Coblation tonsillectomy
What is coblation?
Coblation is a technique that has been developed over the past ten years for the removal of tonsils. It is an alternative to more traditional methods of tonsillectomy including bipolar diathermy or cold steel instruments.
How does coblation work?
Coblation involves the use of a radiofrequency wand that coagulates tissues at a lower temperature than bipolar diathermy. There are two ways of using the same wand:
- Extracapsular: here the tonsil is removed with the external capsule (which surrounds the tonsil), therefore the entire tonsil is removed in one go.
- Intracapsular: here the tonsil is vapourised from its outer surface up to (but not including) the capsule. Consequently postoperative pain is generally less severe with intracapsular coblation, however this technique carries a higher chance of some remnant tonsil tissue being left behind.
Reasons for and benefits of coblation :
The main benefit of coblation is reduced postoperative pain, a faster recovery and earlier return to work or school. Some recent studies also appear to show a reduced rate of postoperative bleeding compared with other traditional techniques. An older study performed shortly after the technique was introduced showed an increased rate of postoperative bleeding, however this was felt to be due to inexperience with using the newer device rather than any weakness of the procedure itself. In the last few years, familiarity with the coblation technique has risen to equal that of the traditional techniques, which might help to explain the recent improved results.
Different techniques used in tonsillectomy:
- Bipolar diathermy: this involves electrical heat generation that dissects tissues and seals off the blood vessels at the same time.
- Cold steel: this involves using instruments only to remove the tonsils. It is said to be associated with a reduced risk of infection although bleeding risk in the early period after the operation is a little higher.
- Coblation: this involves the use of a radiofrequency wand that coagulates tissues at a lower temperature than bipolar diathermy. There are two ways of using the same wand:
- Extracapsular: here the tonsil is removed with the external capsule (which surrounds the tonsil) in the same way as techniques 1 and 2 above
- Intracapsular: here the tonsil is vapourised from its outer surface up to (but not including) the capsule. Consequently postoperative pain is generally less severe with intracapsular coblation, however this technique carries a higher chance of some remnant tonsil tissue being left behind.
Risks/complications:
There are some possible risks, side effects and/or complications that can happen after coblation tonsillectomy surgery. These are similar to the risks associated with the other tonsillectomy techniques and include:
- Pain/discomfort: The recovery following tonsillectomy/adenoidectomy always causes discomfort and pain, and this gets worse over the course of the first five to seven days before getting better again. The pain is generally less severe if the coblation intracapsular technique is used.
- Infection: This occurs in about 1 in 10 patients and can be treated with antibiotics. It is important to make sure that the pain following the surgery does not prevent you from eating as food helps to clear the build up of debris and slough, thereby reducing the risk of a postoperative throat infection.
- Bleeding: This rarely happens following tonsillectomy/adenoidectomy surgery. It is more likely if an infection develops, which itself is more likely if patients do not get into a regular habit of eating.
- Swelling: The soft palate/uvula can get quite swollen after the surgery. This takes about two weeks to settle.
- Adhesions/scarring: Initially the throat will build up yellow/white debris at the site of the removed tonsils, however after about 10-14 days this will be gradually replaced by scar tissue that is normal.
- Ear pain: This is due to the nerves in the throat sending a branch to the ear, which can cause referred pain in the ear. Sometimes the earache can be worse than the throat pain.
- Taste disturbance: It is not unusual to get an alteration in the sense of taste during the recovery period. This can amount to a reduction in being able to detect tastes, or a metallic flavor. In the vast majority of cases this recovers fully. It is highly unusual for any taste disturbance to persist beyond three months.
- Injury to lips/teeth/gums: The lips will get a little swollen particularly at the corner of the mouth. Dental injury is very unusual although an already wobbly tooth may become more loose during the procedure and may need to be removed to avoid it being knocked into the airway.
- Recurrent symptoms: Even with successful and complete removal of the tonsils, it is possible to get sore throats in the future such as with a cold or ‘flu. You should however not get an acute attack of tonsillitis.
- Tonsil regrowth: It is possible for some of the tonsils can regrow after tonsillectomy. The risk of this is around 1% for traditional techniques (diathermy /cold steel) although even if this occurs it does not mean that you will get more problems in the future. It is slightly more likely (risk 3-4%) if the coblation intracapsular technique is used.
- Palatal incompetence: The surgery can in rare cases lead to liquid or food coming out of the nose. This can occur due to a pre-existing weakness of the soft palate or an increased difficulty in the soft palate closing against the back of the nose. In most cases a pre-existing problem with the soft palate can be detected before the surgery, which can then allow modifications to be made during the adenoidectomy surgery (such as a limited or conservative reduction in adenoid tissue).
Postoperative advice and preparation:
It is advised that you avoid contact with people and dirty/dusty environments for a period of two weeks after the surgery. This is to reduce your risk of getting an infection or virus. For most people this means two weeks off school, although patients undergoing intracapsular coblation are noticing much more rapid recovery to the extent that seven to ten days off school may be sufficient.
You should also avoid too much exercise for two weeks or going to parties otherwise the risk of infection and bleeding increases. After two weeks you can resume exercise gently to start with.
Regarding eating, it is best to eat little and often. It is no longer necessary to just eat sharp, crunchy foods although a diet consisting of soft items such as ice cream and mashed potato is also not helpful. A balanced diet of foods that you would normally eat is the best.
Regarding pain relief, please take this regularly and as prescribed. This helps to make your recovery more comfortable and to maintain a good, regular diet.
In most cases a throat spray will be given to you and sometimes antibiotics may also be prescribed.