1
|
Sedgwick MJ, Saunders C, Bateman N. Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta-Analysis. OTO Open 2023; 7:e22. [PMID: 36998549 PMCID: PMC10046729 DOI: 10.1002/oto2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 02/19/2023] Open
Abstract
Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English-language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta-analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5-5.9; p < .0001), 4.1 (95% CI 2.7-5.4; p < .0001), 3.5 (95% CI 1.7-5.4; p = .0002) and 2.8 (95% CI 1.6-4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16-0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19-1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.
Collapse
Affiliation(s)
| | | | - Neil Bateman
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's HospitalManchester University Hospitals NHS Foundation TrustManchesterUK
| |
Collapse
|
2
|
Amin N, Lakhani R. Intracapsular versus extracapsular dissection tonsillectomy for adults: A systematic review. Laryngoscope 2019; 130:2325-2335. [PMID: 31782813 DOI: 10.1002/lary.28435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Tonsillectomy is an extremely common ENT surgical procedure. There is a growing interest in the role of intracapsular dissection tonsillectomy (ICDT) due to reported reduced perioperative complications. We aim to compare the outcomes associated with ICDT versus traditional extracapsular dissection tonsillectomy (ECDT) in the adult population. METHODS Systematic review of all randomized controlled trials (RCTs) comparing ICDT and ECDT for all indications in the adult population. Electronic searches performed through CENTRAL, PubMed, Ovid EMBASE, Web of Science, ClinicalTrials.gov, and WHO ICTRP. Review Manager 5.3 (RevMan 2014) was used to carry out the meta-analysis. RESULTS Nine RCTs were included with a total of 11 reports with mean age of 23.9 years including 181 patients who received ICDT compared to 176 patients receiving ECDT. We found statistically significant reduced postoperative pain and analgesia requirement as well as a reduced rate of secondary postoperative bleeding in patients undergoing ICDT versus ECDT. There appears to be no significant difference in controlling recurrent tonsillitis between the ICDT and ECDT groups. CONCLUSION Across the recorded outcomes we noted no clear benefit to performing ECDT over ICDT and evidence suggests high patient satisfaction with ICDT. Laryngoscope, 130:2325-2335, 2020.
Collapse
Affiliation(s)
- Nikul Amin
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Raj Lakhani
- ENT Department, St George's University Hospital and Epsom Hospital, London, United Kingdom
| |
Collapse
|
3
|
Basu S, Sengupta A, Dubey AB, Sengupta A. Harmonic Scalpel Versus Coblation Tonsillectomy A Comparative Study. Indian J Otolaryngol Head Neck Surg 2019; 71:498-503. [PMID: 31750110 DOI: 10.1007/s12070-019-01679-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022] Open
Abstract
Tonsillectomy is an age old procedure in ENT practice. Though traditional dissection method is gold standard, we surgeons are trying different techniques like electrocautery, coblation, harmonic scalpel (HS) mainly to improve surgical convenience, to decrease operative time, post operative pain, intra and post operative bleeding and fast return to normal life. In this particular study we are comparing coblation and HS as surgical tool in tonsillectomy. It is a prospective double-blind randomized controlled trial where information was compared between two groups of coblation and HS tonsillectomy. A total number of 128 patients were compared over operation time, intra-operative blood loss, postoperative pain, time needed to regain the normal diet and activity and postoperative haemorrhage. We found statistically significant differences in operation time (p < 0.001) and intra operative blood loss (p < 0.001). Secondary haemorrhage rate was far better in HS (1.5%) group compared to coblation (7.8%). Whereas postoperative pain, time needed to go back to the normal diet and activity were better in HS group but the difference is not significant. This study revealed a significantly less operative time and intra-operative and post operative blood loss in harmonic scalpel tonsillectomy in comparison with coblation method. These findings addressed HS tonsillectomy as an advanced method.
