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

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.

Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy

Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.

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

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.

1261 Incidence and Risk of Post Tonsillectomy Bleeds for Tonsillitis And/Or Peritonsillar Abscess (Quinsy) In Adult Patients

Aim Determine the incidence of post tonsillectomy bleeds (PTB) in patients 16 years and over with a background of tonsillitis and/or quinsy. Explore factors that can increase the risk of a haemorrhage. Assess the operation notes for completeness. Method A retrospective review was conducted of 30 tonsillectomies for quinsy and recurrent or chronic tonsillitis from the 01/08/20 to 10/12/20. They were followed up for 28 days. Patient notes including operation notes were reviewed. Results Following surgery 8 out of the 30 patients (26.7%) had a secondary PTB. There were no primary PTB. 4 out of the 8 patients (50%) had to return to theatre to arrest the haemorrhage. The median time was 6 days post-op. Only 1 PTB (12.5%) occurred following a cold dissection and the other 7 (87.5%) following electro dissection. This equated to 39% of the electro dissections resulting in PTB compared to 8.3% of the cold techniques. There were 6 robot-assisted surgeries with 3 (50%) resulting in a haemorrhage. Just over a third (35%) of patients 25 years of age and over had a PTB vs. 10% of those under 25. Only 1 out of the 30 operation notes was completed fully. Examples of details omitted are estimated bloods loss, power settings, findings, and indications. Conclusions A 3.5 times greater rate of PTB is seen in those aged 25 years and over. Hot techniques, in particular those that were robot-assisted, showed a higher incidence of haemorrhages. A pro forma should be utilised to improve the completeness of operation notes.

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

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.

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

Tonsillectomy 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.

A Comparative Study of Coblation versus Dissection Tonsillectomy

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

Comparison of post operative pain in tonsillectomy: a three year prospective study

<p><strong>Background:</strong> Tonsillectomy is the oldest surgery performed by otorhinolaryngologists worldwide. Through ages different techniques have been tried to improve the post surgical outcome and reduce morbidity among patients. Aim of the current study was to compare the post-operative pain among the patients undergoing tonsillectomy by cold dissection, bipolar cautery dissection and coblation dissection.</p><p><strong>Methods:</strong> 142 Patients undergoing tonsillectomy in ENT department of TMMC during the period of 3 year were included in the study. Patients were randomly distributed to undergo different techniques of tonsillectomy. The post-operative pain in patients was assessed using the pre-standardized visual analogue pain scale and results were analyzed.</p><p><strong>Results:</strong> No statistically significant difference was found among the groups undergoing tonsillectomy by cold dissection, bipolar dissection and coblator dissection as the p&gt;0.05. The immediate post-operative pain was found to be slightly higher among the group undergoing tonsillectomy by coblator dissection and the analgesics dose needed in the post-operative period remained the same for all for patients of all the three groups.</p><p><strong>Conclusions:</strong> No statistically significant difference was found in the post-operative pain scores of patients undergoing tonsillectomy by CD, BD and CBD techniques.</p>