removal 1 n n n Coblation set at 6 or 7 Needed 8. 22 minutes for removal of 1 tonsil Removes tissue more effectively and completely 3 EC set between 20 & 25 W Needed 6. 33 minutes for removal of 1 tonsil
Intra-operative Blood Loss n n Coblation: 2. 44 ml per tonsil 1 EC: 5. 39 ml per tonsil 1
Post-operative Pain n 70% of blinded patients reported less pain on side of coblation (p =. 014)1 Pain on days 1 -3 significantly less Narcotic use: UP 3 (7. 6 ± 3. 7) vs UP 2 w/tonsil coblation (5. 1 ± 1. 8)6
Post-operative Hemorrhage n n n Coblation (n=844): 2. 25%4 EC (n=773): 6. 19%4 UP 3 (9. 1%) vs UP 2 w/tonsil coblation (0%)6
Healing at 2 Weeks Post-Op n n n Coblation: pain 3. 31/10 EC: pain 3. 98/10 Return to normal diet: UP 3 (8. 7 ± 3. 3) vs UP 2 w/tonsil coblation (4. 6 ± 2. 0)6 Foreign body sensation: UP 3 (57. 6%) vs UP 2 w/tonsil coblation (23. 3%)6 UP 3 exposes underlying muscles and neurovascular bundles – triggered when pt starts eating – UP 2 leaves them intact
Other considerations n n Cost: EC $25, Coblation $125 Coblation wire thinning Water refraction Smoke production
References n n n 1. Noordijz, JP. Affleck, BD. Coblation Versus Unipolar Electrocautery Tonsillectomy: A Prospective, Radomized, Single-blind Study in Adult Patients. Laryngoscope 2006. 116; 13031306. 2. Plant, RL. Radiofrequency Treatment of Tonsillar Hypertrophy. Laryngoscope 2002. 112: 20 -22. 3. Freidman, M. La. Savio, P. et al. Radiofrequency Tonsil Reduction: Safety, Efficacy, and Morbidity. Laryngoscope 2003. 113: 882 -887. 4. Bellasso, A. et al. Coblation Tonsillectomy versus Dissection Tonsillectomy: Postoperative Hemorrhage. Laryngoscope 2003. 113: 2010 -2013. 5. Divi , B. Benninger, M. Postoperative tonsillectomy Bleed: Coblation versus Noncoblation. Laryngoscope 2005. 115: 31 -33. 6. Freidman, M. et al. Uvulopalatoplasty: A modified Technique for Selected Patients. Laryngoscope 2004. 114: 441 -449.
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