Collapse
Affiliation(s)
- Soumik Basu
- Department of Ent Head Neck Surgery, Institute of Postgraduate Medical Education Research, 244 AJC Bose Road, Kolkata, 700020 India
| | - Anindita Sengupta
- Department of Ent Head Neck Surgery, Institute of Postgraduate Medical Education Research, 244 AJC Bose Road, Kolkata, 700020 India
| | - Arya Brata Dubey
- Department of Ent Head Neck Surgery, Institute of Postgraduate Medical Education Research, 244 AJC Bose Road, Kolkata, 700020 India
| | - Arunabha Sengupta
- Department of Ent Head Neck Surgery, Institute of Postgraduate Medical Education Research, 244 AJC Bose Road, Kolkata, 700020 India
| |
Collapse
|
4
|
Belov SV, Danyleiko YK, Egorov AB, Osmanov EG, Salyuk VA. Plasma Glow Discharge as a Tool for the Dissection and Coagulation of Biological Tissues. BIOMEDICAL ENGINEERING 2019. [DOI: 10.1007/s10527-019-09836-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Wong Chung JERE, van Benthem PPG, Blom HM. Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review. Acta Otolaryngol 2018; 138:492-501. [PMID: 29241412 DOI: 10.1080/00016489.2017.1412500] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Tonsillotomy has emerged as an alternative for tonsillectomy in treating patients with tonsil-related afflictions. Tonsillotomy provides favourable outcomes in children, but treatment of choice in adults remains unclear. This systematic review sought to evaluate the current literature on the efficacy and adverse events of tonsillotomy compared to tonsillectomy in adults. METHODS A Medline and Cochrane search was conducted for randomized clinical trials (RCTs) and cohort studies comparing tonsillotomy to tonsillectomy in adults. Risk of bias was assessed. Outcome measures were efficacy of the procedure in resolving the initial tonsil-related symptoms (tonsillitis, obstructive sleep apnoea, tonsil stones, halitosis, dysphagia), procedure-related complications, recovery time, post-operative use of analgesics, patient satisfaction, and operating time. RESULTS In total nine papers were included. These trials had a high risk of bias and the inter-comparability of results was poor. The reported studies found generally a similar efficacy for both interventions. With regard to pain, the use of analgesics, patient satisfaction and operation time, the results were generally in favour of tonsillotomy. Post-operative haemorrhages were more frequent after tonsillectomy. CONCLUSION Current evidence suggests an equal efficacy of tonsillotomy and tonsillectomy in adults and a preference for tonsillotomy in terms of pain, analgesics use, patient-satisfaction, operation time and post-operative complications.
Collapse
Affiliation(s)
- Justin E. R. E. Wong Chung
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
- Department of Otolaryngology Head and Neck Surgery, HagaZiekenhuis, the Hague, The Netherlands
| | - Peter Paul G. van Benthem
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
| | - Henk M. Blom
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
- Department of Otolaryngology Head and Neck Surgery, HagaZiekenhuis, the Hague, The Netherlands
| |
Collapse
|
6
|
El-Taher M, Aref Z. Coblation Versus Conventional Tonsillectomy: A Double Blind Randomized Controlled Trial. Indian J Otolaryngol Head Neck Surg 2017; 71:172-175. [PMID: 31741955 DOI: 10.1007/s12070-017-1189-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022] Open
Abstract
Post tonsillectomy bleeding and pain are two main problems following traditional tonsillectomy. Coblation therapy (controlled ablation) was first used in tonsillectomy in 2001. A great amount of literature debated around its use with controversial opinions regarding its benefits, efficacy, and cost. This is a prospective double-blind randomized controlled study that compares between coblation tonsillectomy and conventional tonsillectomy as regard operative time, operative blood loss, time needed to return back to the normal activity and diet, and incidence of postoperative hemorrhage whether primary or secondary. The study included 1004 patients with mean age of 10.4 years (range from 4 to 35 years). The first group (coblation tonsillectomy group) included 507 patients, age ranging from 4 to 35 years with mean age 15.1 year. This group included 277 female (54.6%) and 230 male (45.4%). The second group (conventional tonsillectomy group) included 497 patients, age ranging from 4 to 24 years and mean age 14.7 years. This group included 274 female (55.1%) and 223 male (44.9%). Coblation tonsillectomy offers significant advantages over dissection method with less operative time, decreased intraoperative blood loss, early restoration of daily activities and normal diet. However coblation tonsillectomy is associated with a higher incidence of secondary hemorrhage.
