A Comparison of Outcomes in Adult Patients After Intracapsular Laser Tonsillotomy and Cold Steel Tonsillectomy

This study compares selection criteria, 30-day complications, and 6-month outcomes between intracapsular tonsillotomy (TT) using carbon dioxide (CO₂) laser and traditional cold steel tonsillectomy (TE).

A retrospective, observational study.

Laser TT was conducted at 6 different Norwegian hospitals or private clinics and 41 Norwegian hospitals or private clinics performed traditional cold steel TE.

We analyzed data from the Norwegian Tonsil Surgery Register (NTSR), including all adult patients (≥16 years) undergoing tonsil surgery from January 1, 2017, to June 30, 2023. No exclusion criteria were applied. The data are based on 3 questionnaires: one completed by surgeons on the day of surgery, and one completed by patients 30 days and 6 months after surgery.

Laser TT was associated with significantly lower postoperative bleeding and fewer pain-related healthcare contacts. However, cold steel TE had higher symptom resolution at 6 months (P < .001). Men had a higher risk of bleeding (P < .001), while women more often sought help for pain (P < .001). Patients with recurrent or chronic tonsillitis had greater risks for both bleeding and pain-related contacts. Women were more likely to report persistent symptoms at 6 months (P = .01).

Laser TT under local anesthesia is associated with fewer short-term complications but a higher rate of persistent symptoms compared to traditional cold steel tonsillectomy (TE). In this study, cold steel TE demonstrated significantly better long-term outcomes. Careful patient selection for laser TT is essential.