Revision rates after pediatric PITA: A comparative study of microdebrider and coblation techniques

To compare long-term revision rates after pediatric partial intracapsular tonsillectomy and adenoidectomy (PITA) performed using microdebrider versus coblation techniques, and to evaluate whether operative method was independently associated with revision risk.

This retrospective cohort study included healthy children younger than 16 years who underwent PITA for obstructive sleep-disordered breathing, 2016, when coblation technology was introduced and 2023, at a tertiary medical center. Intracapsular reduction of palatine tonsils and adenoids was performed using either powered microdebrider or coblation. The primary outcome was revision PITA for recurrent obstructive symptoms. Revision-free survival was analyzed using Kaplan-Meier methods and compared with log-rank testing. A multivariable Cox proportional hazards model adjusted for age and sex was used. Tonsil size was evaluated as a secondary covariate.

A total of 827 children were included (microdebrider, n = 478; coblation, n = 349). Median follow-up was 60 months overall (60 vs. 47 months). Revision occurred in 31 children: 6 (1.4%) in the microdebrider group and 25 (10.1%) in the coblation group. After 36 months, revision-free survival was 99.4% for microdebrider and 96.1% for coblation (log-rank p < 0.001). Coblation was independently associated with increased revision risk (HR 7.17; 95% CI 2.92-17.60; p < 0.001). Age, sex, and tonsil size were not significant predictors.

In this institutional cohort, microdebrider PITA was associated with lower long-term revision rates than was coblation during the period of coblation was introduced. These findings highlight the influence of institutional experience and procedural execution on revision outcomes after intracapsular surgery and should not be interpreted as evidence of intrinsic device superiority.