Collapse
Affiliation(s)
| | - Zaki Aref
- 2South Valley University Hospital, Qena, Egypt
| |
Collapse
|
7
|
Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017; 8:CD004619. [PMID: 28828761 PMCID: PMC6483696 DOI: 10.1002/14651858.cd004619.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven. OBJECTIVES To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2017, Issue 3); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 April 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) of children and adults undergoing tonsillectomy with coblation compared with any other surgical technique. This review is limited to trials of extracapsular (traditional) tonsillectomy and excludes trials of intracapsular tonsil removal (tonsillotomy). DATA COLLECTION AND ANALYSIS We used the standard Cochrane methods. Our primary outcomes were: patient-reported pain using a validated pain scale at postoperative days 1, 3 and 7; intraoperative blood loss; primary postoperative bleeding (within 24 hours) and secondary postoperative bleeding (more than 24 hours after surgery). Secondary outcomes were: time until resumption of normal diet, time until resumption of normal activity, duration of surgery and adverse effects including blood transfusion and the need for reoperation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included 29 studies, with a total of 2561 participants. All studies had moderate or high risk of bias. Sixteen studies used an adequate randomisation technique, however the inability to mask the surgical teams and/or provide adequate methods to mitigate the risk of bias put nearly all studies at moderate or high risk of detection and measurement bias for intraoperative blood loss, and primary and secondary bleeding. In contrast most studies (20) were at low risk of bias for pain assessment. Most studies did not report data in a manner permitting meta-analysis.Most studies did not clearly report the participant characteristics, surgical indications or whether patients underwent tonsillectomy or adenotonsillectomy. Most studies reported that tonsillitis (infection) and/or tonsillar hypertrophy (obstruction) were the indication for surgery. Seven studies included only adults, 16 studies included only children and six studies included both. Pain At postoperative day 1 there is very low quality evidence that patients in the coblation group had less pain, with a standardised mean difference (SMD) of -0.79 (95% confidence interval (CI) -1.38 to -0.19; 538 participants; six studies). This effect is reduced a SMD of -0.44 (95% CI -0.97 to 0.09; 401 participants; five studies; very low-quality evidence) at day 3, and at day 7 there is low quality evidence of little or no difference in pain (SMD -0.01, 95% CI -0.22 to 0.19; 420 participants; five studies). Although this suggests that pain may be slightly less in the coblation group between days 1 and 3, the clinical significance is unclear. Intraoperative blood loss Methodological differences between studies in the measurement of intraoperative blood loss precluded meta-analysis. Primary and secondary bleeding The risk of primary bleeding was similar (risk ratio (RR) 0.99, 95% CI 0.48 to 2.05; 2055 participants; 25 studies; low-quality evidence). The risk of secondary bleeding was greater in the coblation group with a risk ratio of 1.36 (95% CI 0.95 to 1.95; 2118 participants; 25 studies; low-quality evidence). Using the median of the control group as the baseline risk, the absolute risk in the coblation group was 5% versus 3.6% in the control group. The difference of 1.3% has a 95% CI of 0.2% lower in the coblation group to 3.5% higher. Secondary outcomes Differences in study design and data reporting precluded the identification of differences in the time to resumption of normal diet or activity, or whether there was a difference in the duration of surgery.Although we could not feasibly compare the costs of equipment or operative facility, anaesthetic and surgical fees across different healthcare systems we used duration of surgery as a proxy for cost. Although this outcome was commonly reported in studies, it was not possible to pool the data to determine whether there was a difference.Adverse events other than bleeding were not well reported. It is unclear whether there is a difference in postoperative infections or the need for reoperation. AUTHORS' CONCLUSIONS The coblation technique may cause less pain on postoperative day 1, but the difference is small and may be clinically meaningless. By postoperative day 3, the difference decreases further and by postoperative day 7 there appears to be little or no difference. We found similar rates of primary bleeding but we cannot rule out a small increased risk of secondary bleeding with coblation. The evidence supporting these findings is of low or very low quality, i.e. there is a very high degree of uncertainty about the results. Moreover, for most outcomes data were only available from a few of the 29 included studies.The current evidence is of very low quality, therefore it is uncertain whether or not the coblation technique has any advantages over traditional tonsillectomy techniques. Despite the large number of studies, failure to use standardised or validated outcome measures precludes the ability to pool data across studies. Therefore, well-conducted RCTs using consistent, validated outcome measures are needed to establish whether the coblation technique has a benefit over other methods. In the included studies we identified no clear difference in adverse events. However, given the rarity of these events, randomised trials lack the power to detect a difference. Data from large-scale registries will provide a better estimate of any difference in these rare outcomes.
