Tonsillectomy

Tonsillectomy is one of the most commonly performed surgeries in children, with almost 300,000 tonsillectomies performed annually in the United States1. There are two common indications for tonsillectomy: chronic or recurrent tonsillitis and sleep disordered breathing (SDB) or obstructive sleep apnea (OSA).

While up to 15% of children have SDB/OSA in some form, 90% of cases go undiagnosed due to symptoms being attributable to other behavioral or psychological conditions, such as ADHD2. Diagnosing and treating SDB/OSA is important to protecting the cognitive development, growth, cardiovascular health, and other factors of a child’s development3. The key symptoms are snoring, bedwetting an unusual amount, learning difficulties, and more.

Chronic or recurrent tonsillitis remains important to diagnose and treat due to patient discomfort and infective nature of the condition. There are numerous symptoms that indicate tonsillitis, such as fever, sore throat, bad breath, tonsil stones, snoring, and more.

There are two options for technique when planning a tonsillectomy: extracapsular, known as total tonsillectomy, and intracapsular tonsillectomy.

COBLATION adenotonsillectomy animation

CIT

COBLATION Intracapsular Tonsillectomy, or CIT, is the use of a COBLATION wand to remove all tonsil tissue, while leaving the tonsil capsule in place.

In contrast to total tonsillectomy, a historically more common procedure, CIT leaves the tonsil capsule, a thin, fibrous portion of tissue that separates the tonsil from the underlying muscle, in place. By maintaining the integrity of this capsule, the post-operative benefits include a 64% reduction in risk of post tonsillectomy hemorrhage (PTH), pain free 4.2 days sooner, and a low, 2.2% rate of revision at 5 years post-operatively4-11.

CIT enables surgeons to reduce the likelihood of post-operative complications when compared with total tonsillectomy without sacrificing the efficacy of the procedure. This approach to tonsillectomy is growing in popularity, and 20% of pediatric ENT surgeons in the United States have reported that IT is a part of their practice4.

Total Tonsillectomy

A total tonsillectomy involves the complete removal of all tonsil tissue in the throat, including the lymphatic tissue of the tonsil and the capsule underneath. When performing a total tonsillectomy, choice of technology can have an impact on patient outcomes*12-15.

COBLATION technology, by using a precise, lower temperature plasma field, gives surgeons the ability to remove targeted tonsil tissue while preserving the nearby healthy tissue16-19.

COBLATION tonsillectomies result in significantly less painful recovery post-operatively**12, 16-18 compared to other techniques, and result in a low rate of post tonsillectomy hemorrhage (PTH) and readmission20. There are a variety of wands to suit different surgical preferences, all of which operate at lower temperatures than other instruments such as electrocautery, leading to less thermal damage and less painful recovery*12-15.

Technology options

There are several technologies and techniques to choose from when performing a tonsillectomy. One option is an electrosurgery device, which generates very high temperatures to rupture cells and vaporize tissue, which may cause significant damage such as burning and charring6-8.

On the other hand, there is COBLATION technology, which, unlike electrosurgery, generates significantly lower temperatures on contacted tissue6-9. This gives surgeons the ability to precisely remove targeted tonsil tissue while preserving the nearby healthy tissue16, 19.

Through the integration of saline delivery and suction, COBLATION technology creates an ideal plasma layer for tonsil and adenoid removal. Each COBLATION wand is equipped with the ability to ablate tissue and coagulate blood vessels, all in one device14, 16, 21-24.

Hypertrophic Tonsil

  • Total Tonsillectomy
  • COBLATION Intracapsular Tonsillectomy (CIT)

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Contact us to learn more about COBLATION technology for tonsillectomy.

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No matter how statistically safe a procedure has proven to be, every surgery has risks. Post Tonsillectomy Hemorrhage (PTH) is a potentially serious complication that has been reported in literature for both adult and pediatric patients. It is reported to occur following use of COBLATION devices as well as following the use of other surgical devices and methods. Before making any surgical decision, you should speak with your doctor about any potential risks.

*Compared to monopolar electrocautery, bipolar and cold dissection; p<0.001

**Compared to monopolar electrocautery; p<0.001

COBLATION wands are contraindicated for use in patients with cardiac pacemakers or other electronic device implants.

