• Adenoid ablation using suction diathermy is associated with a number of difficulties, mainly associated with the use of the mirror. Transoral and transnasal 0 degree endoscopes have also been utilised but again have limitations. We describe a technique that overcomes the above problems.
• A prospective case series of patients undergoing suction diathermy adenoidectomy under direct vision using a transoral 45 degree endoscope connected to a monitor was conducted, performed by surgical trainees and under direct supervision of the consultant trainer (J.R.-J.).
• Intra-operatively, trainees had to demonstrate to the trainer the appropriate anatomy, completed adenoid ablation, and haemostasis.
• Fifty-six cases have been performed. In every case, it was possible for the trainer to monitor the trainee's technique throughout the entire procedure. No complications have been reported.
• We describe a modified technique which overcomes the disadvantages previously encountered by conventional suction diathermy adenoid ablation.