Collapse
Affiliation(s)
- Melissa Pynnonen
- Taubman CenterDepartment of Otolaryngology ‐ Head and Neck Surgery1500 E Medical Center DriveAnn ArborMichiganUSA
| | - Jennifer V Brinkmeier
- Saint Louis University School of MedicineOtolaryngology ‐ Head and Neck Surgery1465 S. Grand BoulevardRoom B‐826Saint LouisMissouriUSA63104
| | - Marc C Thorne
- Taubman CenterDepartment of Otolaryngology ‐ Head and Neck Surgery1500 E Medical Center DriveAnn ArborMichiganUSA
| | | | | | | |
Collapse
|
8
|
|
9
|
Abstract
Objectives: We performed a prospective study to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) in adults and children who underwent Coblation tonsillectomy (CTE) under general anesthesia. Methods: The data of 63 adults and children (mean age, 21.8 years) were analyzed. Results: There were 7 episodes of considerable bleeding (11.1%) that required surgical treatment under general anesthesia in 6 patients, of whom 5 experienced secondary bleeding (>24 hours). Moreover, bleeding and massive swelling of the pharynx required surgical treatment and prolonged intubation (35 hours) in 1 patient. None of the patients received blood transfusions. There was no case with a lethal outcome. Less intense bleeding (clots; blood-tinged sputum) was observed in 17 patients (27%) who required readmission or prolonged inpatient observation, 1 of whom had previously undergone surgical treatment of PTH. However, these 17 patients had an uneventful clinical course. In total, 22 patients experienced minor or major forms of PTH (34.9%). Conclusions: At least in our hands, CTE dramatically increased the frequency of PTH. The high rate of secondary bleeding contrasts with our documented experience using conventional methods, ie, cold dissection and suture ligation, to achieve hemostasis (7.9% with CTE versus <0.8% with conventional methods). Therefore, at our institution, tonsillectomy with conventional instruments remains the method of choice.
Collapse
Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology-Plastic Head and Neck Surgery, St Anna Hospital, Duisburg, Germany
| | | | | |
Collapse
|
10
|
Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 2016; 273:989-1009. [DOI: 10.1007/s00405-016-3904-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
|
11
|
Recommandation de la SFORL (version courte) sur la prise en charge de la douleur post-amygdalectomie chez l’adulte. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.aforl.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
12
|
Guidelines (short version) of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:227-32. [PMID: 25106699 DOI: 10.1016/j.anorl.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The present clinical practice guidelines cover the entire field of management of post-tonsillectomy pain. Given the French and European regulatory restrictions on the use of codeine, an update appears necessary to clarify the management of post-tonsillectomy pain in adults. METHOD A work group approached the issue of pain management, following the chronological pathway from initial consultation to postoperative period. As exhaustive a study of the literature as possible assessed the pain impact of the various surgical techniques and the efficacy of the various analgesia schedules. RESULTS Guidelines on the management of post-tonsillectomy pain in adults were drawn up and graded, based on the levels of evidence of selected articles and on work group consensus. The guidelines stress the importance of patient information and seek to harmonize practice, reduce the risk of postoperative complications and above all improve control of post-tonsillectomy pain in adults.
Collapse
|
13
|
Windfuhr JP, Savva K, Dahm JD, Werner JA. Tonsillotomy: facts and fiction. Eur Arch Otorhinolaryngol 2014; 272:949-969. [DOI: 10.1007/s00405-014-3010-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/13/2014] [Indexed: 11/30/2022]
|
14
|
Windfuhr JP, Werner JA. Tonsillotomy: it's time to clarify the facts. Eur Arch Otorhinolaryngol 2013; 270:2985-96. [DOI: 10.1007/s00405-013-2577-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
15
|
Stelter K, Ihrler S, Siedek V, Patscheider M, Braun T, Ledderose G. 1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study. Eur Arch Otorhinolaryngol 2011; 269:679-84. [PMID: 21792687 DOI: 10.1007/s00405-011-1681-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/17/2011] [Indexed: 11/28/2022]
Abstract
In the last decade, tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. In a previous study, the tonsillotomy with laser or radiofrequency therapy proved as a safe and effective procedure with minimal pain and hemorrhage. This follow-up study determines which method is more effective with respect to long-term outcome, recurrence of tonsillar hyperplasia and recurrence of tonsillitis. A prospective, randomised, double-blinded controlled clinical study was conducted at the Department of Otorhinolaryngology of the Ludwig-Maximilians-University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Tonsillotomy was performed on one side with monopolar radiofrequency and on the other side with a carbon dioxide laser. Exactly 1 year after the procedure, all 26 patients were documented by digital photography to define a possible recurrence of tonsillar hyperplasia. All parents were asked for occurring tonsillitis and fulfilled the Glasgow Children's Benefit Inventory (GCBI) for health-related quality of life after surgical procedures. In seven children, a slightly visible recurrence of the tonsillar hyperplasia occurred, without any symptoms or correlation to the different methods and sides. One child with recurrent tonsillitis and hyperplasia had to be tonsillectomized 8 months after the initial tonsillotomy procedure. The specimen showed open crypts with bacterial infection in the deep. The GCBI resulted in highly significant benefits of the surgery in all categories and subcategories. In conclusion, both methods, the laser tonsillotomy and the radiofrequency method, were equal concerning the effectiveness and safety after 1 year. Further investigations have to aim at the long-term outcome after tonsillotomy in patients with recurrent infections.
