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Lou Z. A comparison of coblation and modified monopolar tonsillectomy in adults. BMC Surg 2023; 23:141. [PMID: 37231422 DOI: 10.1186/s12893-023-02035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To compare the intraoperative records and postoperative clinical outcomes of adults who underwent coblation and modified monopolar tonsillectomy tonsillectomies. MATERIALS AND METHODS Adult patients with tonsillectomy were randomly divided into the coblation and modified monopolar tonsillectomy groups. The estimated blood loss, postoperative pain score, operation time, post-tonsillectomy hemorrhage (PTH), and cost of disposable equipment were compared. RESULTS Pain intensity in the coblation and monopolar groups was similar on postoperative days 3 and 7. However, the mean maximum pain score in the monopolar group was significantly higher compared to the coblation group on postoperative days 1 (P < 0.01) and 2 (P < 0.05).Secondary PTH occurred in 7.1% (23/326) of patients in the coblation group and 2.8% (9/327) of patients in the monopolar group (P < 0.05). CONCLUSION Although pain was significantly increased on postoperative days 1 and 2 in the modified monopolar tonsillectomy group, the operation time, secondary PTH, and medical costs were significantly decreased compared to the coblation technique group.
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Affiliation(s)
- Zhengcai Lou
- Department of operating theater, Yiwu central Hospital, 699 jiangdong road, 322000, Yiwu city, Zhejiang provice, China.
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Lou Z. Associations Between Post-tonsillectomy Hemorrhage and Anatomical Subsites of the Tonsillar Fossa. EAR, NOSE & THROAT JOURNAL 2023:1455613231169235. [PMID: 37024450 DOI: 10.1177/01455613231169235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE This study presents a novel classification of the anatomical subsites of the tonsillar fossa and discusses their associations with post-tonsillectomy hemorrhage (PTH) after extracapsular tonsillectomy. MATERIALS AND METHODS Coblation tonsillectomy was performed on three adult cadavers and the anatomical subsites of the tonsillar fossa based on the distribution of the tonsillar feeding artery: the upper pole (subsite A), most of the tonsil body (subsite B), the inferior tonsil body (subsite C), and components of the lower pole (subsites D and E). Extracapsular tonsillectomy was prospectively performed using various surgical techniques and PTH was evaluated. RESULTS A cadaveric study revealed that the intra- and extra-capsular vessel topographies were essentially identical. Although the demarcation lines varied either up or down by a few millimeters, the arterial vascular network was particularly dense at subsites D and E, and the vessel diameter at these subsites was significantly greater than at subsite C and also (especially) at subsite E. Of 680 patients who underwent tonsillectomy, PTH developed early in 13 (31.7%) and late in 28 (68.3%). Surgical interventions were required by 29/41 patients (70.7%). Subsites D and E were the most common subsites of late PTH and PTH that required intervention. Such intervention was rarely necessary when PTH developed at subsite A or B. CONCLUSIONS The new classification of the anatomical subsites of the tonsillar fossa aids inexperienced surgeons and provides an anatomical rationale for variation in surgical technique that minimizes vascular injury, thus improving safety.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, Yiwu, China
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A single center retrospective comparison of post-tonsillectomy hemorrhage between BiZact and Coblator. Int J Pediatr Otorhinolaryngol 2022; 158:111165. [PMID: 35500397 DOI: 10.1016/j.ijporl.2022.111165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/09/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Over 550,000 tonsillectomies are performed every year. While post-tonsillectomy hemorrhage (PTH) has been studied in the coblator, bovie, and cold steel technique, there is a dearth of studies examining the post-tonsillectomy outcome using BiZact. This study examines the rate of BiZact PTH requiring control of hemorrhage in the OR and assess resident comfort using the device. METHODS Retrospective chart review for all tonsillectomies performed between January 2018 and December 2020 were performed. Rates of PTH were analyzed. In addition, a 7-question BiZact resident experience survey was administered to 25 otolaryngology residents. RESULTS 1384 patients were included in this study; 444 (32%) Bizact and 940 (68%) Coblation. 11 (2.48%) BiZact patients had PTH requiring OR for control of hemorrhage, compared to 44 (4.68%) Coblation patients. There were no patient deaths because of PTH. The mean age of patients with PTH was 7.44 (SD 4.07) years old. 22 (88%) residents responded to the survey. 17 (77.27%) felt more confident with Coblator while performing tonsillectomy most commonly reported for ease of use, followed by BiZact 4 (18.18%), most commonly reported for improved surgical plane. CONCLUSION BiZact is a safe and effective addition. At our institution, the rate of secondary PTH requiring OR intervention for BiZact is comparable to the national average for other tonsillectomy devices. The rate of BiZact PTH requiring OR intervention in our experience was nearly half of those done with Coblator. Overall residents at SCHC preferred Coblator over BiZact mainly attributed to Coblator's versatility and ability to control intraoperative tonsil bleeding without additional instruments despite BiZact's shorter operative time.