  1. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillec-tomy in children (update).Otolaryngol – Head Neck Surg2019;160:S1–S42. https://doi.org/10.1177/0194599818801757.
  2. Martinka, Vicki. “Researchers Say up to 15% of Children Have Sleep Apnea, Yet 90% Go Undiagnosed.” American Osteopathic Association, 19 July 2019, https://osteopathic.org/2019/02/12/researchers-say-up-to-15-of-children-have-sleep-apnea-yet-90-go-undiagnosed/.
  3. “Pediatric Sleep-Disordered Breathing.” ENT Health, American Academy of Otolaryngology-Head and Neck Surgery, 12 Dec. 2022, https://www.enthealth.org/conditions/pediatric-sleep-disordered-breathing/.
  4. Smith+Nephew 2021. Partial tonsillectomy using COBLATION versus alternative tonsillectomy techniques: A systematic literature review with meta-analysis. Internal Report. EA/ENT/COBLATION/002/V4.
  5. Amin N, Bhargava E, Prentice JG, Shamil E, Walsh M, Tweedie DJ. Coblation Intracapsular Tonsillectomy in Children: A Prospective Study of 1257 Consecutive Cases with Long Term Follow Up. Clin Otolaryngol. 2021;00:1 – 9.
  6. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization Following Tonsillectomy in Children: A Systematic Review and MetaAnalysis. Otolaryngol Head Neck Surg. 2017;156:442 – 455.
  7. Varadharajan K, Caton N, Faulkner J, Khemani S. Coblation® intracapsular tonsillectomy in children with recurrent tonsillitis: Initial experience. Int J Pediatr Otorhinolaryngol. 2020;135:110113.
  8. Chau SM, Sharma GK, Ahuja GS, Huoh KC, Pham NS. Post-Operative Hemorrhage Rates in Coblation Intracapsular Tonsillectomy: A 6-year Experience. Poster presented at: Combined Otolaryngology Spring Meetings (COSM)2019; Austin, Texas.
  9. Albright JT, Duncan NO, Smerica AM, Edmonds JL. Intra-capsular complete tonsillectomy, a modification of surgical technique to eliminate delayed post-operative bleeding. Int J Pediatr Otorhinolaryngol. 2020;128:109703.
  10. Keltie K, Donne A, Daniel M, et al. Paediatric tonsillectomy in England: A cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008-2019). Clin Otolaryngol. 2021;00:1–10 .
  11. Huoh, K, Haidar, Y, Dunn, B. Current Status and Future TrendsL Pediatric Intracapsular Tonsillectomy in the United States. The Laryngoscope. 2020;00:1-9.
  12. Smith+Nephew 2017. Coblation Dissection Versus Monopolar Dissection – A Systematic Review and Meta-analysis. Internal Report. P/N 91999.
  13. Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol. 2001;61(3):195 – 198.
  14. Ahmad MU, Wardak AN, Hampton T, Siddiqui MRS, Street I. Coblation versus cold dissection in paediatric tonsillectomy: a systematic review and meta-analysis. J Laryngol Otol. 2020;134(3):197 – 204.
  15. Parsons SP, Cordes SR, Comer B. Comparison of Posttonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery. Otolaryngol – Head Neck Surg. 2006;134(1):106 – 113.
  16. Magdy EA, Elwany S, El-Daly AS, Abdel-Hadi M, Morshedy MA. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol. 2008;122(3):282 – 290.
  17. Smith+Nephew 2010. PROCISE LW & MLW, Thermal Measurement and Comparison to CO2 and KTP Laser Systems. Internal Report. P/N 86257 Rev. A.
  18. Smith+Nephew 2010. PROcise XP Comparative Thermal Measurement Bench-Top Study. Internal Report. P/N 60736-01 Rev. A.
  19. Roje Z, Racic G, Dogas Z, Pisac VP, Timms MS. Postoperative Morbidity and Histopathologic Characteristics of Tonsillar Tissue Following Coblation Tonsillectomy in Children: A Prospective Randomized Single-Blind Study. Coll Antropol. 2009;33(1):293 – 298.
  20. Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization Following Tonsillectomy in Children: A Systematic Review and MetaAnalysis. Otolaryngol Head Neck Surg. 2017;156:442 – 455.
  21. Mularczyk C, Walner DL, Hamming KK. Coblation versus microdebrider in pediatric adenoidectomy. Int J Pediatr Otorhinolaryngol. 2018;104:29 – 31.
  22. Amin N, Bhargava E, Prentice JG, Shamil E, Walsh M, Tweedie DJ. Coblation Intracapsular Tonsillectomy in Children: A Prospective Study of 1257 Consecutive Cases with Long Term Follow Up. Clin Otolaryngol. 2021;00:1 – 9.
  23. Carney SA, Timms MS, Marnane CN, Krishnan S, Rees G, Mirza S. Radiofrequency coblation for the resection of head and neck malignancies. Otolaryngol – Head Neck Surg. 2008;138(1):81 – 85.
  24. Elbadawey MR, Hegazy HM, Eltahan AE, Powell J. A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy. J Laryngol Otol. 2015;129(11):1058 – 1063.

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