Collapse
Affiliation(s)
- Klaus Stelter
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre of Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
16
|
Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011; 268:807-16. [PMID: 21373898 PMCID: PMC3087106 DOI: 10.1007/s00405-011-1535-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/07/2011] [Indexed: 11/09/2022]
Abstract
After the surgical procedure of tonsillectomy, hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using the coblation technique. 24 prospective, randomized, and controlled studies were included in the meta-analysis. Data of 796 patients who had undergone coblation tonsillectomy were analyzed. Hemorrhages occurred in 33 patients: 2 classified as primary and 26 as secondary hemorrhages. 5 could not be classified into either group. Overall, the total hemorrhage rate for the coblation procedure was 4.1% with a 95% confidence interval from 2.8 to 5.5%. The overall hemorrhage rate of 4.1% found in this meta-analysis shows that coblation is a safe and effective technique for tonsillectomies with a secondary bleeding rate similar to what is reported for comparable techniques such as bipolar diathermia.
Collapse
|
17
|
Wilson YL, Merer DM, Moscatello AL. Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope 2009; 119:162-70. [PMID: 19117287 DOI: 10.1002/lary.20024] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate three current tonsillectomy techniques--intracapsular microdebridement, intracapsular coblation, and traditional extracapsular electrocautery dissection--comparing surgical parameters, efficacy, and morbidity in the treatment for obstructive sleep disordered breathing in children. STUDY DESIGN Prospective, double-blinded study with follow-up by telephone interview. METHOD From February 2004 to July 2006, a total of 156 patients between the ages of 6 months and 22 years scheduled for adenotonsillectomy were randomly assigned to electrocautery, coblator, and microdebrider groups. OUTCOME MEASURES 1) Patient demographics; 2) Intraoperative time; 3) Surgeon's perception of difficulty; 4) Indicators of postoperative morbidity: pain, use of pain medication, return to diet, and activity level; 5) Complications; 6) Cost. RESULTS Microdebrider technique produced the shortest total surgical time, averaging 16 minutes. Use of coblation resulted in 2 less days of pain medication compared to electrocautery. Patients in the coblator and microdebrider groups returned to a normal diet 1.51 days and 1.77 days earlier, respectively, than in the electrocautery group. They also returned to preoperative activity levels 1.85 days and 2.06 days earlier than in the electrocautery group. Of all three methods, the microdebrider was the most cost effective. The coblator and microdebrider did not differ significantly from each other in all other parameters. The three techniques showed no statistically significant difference in assessment of difficulty, average pain scores, or postoperative complications. CONCLUSIONS Postoperative recovery following intracapsular adenotonsillectomy in children with obstructive sleep apnea is significantly earlier with use of either the coblator or microdebrider versus traditional extracapsular tonsillectomy with electrocautery. Microdebrider and coblator were comparable in all other areas except for shorter operative time and less cost for the microdebrider.
Collapse
Affiliation(s)
- Yushan L Wilson
- Department of Otolaryngology, New York Eye and Ear Infirmary, New York, New York 10003, USA
| | | | | |
Collapse
|
18
|
Korkmaz O, Bektas D, Cobanoglu B, Caylan R. Partial tonsillectomy with scalpel in children with obstructive tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2008; 72:1007-12. [PMID: 18439689 DOI: 10.1016/j.ijporl.2008.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 03/03/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare postoperative pain of partial tonsillectomy (PT) with scalpel and total classical tonsillectomy (TT). METHODS Prospective, randomized study at a tertiary care institution. Ninety-six children who were diagnosed with obstructive tonsillar hypertrophy were included to the study. Children's tonsils were removed totally (Group TT) by classical dissection tonsillectomy or partially (Group PT) using scalpel and tissue scissors. The parents were instructed to fill out a form daily for nine postoperative days; recording total amount of analgesics administered that day and a Visual Analog Scale (VAS) each day assessing child's life quality and daily activities. RESULTS Eighty-one children (2-14 years old) who completed the study were included in the analysis. Total tonsillectomy group (Group TT) consisted of 41 patients and partial tonsillectomy group (Group PT) consisted of 40 patients. There was no difference between two groups' operative parameters such as operation time [21.3 min (PT) and 22.3 min (TT)] and blood loss [44.2 ml (PT) and 46.0 ml (TT)] (p>0.05). PT group received significantly less dosage of analgesics per day; 1.18+/-1.27 vs. 2.00+/-1.45 (p<0.005). Total used analgesic dose in PT group were also lower than TT group (10.7+/-7.13 vs. 18.02+/-6.99 doses). When each day's analgesic use was compared separately a significant difference was found (p<0.05) in all days except 9th postoperative day (p>0.05). There was no difference in the pain scores between two techniques (p>0.05). CONCLUSION Unlike tonsillectomy, PT aims to remove the tonsilla palatina subtotally. It is especially performed in children with obstructive tonsils. PT with scalpel is an inexpensive and safe method necessitating only standard surgical instruments. It causes less postoperative pain than classical dissection tonsillectomy.
