Coblation cryptolysis for treatment of tonsillar stones: a randomized clinical study

Abstract Background Tonsillectomy is usually indicated in patients with tonsillar stones. It is thought coblation cryptolysis avoids the hazards related to monopolar bipolar diathermy and the regular cold surgical technique. This study compared the peri-operative outcomes in patients with tonsillar stones submitted to coblation cryptolysis, monopolar bipolar dissection, and cold dissection techniques. This randomized study included 105 patients with tonsillar stones. The included patients comprised three groups: GI (n = 35) was subjected to cold dissection, GII (n = 35) was subjected to monopolar bipolar diathermy tonsillectomy, and GIII (n = 35) was subjected to coblation cryptolysis. Outcome parameters included operative time, intraoperative bleeding, consumption of postoperative analgesia, and time to normal food intake. Results GIII patients experienced significantly shorter operative time, less intraoperative bleeding, less consumption of postoperative analgesics, and less time to normal diet when compared with the other two groups. Conclusion Coblation cryptolysis is a safe and effective technique in the management of tonsillar stones. It appears to be superior to other surgical interventions.

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Coblation versus cold dissection in paediatric tonsillectomy: a systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000377 ◽

2020 ◽

Vol 134 (3) ◽

pp. 197-204

Author(s):

M U Ahmad ◽

A N Wardak ◽

T Hampton ◽

M R S Siddiqui ◽

I Street

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Alternative Technique ◽

Operative Blood Loss ◽

Operative Outcomes ◽

Significant Difference ◽

Dissection Techniques ◽

Cold Dissection

AbstractBackgroundCold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates.ObjectiveThis study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques.MethodsA systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded.ResultsSeven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05).ConclusionThe coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.

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A Comparative Study of Coblation versus Dissection Tonsillectomy

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v26i2.50613 ◽

2020 ◽

Vol 26 (2) ◽

pp. 121-127

Author(s):

Dipankar Lodh ◽

SM Abdul Awual ◽

Md Tawhidul Islam Mondol ◽

Md Shahriar Islam ◽

Mohammad Nazrul Islam ◽

...

Keyword(s):

Postoperative Pain ◽

Recovery Time ◽

Postoperative Morbidity ◽

Normal Diet ◽

Chronic Tonsillitis ◽

Study Patient ◽

Intraoperative Bleeding ◽

Duration Of Surgery ◽

Time Required ◽

Cold Dissection

Objectives: To compare the efficacy of coblation tonsillectomy and dissection tonsillectomy regarding the duration of surgery, amount of intraoperative bleeding, postoperative pain, recovery time and complications. Methods: 50 patients aged 5-30 years with chronic tonsillitis who underwent tonsillectomy operation were randomly divided into two groups. One group underwent coblation tonsillectomy while other group with dissection tonsillectomy. Chronic tonsillitis patients with adenoid hypertrophy and Otitis media with effusion were excluded by diagnostic nasal endoscopy, imaging and audiometry. All patient were examined regularly after surgery for 10 days to assess the postoperative morbidity and efficacy of both coblation and dissection methods. Duration of surgery, amount of intraoperative bleeding, recovery time, postoperative pain& requirement of analgesics, time required to regain normal diet & activityand complication were assessed. Result: Comparing the coblation tonsillectomy to cold dissection group the mean duration of surgery was 9.7 versus 18.4 minutes, the amount of intra operative bleeding 10.62 versus 28.72 milliliter. The difference on the postoperative pain scale, requirement of analgesics, condition of the tonsillar fossa, time required to regain normal diet & activity between two groups were statistically significant. Conclusion: In our study patient underwent coblation tonsillectomy providing a near bloodless field, minimum operating time, less postoperative pain, quicker return to normal diet, normal activity and less use of analgesics than patients underwent dissection tonsillectomy. Postoperative morbidity and complications were lower as compared to conventional cold dissection technique. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 121-127

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Comparision of Coblation and Cold Dissection Techniques outcome among Tonsillectomy patients at Birat Medical College and Teaching Hospital

Nepal Medical College Journal ◽

10.3126/nmcj.v23i3.40376 ◽

2021 ◽

Vol 23 (3) ◽

pp. 198-203

Author(s):