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Liu S, Tang R, Mao S, Zhang W. Clinical outcomes of coblation-assisted pediatric endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 2022; 156:111089. [PMID: 35255444 DOI: 10.1016/j.ijporl.2022.111089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/06/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric skull base surgeries are confined by developmental and anatomical issues. Radiofrequency coblation integrates the functions of ablation, suction, and coagulation with the ability to dissolve tissues with limited thermal injury, making it an ideal instrument for pediatric skull base surgery. We sought to evaluated the clinical outcomes of coblation-assisted pediatric endoscopic skull base surgery. METHODS Medical records of patients under 15 years of age undergoing endoscopic skull base surgery were retrospectively reviewed. The estimated blood loss (EBL)/operating time (OT) and Wormald grade were used for intraoperative blood loss grading. RESULTS Generally, 28 patients (17 males, 11 females) with an average age of 8.4 ± 4.2 years, (range, 11 months to 15 years old) were included. Coblation was applied in 20 patients for mucosa coagulation and handling, cartilage removal, tumor separation and excision. The primary diagnoses included juvenile nasopharyngeal angiofibroma (n = 5), traumatic cerebrospinal fluid (CSF) leak (n = 6), congenital meningoencephalocele (n = 6) and miscellaneous sinonasal and skull base neoplasm (n = 11). The application of coblation was related with a significant decrease in EBL/OT (34.1 ± 17.5 vs 56.3 ± 22.6 ml/h, p = 0.048) and Wormald grade (5.7 ± 1.5 vs 6.9 ± 2.0, p = 0.038), compared with the traditional techniques. All surgical procedures were uneventful. No significant difference in postoperative complications, including cranial nerve dysfunction and CSF rhinorrhea were documented during the follow-up period (average, 34.7 ± 4.4 months). CONCLUSION We suggested the coblation be a safe and effective instrument for pediatric skull base surgery.
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Affiliation(s)
- Shixian Liu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ru Tang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Song Mao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weitian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Cai FG, Hong W, Ye Y, Liu YS. Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy. Gland Surg 2022; 11:175-185. [PMID: 35242679 PMCID: PMC8825514 DOI: 10.21037/gs-21-832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/07/2022] [Indexed: 01/24/2024]
Abstract
BACKGROUND Surgical removal of the primary lesion is a common treatment for chronic tonsillitis, recurrent tonsillitis, and tonsillar hypertrophy, and is the most widely performed surgery in otorhinolaryngology. With the development and progress of medical science and technology, the methods of tonsillectomy have gradually diversified, and it is of great significance to seek the best tonsillectomy method. This meta-analysis explored the advantages and disadvantages of coblation tonsillectomy (CT) and electrocautery tonsillectomy (ET). METHODS The keywords "coblation", "radiofrequency ablation", "electrocautery", and "tonsillectomy" were used to search the PubMed, Embase, Cochrane library, Clinicaltrials.gov, and Google Scholar databases, and randomized controlled trials (RCTs) of the 2 procedures since the establishment of the database were included. After screening and bias risk assessment, a meta-analysis was performed using Stata 16.0 software. RESULTS A total of 10 articles met the inclusion criteria and entered the final meta-analysis. There were 1,056 participants, including 547 patients who underwent CT and 509 patients who underwent ET. There was no significant difference in the operation time between CT and ET [standard mean difference (SMD) =0.39, 95% CI: -0.35 to 1.13, Z=1.044, P=0.296]. CT resulted in less intraoperative blood loss than ET (SMD =-2.62, 95% CI: -4.83 to -0.41, Z=-2.322, P=0.020). The postoperative pain score of CT was less than ET, but the difference was not statistically significant (SMD =-0.28, 95% CI: -0.58 to 0.01, Z=-1.866, P=0.062). CT resulted in less time to return to normal diet after surgery than ET, and the difference was statistically significant (SMD =-0.36, 95% CI: -0.60 to -0.12, Z=-2.918, P=0.004). DISCUSSION CT resulted in less intraoperative blood loss and faster postoperative recovery than ET, but there was no significant difference in operation time, postoperative pain, and the incidence rate of postoperative complications between the 2 groups.
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Affiliation(s)
- Fu-Guo Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Wei Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Yu Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Shangrao People’s Hospital (Affiliated Shangrao Hospital to Nanchang University), Shangrao, China
| | - Ye-Song Liu
- Department of Otorhinolaryngology, Yancheng Third People’s Hospital (The Affiliated Yancheng Hospital of Southeast University Medical School), Yancheng, China
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Bou Sanayeh E, Idriss S, Farchakh Y, Hanna C, Hallit S, Romanos B. Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population. Int J Pediatr Otorhinolaryngol 2021; 143:110655. [PMID: 33639493 DOI: 10.1016/j.ijporl.2021.110655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities. METHODS A randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: "FLACC-R" (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and "Wong Baker faces" for older children. Additional post-operative outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales. RESULTS Significantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively. CONCLUSION When compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.