Collapse
Affiliation(s)
- Omer Korkmaz
- Department of Otolaryngology, KTU Medical School, Trabzon, Turkey
| | | | | | | |
Collapse
|
19
|
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. [PMID: 17651267 DOI: 10.1111/j.1365-2273.2007.01468.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. DESIGN A prospective, single blind, randomised controlled trial. SETTING ENT clinic, University Teaching Hospital. PARTICIPANTS Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. METHODS Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. MAIN OUTCOME MEASURES Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit. RESULTS The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. CONCLUSION In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.
Collapse
Affiliation(s)
- S Mitic
- ENT Department, Akershus University Hospital, Oslo, Norway.
| | | | | | | |
Collapse
|
20
|
Randomized study comparing postoperative pain between coblation and bipolar scissor tonsillectomy. Eur Arch Otorhinolaryngol 2007; 265:817-20. [PMID: 18034258 DOI: 10.1007/s00405-007-0537-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
Abstract
Coblation tonsillectomy has shown promising results with respect to postoperative pain when compared with other techniques. Our study was designed to compare this technique with bipolar scissor tonsillectomy. Forty adult patients with a history of chronic or recurrent tonsillitis referred for standard tonsillectomy were recruited and randomized into two groups. Twenty were operated with Coblator and 20 with bipolar scissors. Exclusion criteria were a history of quinsy, bleeding disorder, or any major health problems. All participants completed the study. Postoperative pain, return to normal diet, and estimated need for sick leave were utilized as parameters. Data on operative time, difficulty of tissue removal, and hemostasis were also analyzed. Operative time was longer (P < 0.001) and tissue removal as well as hemostasis control were more difficult (P = 0.005, P = 0.013) with Coblator than with bipolar scissors. Participants in Coblator group assessed higher pain scores 1 and 3 h postoperatively (P = 0.044, P = 0.036). From the time of extubation, patients had access to an opioid (fentanyl) via a self-controlled analgesia device. The number of doses of analgesics needed during the hospital stay was significantly higher in the Coblator group (P = 0.020). During the 14-day follow-up, no significant differences were found in pain scores, return to solid food or subjective working ability between the groups. Considering the overall outcome of the patients the results did not favor coblation technique over bipolar scissors.
Collapse
|
21
|
Abstract
BACKGROUND The introduction of coblation tonsillectomy (CTE) may contribute to reduce the postoperative morbidity in terms of pain, delayed oral intake and bleeding. METHODS A prospective pilot study was undertaken to evaluate the clinical course by inpatient observation (5 days) and telephone contact 6 months after CTE. The data from 61 patients (aged 44 months-69 years) were analyzed. The patients were grouped into those with surgical care of bleeding (A), non-surgical care of bleeding (B), and no bleeding event (C). RESULTS The study was terminated early due to major bleeding complications in seven patients (A). Fifteen patients experienced minor (B) and 41 no (C) bleeding episodes. In the interview, 29 patients identified pain, lasting 16.7 (A), 11.6 (B) and 11 (C) days, as the most significant complication of surgery. CONCLUSIONS The introduction of CTE was followed by a dramatic increase in major bleeding complications, including late bleeding episodes. Pain following tonsillectomy remains a problem to be solved by further techniques. We will continue to perform the cold dissection technique.
Collapse
Affiliation(s)
- J P Windfuhr
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser-Krankenhaus St. Anna, Duisburg, Germany.
| | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND Tonsillectomy is one of the most commonly performed surgical procedures. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVES To assess the effectiveness of coblation tonsillectomy compared with other surgical techniques in reducing morbidity. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to 2006) and EMBASE (1974 to 2006). The date of the last search was December 2006. SELECTION CRITERIA Randomised controlled trials of children and adults undergoing tonsillectomy by means of coblation compared with any other surgical technique for removal of the tonsils. Trials were assessed for methodological quality according to the method outlined in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. DATA COLLECTION AND ANALYSIS Data were extracted using standardised data extraction forms. Authors were contacted where additional data were required. MAIN RESULTS Nineteen studies were identified with sufficient data for further assessment. Four of these were excluded because intra-capsular tonsillectomy (i.e. tonsillotomy) rather than sub-capsular tonsillectomy was performed, and a further five studies because tonsils rather than participants were randomised. One further study was excluded because, although describing itself as a randomised trial, its participants turned out not to have been randomised to their intervention groups. Nine trials met the inclusion criteria, comparing coblation to other tonsillectomy techniques. All but two studies were of low quality and therefore a meta-analytical approach was not appropriate. In most studies, when considering most outcomes, there was no significant difference between coblation and other tonsillectomy techniques. AUTHORS' CONCLUSIONS In terms of postoperative pain and speed and safety of recovery, there is inadequate evidence to determine whether coblation tonsillectomy is better or worse than other methods of tonsillectomy. Evidence from a large prospective audit suggests that it has been associated with a higher level of morbidity, in terms of postoperative bleeding. Large, well-designed randomised controlled trials supplemented by data from large prospective audits are needed to produce information on effectiveness and morbidity respectively.
Collapse
Affiliation(s)
- M J Burton
- Cochrane ENT Disorders Group, Department of Otolaryngology - Head and Neck Surgery, Level LG1, West Wing, John Radcliffe Hospital, Oxford, UK, OX3 9DU.
| | | |
Collapse
|
23
|
Abstract
BACKGROUND Controversy surrounds the question of which technique should be preferred for tonsillectomy in order to reduce postoperative morbidity in terms of pain, bleeding, activity and return to normal diet. This study reviews the current literature on coblation tonsillectomy (CTE). MATERIALS AND METHODS All studies published in peer-reviewed journals reporting postoperative morbidity following CTE until July 2006 were included in our study. RESULTS A total of 21 studies matched our search criteria but there were excluded from further analysis because coblation was used only for volume reduction of the tonsils. Reduced morbidity was registered in eight studies, two could not identify any difference and five studies reported an increased postoperative morbidity. Seven different surgical procedures were compared in 17 studies to CTE. The patients were not followed-up in four studies and the follow-up exceeded 1 week in nine studies only. Wound inspection was performed in four studies and a better wound healing reported in two of these, but by the same authors. Postoperative bleeding requiring surgical treatment under general anaesthesia occurred with an incidence of 0% to 11.5%. Secondary bleeding (>24 h) prevailed in all but two studies. Postoperative pain was evaluated in ten studies with conflicting results. CONCLUSIONS The design of the current studies varies in size, age distribution, indications for surgery, the surgical techniques compared and follow-up. The results are heterogenous and further evidence is still required to show that CTE is a safe alternative. Therefore, calculation of cost-effectiveness of a commonly performed expensive CTE as a new standard technique is currently impossible.
Collapse
Affiliation(s)
- J P Windfuhr
- Klinik für HNO-Krankheiten; Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser Krankenhaus St. Anna, Duisburg.
| |
Collapse
|
24
|
Herzog C. [Coblations-tonsillectomy]. HNO 2007; 55:333; author reply 333-6. [PMID: 17406844 DOI: 10.1007/s00106-006-1449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Shah UK, Dunham B. Coblation for Tonsillectomy: An Evidence-Based Review. ACTA ACUST UNITED AC 2007; 69:349-57. [DOI: 10.1159/000108367] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
26
|
Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy Techniques and Pain: A Review of Randomized Controlled Trials and Call for Standardization. ACTA ACUST UNITED AC 2007; 69:364-70. [DOI: 10.1159/000108369] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
27
|
Abstract
Radiofrequency coblation is a new technology that is finding favour as a method for performing tonsillectomy. Its benefits include reduced pain and postoperative morbidity but there is controversy regarding possible increased postoperative haemorrhage rates.