Bipin Koirala ◽

R.K. Shah ◽

K. Shrestha ◽

S. Sapkota

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Teaching Hospital ◽

Operative Time ◽

Postoperative Bleeding ◽

Postoperative Blood Loss ◽

Early Recovery ◽

Medical College ◽

Dissection Techniques ◽

Cold Dissection

Tonsillectomy is the most commonly performed surgery. Cold dissection tonsillectomy remains as the gold standard for tonsil removal, although it may increase risk for complication. Coblation tonsillectomy is a new technique .There are studies comparing these two method of surgery and have shown coblation technique to cause less postoperative pain, less intra operative time along with less intra and postoperative blood loss. In contrary few studies have shown it to be ineffective in reducing postoperative bleeding. Hence more studies are still required. Thus the objective of the present study was to compare coblation and cold dissection techniques outcome among tonsillectomy patients at Birat Medical College and Teaching Hospital. The study intended to determine and compare the intraoperative time, intra operative blood loss and postoperative pain in coblation and cold dissection tonsillectomy. This is a hospital based cross sectional comparative study. Eighty six patients underwent tonsillectomy during the study period of one year (15th Feb 2020 to 14th Feb 2021) in the department of ENT HNS, Birat Medical College and Teaching Hospital. Among 86 patients, 43 underwent cold dissection and 43 coblation tonsillectomy. Method of surgery was based on odd and even serial number of the patients during presentation. This study showed that intra operative time, intraoperative blood loss and post operative pain score was 16.77±2.7mins, 36.51±128ml and 6.28 respectively in coblation method and 37.84±3.1 mins, 101.4±12.7ml and 7.88 respectively in cold dissection method. Hence coblation method is a safer and effective method of tonsillectomy compared to cold dissection which ultimately leads to less post operative analgesics demands and early recovery.

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Conventional Laparoscopic Nissen Fundoplication versus Rossetti’s Modification in Management of GERD; A Comparative Study

QJM ◽

10.1093/qjmed/hcaa050.067 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

K A Elfiky ◽

K Elsaeed ◽

M I Hassan ◽

A A Ain-shoka ◽

M A Elsayed ◽

...

Keyword(s):

Operative Time ◽

Splenic Injury ◽

Nissen Fundoplication ◽

Randomized Study ◽

Laparoscopic Nissen Fundoplication ◽

University Hospitals ◽

Operative Outcomes ◽

Laparoscopic Nissen ◽

One Year ◽

High Pressure Zone

Abstract Background gastroesophageal reflux disease (GERD) is increasingly prevalent and costly, and it may affect as much as 20% of the western population. The pathophysiology of GERD is not due to acid overproduction but rather mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. Aim of the Work to prospectively compare between laparoscopic Nissen fundoplication and its Rossetti’s modification as anti-reflux procedures along with their operative and post-operative outcomes. Patients and Methods this is a prospective randomized study that was conducted on twenty (20) patients presenting to Ain-Shams University Hospitals in whom fundoplication was indicated for management of chronic GERD and was operated upon starting October 2016 to October 2018 with minimal follow up duration of one year. Results both procedures were nearly efficient and equal as regards the symptomatic control for the patients, the improvement in their quality of life, healing of esophagitis restoration of the high pressure zone, and post-operative hospital stay, while the Nissen’s procedure was nearly similar to the Rossetti’s modification in the aspect of post-operative dysphagia and gas-bloat syndrome, the modified Rossetti procedure showed significant superiority regarding the operative time, the incidence of intra-operative bleeding and splenic injury. Conclusion the Rossetti procedure carried better results in the operative time, operative bleeding and splenic injury though it showed nearly no difference in incidence of post-operative dysphagia.

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Coblation Tonsillectomy Versus Blunt Dissectomy Tonsillectomy in Children

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v4i1.13681 ◽

2013 ◽

Vol 4 (1) ◽

pp. 25-29 ◽

Cited By ~ 5

Author(s):

M A Matin ◽

M Alamgir Chowdhury ◽

Md Enamul Haque ◽

Md Nurul Islam ◽

Tahsina Shamim ◽

...

Keyword(s):

Blood Loss ◽

Granulation Tissue ◽

Operative Time ◽

Randomized Study ◽

Normal Diet ◽

The Other ◽

Female Ratio ◽

Tonsillar Fossa ◽

Early Return ◽

Maximum Pain

Tonsillectomy is one of the most common surgical procedure performed world wide by the ENT Surgeons.Various methods of tonsillectomy have been practiced over the century aimed at reducing or eliminating intraoperative and postoperative morbidity. Coblation tonsillectomy is a recently introduced surgical technique. Tonsillectomy over blunt dissection tonsillectomy in respect of operative time, intraoperative blood loss, postoperative pain, rate of healing of tonsillar fossa and other postoperative complications. This prospective randomized study was done at Maleka Nursing Home, Bogra and Bangladesh ENT Hospital, Dhaka for 36 months from 1st January 2008 to 31December 2010. 200 children were divided into two groups of equal number. In one group, the tonsillectomy performed by Coblation method and in the other group the tonsillectomy Age ranged from 3-12 years with mean age 5.6 in coblation group and 4-14 years with mean age 7.2 in dissection group. Number of male patients were slightly more than female with male female ratio was 3:2 in coblation group and 3.7:2 in dissection group. Operative time and amount of blood loss is significantly reduced in the coblation group (10-25 min, mean 12 min in coblation group, 18-35 min, mean 25 min in dissection group. Tonsillectomy by using coblation have shown less intraoperative bleeding (5ml-100 ml, mean 15 ml compared with 50-230 ml, mean 65 ml in dissection method).During post operative follow-up on day 8, children of coblation group experienced mild to moderate pain with maximum pain on day 2 and no pain on day 8. On the other hand dissection group experienced moderate to severe pain with maximum pain on day 4 and little or no pain on day 8.Children of coblation group returned to normal diet on day 3 and children of dissection group on day 8.On 8th post operative day, coblation group showed smooth healing without any granulation tissue in tonsillar fossa whereas granulation tissue is observed in dissection group. No major complications were noted in any group except one secondary haemorrhage in dissection group. Coblation tonsillectectomy offers less operative time, minimum blood loss, less post operative pain,early return to normal diet and rapid healing of tonsillar fossa. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13681 AKMMC J 2013: 4(1): 25-29

