Radiofrequency coblation tonsillectomy

Trans-nasal Endoscopic Sphenopalatine Artery Ligation in Epistaxis: Coblation Versus Electrocauterization

Epistaxis is one of the most common emergencies encountered by otorhinolaryngologist. Although anterior epistaxis is easy to manage but posterior epistaxis is usually refractory. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) is now a well established surgical technique for the management of refractory epistaxis. Electrocauterization and clipping are the most common methods used for ligation. Coblation is an upcoming tool with promising results in endoscopic skull base surgeries and tonsillectomies but has not been explored much in TESPAL. It was a randomised observational study.50 patients of refractory epistaxis were included in the study. The patients were divided into 2 groups. Group A underwent TESPAL using electrocauterization while Group B underwent TESPAL using coblation. The data was collected and analysed for various parameters like experience of the surgeon, time taken for surgery, episodes of rebleeding and postoperative crusting. Out of 50 cases in our study 27 were males and 23 were females. Most common age group was 60-70 years (68%). Most common cause was hypertension (86%). Surgeons were happy 21/25 times in coblation group compared to 9/25 times in electrocauterization group. There were 4/25 rebleeding episodes in electrocauterization group compared to none in coblation group. Post-operative crusting was also less in coblation group compared to electrocauterization. Though electrocauterization is a well established method for TESPAL our experience with coblation in TESPAL has been extremely satisfying. We suggest our colleagues to conduct more research studies on use of coblation in TESPAL to reach a consensus.

Comparison of short-term recovery in children with obstructive sleep apnea undergoing tonsillotomy vs. tonsillectomy

OBJECTIVES

To compare the pain levels, degrees of pharyngeal swelling, and weight loss after tonsillectomy vs. tonsillotomy in children clinically diagnosed with obstructive sleep apnea (OSA) over the first seven postoperative days, and to determine which procedure was associated with better recovery in the early postoperative period.

METHODS

Between April 2021 and December 2021, 121 children with OSA (80 males and 41 females), ranging from 3 to 12 years of age with an average age of 6.7 years, were prospectively enrolled in this study conducted at Zhengzhou Central Hospital Affiliated to Zhengzhou University. The patients were randomly divided into two groups: a tonsillotomy group with 63 cases (40 males and 23 females) and a tonsillectomy group with 58 cases (40 males and 18 females). The patients' pain levels [as indicated by Parents' Postoperative Pain Measure (PPPM) scores] and degrees of pharyngeal swelling were recorded for seven days postoperatively, and the patients' body weights were recorded on postoperative day seven.

RESULTS

In the tonsillotomy group, the PPPM scores were the highest on the day of surgery and on the first postoperative day; the patients' pain levels gradually decreased.The PPPM scores in the tonsillectomy group were higher than those in the tonsillotomy group from the day of surgery to the seventh postoperative day (p < 0.05). The degree of pharyngeal swelling was lower in the tonsillotomy group than in the tonsillectomy group. Weight loss was lower in the tonsillotomy group than in tonsillectomy group on the 7th day after surgery (p < 0.05). On the fifth, sixth, and seventh postoperative days, compared with preschool children, school-age children who had undergone tonsillotomy experienced more pain relief than those who had undergone tonsillectomy (p < 0.05).

CONCLUSION

Children with OSA experienced less pain, less pharyngeal swelling, and less weight loss with tonsillotomy than with tonsillectomy. On the fifth, sixth, and seventh postoperative days, compared with preschool children, tonsillotomy in school-age children is more advantageous in school-age children.

Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy

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.

Clinical Effects of Radiofrequency Coblation for Adult Laryngopharyngeal Vascular Lesions

OBJECTIVE

To explore the feasibility and efficacy of transoral radiofrequency coblation surgery (TRS) in the treatment of adult laryngopharyngeal vascular lesion (LVL).

METHODS

A total of 15 patients with LVL were retrospectively studied, including 11 capillary lesions and five cavernous lesions (there was one case with two separate lesions). All of the lesions were treated with TRS alone (capillary lesion) or with a combination of TRS and sclerotherapy (cavernous lesion). The treatment efficacy was evaluated according to the modified Achauer criteria: grade 1, no change in size; grade 2, a decrease of < 50% in size; grade 3, a decrease of ≥ 50% but < 100%; and grade 4, the disappearance of the lesion with no recurrence for at least 6 months.

RESULTS

The surgical procedures were successfully completed in all patients. According to the modified Achauer criteria, the treatment outcomes were grade 4 for 10 capillary lesions and one cavernous lesion; grade 3 for one capillary lesion and one cavernous lesion; grade 2 for one cavernous lesion; and grade 1 for two cavernous lesions, respectively. No complications related to the surgery, including bleeding, dysphagia, and infections, occurred after treatment.

CONCLUSION

The TRS is an effective treatment option for LVL, especially for patients with laryngopharyngeal capillary lesions.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:566-570, 2021.

Emerging Roles of Coblation in Rhinology and Skull Base Surgery

Coblation is a technology that incorporates bipolar radiofrequency energy to ablate tissue at relatively low temperatures. Its use for sinonasal surgery is actively being investigated, including applications for turbinate reduction, sinus surgery, skull base surgery, and adenoidectomy. Potential benefits include reduction in blood loss, improved endoscopic surgical visualization, and reduction in postoperative pain. The main drawbacks are its relatively high cost, potential adverse effects on functional epithelium, and relative paucity of long-term outcomes.

Coblation for epistaxis management in patients with hereditary haemorrhagic telangiectasia: a multicentre case series

Objective:

To propose radiofrequency coblation as a potential treatment modality for mild to moderate epistaxis in patients with hereditary haemorrhagic telangiectasia.

Method:

Case reports and review of the world literature concerning coblation and other treatment modalities for epistaxis in patients with hereditary haemorrhagic telangiectasia.

Results:

Effective epistaxis control was achieved in four out of five cases of hereditary haemorrhagic telangiectasia. In the fifth case, we struggled to achieve haemostasis due to disease severity.

Conclusion:

Radiofrequency coblation is a novel technique, which was found to be a safe, effective, quick and well tolerated treatment option for epistaxis management in patients with hereditary haemorrhagic telangiectasia.

Radiofrequency coblation for the resection of head and neck malignancies

Objective

To review the safety and efficacy of the use of radiofrequency coblation for endoscopic resection of upper aero-digestive tract malignancies and to compare length of procedures using coblation with CO2 laser surgery.

Study Design and Setting

A retrospective case-note review of 40 adult patients with endoscopically treated mucosal squamous cell carcinoma of the head and neck, 20 having undergone resection using radiofrequency coblation and being case-matched to 20 treated with CO2 laser.

Results

Coblation proved to be an effective method for resection of selected head and neck malignancies. It allows for much faster resection times than the CO2 laser ( P = 0.017) especially in the oropharynx ( P = 0.007), but the large probes currently available can cause problems in assessment of adequate resection margins.

Conclusions

Although current probe design limits the potential for resection of some tumors, radiofrequency coblation appears to be an attractive evolving technique for the endoscopic resection of selected upper aerodigestive tract malignancies.