Collapse
|
28
|
Moorthy R, Scott A. Double-blind randomized control trial of coblation tonsillotomy versus coblation tonsillectomy on post-operative pain in children. Clin Otolaryngol 2005; 30:571; author reply 572-3. [PMID: 16402993 DOI: 10.1111/j.1749-4486.2005.01116.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Arya AK, Donne A, Nigam A. Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain in children. Clin Otolaryngol 2005; 30:226-9. [PMID: 16111417 DOI: 10.1111/j.1365-2273.2005.00970.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to establish if children experienced any difference in pain, between coblation tonsillectomy and coblation tonsillotomy. DESIGN A double-blind randomized controlled trial was performed. SETTING District general hospital department of Otolaryngology. PARTICIPANTS Eighteen children listed for tonsillectomy were recruited into the study. Each was randomly assigned either tonsillotomy or tonsillectomy in the right tonsil. The contralateral tonsil was removed by the other method. In the first 24-h period (while in hospital) the children were interviewed at 2, 5, 10 and 24 h to quantify the pain they perceived in right and left sides. There was a four point visual analogue scoring system for monitoring pain. The power of the study was 80%. In this study the patients were their own controls. MAIN OUTCOME MEASURES Visual analogue pain scores were plotted against time and the area under the curves was calculated (AUC). RESULTS The AUC mean difference was 0.47. A t-test for the difference gives a P-value of 0.85 and a 95% confidence interval for difference is -0.79 to 5.73, which clearly contains zero. Using AUC as a combined pain score there is no statistically significant difference between tonsillotomy and tonsillectomy (power value of 80%). CONCLUSIONS There is no demonstrable statistical difference between techniques when measuring pain experienced by children in the 24-h postoperative period.
Collapse
Affiliation(s)
- A K Arya
- Department of Otolaryngology, Head and Neck Surgery, Blackpool Victoria Hospital, UK.
| | | | | |
Collapse
|
30
|
Philpott CM, Wild DC, Mehta D, Daniel M, Banerjee AR. A double-blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post-operative symptoms. Clin Otolaryngol 2005; 30:143-8. [PMID: 15839866 DOI: 10.1111/j.1365-2273.2004.00953.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare postoperative symptoms following coblation tonsillectomy with those experienced following a traditional cold dissection. DESIGN A prospective randomized controlled trial. SETTING Secondary otorhinolaryngology care. PARTICIPANTS Ninety-two adult patients with recurrent tonsillitis meriting tonsillectomy were recruited and randomly allocated into either coblation or cold dissection tonsillectomy groups. MAIN OUTCOME MEASURES Primary outcomes were post-operative pain, otalgia, swallowing and analgesia use at 6-8 hours, 1, 3, 7 and 14 days post-operative. Secondary outcomes were post-operative day returned to eating and returned to normal activities/work. RESULTS No significant differences between the two groups (P >or= 0.1) were found in any of the above primary outcomes, apart from swallowing at 6-8 hrs post-operatively where the cold dissection group had less pain. This group also returned earlier to normal eating (P = 0.03). The power of the study was sufficient to show a difference in the visual analogue scores of 2 between groups. CONCLUSIONS The use of coblation to perform tonsillectomy does not confer any symptomatic benefits to the patient over conventional cold dissection tonsillectomy.
Collapse
Affiliation(s)
- C M Philpott
- Department of Otorhinolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | | | | | | | | |
Collapse
|
31
|
Abstract
The bipolar scissors, coblator, harmonic scalpel, and somnoplasty techniques are widely available and offer new choices for the operating arena. There are advantages and disadvantages to all four techniques. With time, these dissection methods will prove their lasting power. Otolaryngologists have already begun to expand their applications and will surely play a role in their use and development.
Collapse
Affiliation(s)
- Thomas Carroll
- Department of Otolaryngology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B 205, Denver, CO 80262, USA.
| | | | | |
Collapse
|
32
|
Chang KW. Randomized controlled trial of Coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005; 132:273-80. [PMID: 15692541 DOI: 10.1016/j.otohns.2004.11.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the postoperative recovery of patients receiving Coblation-assisted (Arthrocare, Sunnyvale, CA) intracapsular tonsillectomy with that of patients receiving traditional subcapsular electrocautery tonsillectomy. STUDY DESIGN AND SETTING This was a prospective, randomized, double-blinded, controlled study. One hundred one children, aged 2 to 16 years, were randomized to Coblation or to conventional electrocautery tonsillectomy. Only patients with the operative indication of obstructive sleep apnea were entered into the study. Intracapsular tonsillectomy was performed on the Coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcome measures were assessed on days 1, 3, and 5 after surgery. These included child and parental rating of pain by using the Wong Faces pain scale, analgesic use, oral intake, and activity level. Patients, parents, and the nurse practitioner obtaining the outcome data were blinded to treatment arm. RESULTS Treatment groups were similar in age, gender, and weight. Surgical time and estimated blood loss were similar. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percentage of normal activity level returned to >70% earlier and more frequently in Coblation patients. There was slightly decreased analgesic use on postoperative day 5 in the Coblation group. CONCLUSIONS AND SIGNIFICANCE Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery after Coblation-assisted intracapsular tonsillectomy.
Collapse
Affiliation(s)
- Kay W Chang
- Division of Pediatric Otolarnygology, Lucile Packard Children's Hospital at Stanford, CA, USA.
| |
Collapse
|