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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy
1ENT Department, Akershus University Hospital, Oslo, Norway. smitic@online.no
Insights
Coblation tonsillectomy offers a faster recovery for children compared to dissection tonsillectomy. Patients experienced less pain, quicker return to normal diet and activity, and reduced medication needs, shortening overall recovery by about two days.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative recovery significantly impacts children's well-being and parental burden.
Purpose of the Study:
- To compare postoperative recovery between coblation tonsillectomy and dissection tonsillectomy in children aged 4-12 years.
- To evaluate pain, nutrition, activity levels, and analgesic use during the 10-day postoperative period.
Main Methods:
- Prospective, single-blind, randomized controlled trial involving 40 pediatric patients.
- Patients were randomly assigned to either coblation or dissection tonsillectomy with bipolar diathermy.
- Postoperative recovery was assessed using daily diaries for pain, nutrition, and activity.
Main Results:
- Coblation tonsillectomy resulted in significantly lower pain scores (6.2 vs. 9.6), improved nutrition (6.6 vs. 8.9), and increased activity (6.6 vs. 8.4) compared to dissection.
- Intraoperative bleeding was significantly reduced in the coblation group.
- Recovery time was approximately 2 days shorter for the coblation tonsillectomy group.
Conclusions:
- Coblation tonsillectomy leads to improved postoperative outcomes in children, including reduced pain and faster return to normal diet and activity.
- The coblation technique demonstrates less morbidity and a shorter overall recovery period compared to dissection tonsillectomy.
- This pilot study suggests coblation tonsillectomy as a potentially superior method for pediatric tonsillectomy.
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.
