Coblation versus Unipolar Electrocautery Tonsillectomy: A Prospective, Randomized, Single-Blind Study in Adult Patients

Authors

  • J Pieter Noordzij MD,

    Corresponding author
    1. Otolaryngology–Head and Neck Surgery Service, RAF Lakenheath (U.S. Air Force Base), United Kingdom.
    Current affiliation:
    1. Dr. Noordzij is currently at Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
    • J. Pieter Noordzij, MD, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, 7302 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN 37232-8783, U.S.A.
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  • Brian D. Affleck MD

    1. Otolaryngology–Head and Neck Surgery Service, RAF Lakenheath (U.S. Air Force Base), United Kingdom.
    Current affiliation:
    1. Dr. Affleck is currently at Osan Air Base in South Korea.
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  • The opinions or assertions contained here are the private views of the authors and are not to be considered as official or as reflecting the views of the Department of Defense.

Abstract

Objectives: To determine if the coblation tonsillectomy (subcapsular dissection) results in less postoperative pain, equivalent intraoperative blood loss, equivalent postoperative hemorrhage rates, and faster healing compared with tonsillectomy was performed using unipolar electrocautery in adult patients.

Study Design: The authors conducted a prospective clinical trial.

Methods: Forty-eight patients underwent tonsillectomy and were randomly assigned to have one tonsil removed with coblation and the other with unipolar electrocautery. Outcome measures included time to remove each tonsil, intraoperative blood loss, patient-reported pain, postoperative hemorrhage, and amount of healing 2 weeks after surgery.

Results: Mean time to remove a single tonsil with coblation and electrocautery was 8.22 minutes and 6.33 minutes, respectively (P = .011). Mean intraoperative blood loss for each technique was less than 10 mL. Postoperative pain was significantly less with coblation as compared with electrocautery: 18.6% less painful during the first week of recovery. Seventy percent of blinded patients identified the coblation side as less painful during the overall 14-day convalescent period. Postoperative hemorrhage rates (2.1% for coblation and 6.2% for electrocautery) were not significantly different. No difference in tonsillar fossa healing was observed between the two techniques 2 weeks after surgery. During nine of the 48 surgeries, wires on the tip of the coblation handpiece experienced thinning to the point of discontinuity while removing a single tonsil.

Conclusions: Coblation subcapsular tonsillectomy was less painful than electrocautery tonsillectomy in this 48-patient group. On average, intraoperative blood loss was less than 10 mL for both techniques. Postoperative hemorrhage rates and the degree of tonsillar fossa healing were similar between the two techniques. The coblation handpiece experienced degradation of vital wires in 18% of cases necessitating the use of a second, new handpiece.

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