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Affiliation(s)
- Elie Bou Sanayeh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Samar Idriss
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Youssef Farchakh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Charlie Hanna
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; INSPECT-LB: National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon.
| | - Bassam Romanos
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon.
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Li J, Luo L, Chen W, Zhang J, Deng X, Liao L, Zeng X, Wang B. Application of Coblation Tonsillectomy with Inferior Pole Capsule Preservation in Pediatric Patients. Laryngoscope 2020; 131:1157-1162. [PMID: 32975857 DOI: 10.1002/lary.29089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the application and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric patients with tonsillar hypertrophy and recurrent tonsillitis. STUDY DESIGN Retrospective chart review. METHODS A total of 726 children who were diagnosed with either tonsillar hypertrophy or recurrent tonsillitis were included. Children were divided into two groups according to the surgical technique: conventional coblation tonsillectomy and coblation tonsillectomy with inferior pole capsule preservation. The duration of surgery, intraoperative hemorrhage volume, and postoperative pain, as well as postoperative hemorrhage data in the format of time, location, and degree were compared between the two groups. RESULTS Of the 726 children included, conventional coblation tonsillectomy was performed in 320 children, coblation tonsillectomy with inferior pole capsule preservation was performed in 406 children. There were no significant differences in duration of surgery or intraoperative hemorrhage volume between the two groups. Children who underwent coblation tonsillectomy with inferior pole capsule preservation showed a remarkable improvement in postoperative pain on days 3 and 5 postoperatively. Additionally, the coblation tonsillectomy with inferior pole capsule preservation group exhibited a significantly lower total postoperative hemorrhage rate, secondary hemorrhage rate, and hemorrhage rate in the inferior pole compared with that in the conventional coblation tonsillectomy group. During the 1-year follow-up period, no cases of tonsillar re-hypertrophy or recurrent tonsillitis were observed in either group. CONCLUSION For pediatric tonsillar hypertrophy and recurrent tonsillitis, coblation tonsillectomy with inferior pole capsule preservation is a safe and effective technique, capable of reducing postoperative pain and hemorrhage, especially secondary hemorrhage at the inferior pole. LEVEL OF EVIDENCE 3b Laryngoscope, 131:1157-1162, 2021.
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Affiliation(s)
- Jingjia Li
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lixia Luo
- Department of Nosocomial Infection Control, The First People's Hospital of Foshan, Foshan, China
| | - Weixiong Chen
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jianli Zhang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xuequan Deng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lieqiang Liao
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xianping Zeng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Bin Wang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
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McCoy JL, Maguire RC, Tobey ABJ. Cost benefit of coblation versus electrocautery adenotonsillectomy for pediatric patients. Int J Pediatr Otorhinolaryngol 2020; 136:110197. [PMID: 32604002 PMCID: PMC7429248 DOI: 10.1016/j.ijporl.2020.110197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/08/2020] [Accepted: 06/10/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Coblation and electrocautery are two common techniques used for adenotonsillectomy (T&A). Numerous studies have assessed surgical outcomes of coblation versus electrocautery and overall, postoperative complications are similar with the exception of a decrease in patient reported postoperative pain for coblation. Instrumentation required for coblation is significantly more expensive than that required for electrocautery. With minimal outcome differences, justification for the additional instrumentation costs is difficult. We performed this study to assess if there is a difference between operative & postoperative costs of electrocautery and coblation. METHODS 300 patient medical records were reviewed from 2015 to 2017 with equal numbers of electrocautery and coblation surgeries. Outcome measures included finance information, duration and cost of OR and Phase I and Phase II post-anesthesia care unit (PACU), in-hospital pharmacy costs, and postoperative complications. Logistic regression was used for analysis. RESULTS The median patient age for each surgical technique was 6 years old. Electrocautery resulted in more time in the OR compared to coblation, (OR:1.11,95%CI:1.07-1.15, p < .001), with greater associated costs, p < .001. Electrocautery patients were under anesthesia longer and had a longer surgical duration, p < .001. These same patients had longer duration in Phase II PACU, p = .028, and were given pain medications an increased number of times, p < .001. Total costs including operative expense, physician charges, OR and anesthesia times, pharmacy, and instrument were significantly higher for electrocautery patients, p = .003. There were no differences in ED visits, post-tonsillectomy bleed, or additional surgery between techniques, p > .05. CONCLUSION T&A electrocautery technique was found to have increased overall indirect costs. Costs of instrumentation in addition to increased operative time, use of analgesics and post-operative care contribute to costs associated with electrocautery and coblation should be used when assessing surgical costs.
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Affiliation(s)
- Jennifer L. McCoy
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh PA
| | - Raymond C. Maguire
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh PA,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Allison B. J. Tobey
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh PA,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh PA
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