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Comparison Of Harmonic Scalpel, Coblation And Cold Dissection For Tonsillectomy In Adult

10.22541/au.163252266.66248446/v1 ◽

2021 ◽

Author(s):

Xinqi Hu ◽

Jiaying Li ◽

Xidong Cui ◽

Guangbin Sun

Keyword(s):

Postoperative Pain ◽

Operative Time ◽

Harmonic Scalpel ◽

Postoperative Bleeding ◽

Growth Time ◽

Recurrent Tonsillitis ◽

Intraoperative Bleeding ◽

Significant Difference ◽

Double Blinded ◽

Cold Dissection

Objectives: To compare the safety and effectiveness of tonsillectomy with three different techniques. Design: A double-blinded randomized prospective clinical trial Setting and Participants: Totally120 patients with recurrent tonsillitis between April 2018 and April 2020 were included. Main Outcome Measures: Operative time, intra and post operative bleeding loss, pseudomembrane growth time, pseudomembrane shedding time, postoperative pain, and necrosis depth of specimens were compared of harmonic scalpel(HS), coblation and cold dissection(CD) tonsillectomy. Results: The operative time and intraoperative bleeding loss was significantly less in HS and coblation group than CD group(p < 0.05). Pseudomembrane growth time and pseudomembrane shedding time were significantly longer in the HS group compared with the other groups(p < 0.05). The postoperative pain levels were significantly higher on the first postoperative day in CD group(p < 0.05), and significantly lower on the third and seventh postoperative day in coblation group(p < 0.05). There was no significant difference among three techniques in terms of postoperative bleeding loss(p > 0.05). The deepest necrosis depth in specimen was found in HS group(p > 0.05), while in CD group, only edema was observed without necrosis. Conclusion: To compared with HS and CD, coblation is a faster, safer and more painless technique for tonsillectomy in adult.

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A Comparative Analysis of Outcomes of Conventional Cold Dissection Versus Laser Tonsillectomy in Pediatric Cases in a Tertiary Care Hospital in Haryana

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-020-02301-1 ◽

2021 ◽

Author(s):

Amit Kumar ◽

Surender Kumar ◽

Anand Krishnan ◽

Manish Verma ◽

Uma Garg ◽

...

Keyword(s):

Operative Time ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Paediatric Population ◽

Care Hospital ◽

Secondary Complications ◽

Post Operative Pain ◽

Secondary Bleeding ◽

Paediatric Age ◽

Cold Dissection

AbstractTonsillectomy is one of the commonest ENT procedures done in paediatric population, the technique of which has evolved over years to decrease the morbidity associated with the surgery. This prospective randomized comparative study is done to evaluate the efficacy of two different techniques of this surgery, conventional cold dissection and laser tonsillectomy based on operative time, blood loss, post-operative pain and occurrence of secondary complications. The study was done in 68 patients of paediatric age group, 34 in each group underwent cold dissection and laser tonsillectomy. Operative time and bleeding were significantly low for laser group. Pain score was comparable in early post-operatives days, but was high towards the end of first week. Our study reported only one incidence of complication in the form of a secondary bleeding.

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Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽

10.1186/s12894-021-00797-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giorgio Bozzini ◽

Matteo Maltagliati ◽

Umberto Besana ◽

Lorenzo Berti ◽

Albert Calori ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Randomized Study ◽

Urine Volume ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625948 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S287-S288 ◽

Cited By ~ 1

Author(s):

Tyler Kenning ◽

Carlos Pinheiro-Neto

Keyword(s):

Cerebrospinal Fluid ◽

Elderly Population ◽

Operative Time ◽

The Elderly ◽

High Flow ◽

Endoscopic Endonasal ◽

Surgical Interventions ◽

Perioperative Morbidity ◽

Increased Risk ◽

Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

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Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study

Gastroenterology Research and Practice ◽

10.1155/2016/6419603 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Valeria Tognoni ◽

Domenico Benavoli ◽

Emanuela Bianciardi ◽

Federico Perrone ◽

Simona Ippoliti ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Operative Time ◽

Intraoperative Complications ◽

Randomized Study ◽

Control Group ◽

Bodyweight Loss ◽

Relevant Difference ◽

Banded Sleeve Gastrectomy ◽

Time Required

Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG). We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG).Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months.Results. Twenty-five patients received LSG (group A) and 25 LBSG (group B). The mean preoperative BMI was47.3±6.58 kg/m2and44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were37.86±5.72 kg/m2and37.58±6.21 kg/m2(p=0.869),33.64±6.08 kg/m2and32.03±5.24 kg/m2(p=0.325), and29.72±4.40 kg/m2and27.42±4.47 kg/m2(p=0.186); no statistical relevant difference was registered between the two groups.Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

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