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Coblation tonsillectomy versus cold steel dissection tonsillectomy: a morphological study

Published online by Cambridge University Press:  22 August 2019

N Lieberg ,
M Aunapuu  and
A Arend
N Lieberg
Affiliation:
Ear Clinic, Tartu University Hospital, Tartu, Estonia
M Aunapuu
Affiliation:
Institute of Biomedicine and Translational Medicine, Department of Anatomy, University of Tartu, Estonia
A Arend*
Affiliation:
Institute of Biomedicine and Translational Medicine, Department of Anatomy, University of Tartu, Estonia
*
Author for correspondence: Dr Andres Arend, Institute of Biomedicine and Translational Medicine, Department of Anatomy, University of Tartu, 19 Ravila Street, Tartu 50411, Estonia E-mail: [email protected]
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Abstract

Objective

To compare the extent of tissue damage produced by conventional cold steel and coblation tonsillectomy.

Methods

Twenty patients underwent conventional and 18 underwent coblation tonsillectomy. The removed tonsils were histopathologically evaluated.

Results

Analgesic use was lower in the coblation group during the early post-operative period. Histological investigation of tonsils removed by the conventional method showed intensive haemorrhage and hyperaemia in the tonsillar capsules, which was not seen in the coblation group. Furthermore, in the coblation group, there was less mast cell degranulation (p = 0.0081) and a smaller amount of skeletal muscle tissue (p = 0.0043) in the tonsillar capsules, indicating less tissue damage.

Conclusion

Compared to the cold steel technique, coblation tonsillectomy is superior in terms of less early post-operative pain and less damage to surrounding tissues. Significantly lower mast cell degranulation in coblation tonsillectomy may contribute to the reduction of post-operative pain.

Keywords

TonsillectomyCoblationPainMast Cells
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 9 , September 2019 , pp. 770 - 774
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr A Arend takes responsibility for the integrity of the content of the paper

References

1McNeill, RA. A history of tonsillectomy: two millenia of trauma, haemorrhage and controversy. Ulster Med J 1960;29:59–63Google Scholar
2Linden, BE, Gross, CW, Long, TE, Lazar, RH. Morbidity in pediatric tonsillectomy. Laryngoscope 1990;100:120–4Google Scholar
3Messner, AH. Tonsillectomy. Oper Tech Otolaryngol 2005;16:224–8Google Scholar
4Timms, MS, Temple, RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:450–2Google Scholar
5Roje, Z, Racić, G, Dogas, Z, Pisac, VP, Timms, M. Postoperative morbidity and histopathologic characteristics of tonsillar tissue following coblation tonsillectomy in children: a prospective randomized single-blind study. Coll Antropol 2009;33:293–8Google Scholar
6Metcalfe, C, Muzaffar, J, Daultrey, C, Coulson, C. Coblation tonsillectomy: a systematic review and descriptive analysis. Eur Arch Otorhinolaryngol 2017;274:2637–47Google Scholar
7Wiltshire, D, Cronin, M, Lintern, N, Fraser-Kirk, K, Anderson, S, Barr, R et al. The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques. J Laryngol Otol 2018;132:240–5Google Scholar
8Magdy, EA, Elwany, S, el-Daly, AS, Abdel-Hadi, M, Morshedy, MA. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122:282–90Google Scholar
9Di Rienzo Businco, L, Coen Tirelli, G. Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures. Acta Otorhinolaryngol Ital 2008;28:67–72Google Scholar
10Omrani, M, Barati, B, Omidifar, N, Okhovvat, AR, Hashemi, SA. Coblation versus traditional tonsillectomy: a double blind randomized controlled trial. J Res Med Sci 2012;17:45–50Google Scholar
11Izny Hafiz, Z, Rosdan, S, Mohd Khairi, MD. Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain. Med J Malaysia 2014;69:74–8Google Scholar
12Rakesh, S, Anand, TS, Payal, G, Pranjal, K. A prospective, randomized, double-blind study of coblation versus dissection tonsillectomy in adult patients. Indian J Otolaryngol Head Neck Surg 2012;64:290–4Google Scholar
13Elbadawey, MR, Hegazy, HM, Eltahan, AE, Powell, J. A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy. J Laryngol Otol 2015;129:1058–63Google Scholar
14Bäck, L, Paloheimo, M, Ylikoski, J. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study. Arch Otolaryngol Head Neck Surg 2001;127:1106–12Google Scholar
15Moesgaard, L, Mirz, F. No clinical advantages of coblation tonsillectomy compared with traditional tonsillectomy. Dan Med J 2012;59:A4355Google Scholar
16Hong, SM, Cho, JG, Chae, SW, Lee, HM, Woo, JS. Coblation vs. electrocautery tonsillectomy: a prospective randomized study comparing clinical outcomes in adolescents and adults. Clin Exp Otorhinolaryngol 2013;6:90–3Google Scholar
17Alexiou, VG, Salazar-Salvia, MS, Jervis, PN, Falagas, ME. Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg 2011;137:558–70Google Scholar
18Álvarez Palacios, I, González-Orús Álvarez-Morujo, R, Alonso Martínez, C, Ayala Mejías, A, Arenas Brítez, O. Postoperative pain in adult tonsillectomy: is there any difference between the technique? Indian J Otolaryngol Head Neck Surg 2017;69:187–93Google Scholar
19Praveen, CV, Parthiban, S, Terry, RM. High incidence of post-tonsillectomy secondary haemorrhage following coblation tonsillectomy. Indian J Otolaryngol Head Neck Surg 2013;65:24–8Google Scholar
20Blanchford, H, Lowe, D. Cold versus hot tonsillectomy: state of the art and recommendations. ORL J Otorhinolaryngol Relat Spec 2013;75:136–41Google Scholar
21Windfuhr, JP, Deck, JC, Remmert, S. Hemorrhage following coblation tonsillectomy. Ann Otol Rhinol Laryngol 2005;114:749–56Google Scholar
22Lehr, HA, Mankoff, DA, Corwin, D, Santeusanio, G, Gown, AM. Application of Photoshop-based image analysis to quantification of hormone receptor expression in breast cancer. J Histochem Cytochem 1997;45:1559–65Google Scholar
23Lowe, D, van der Meulen, J; National Prospective Tonsillectomy Audit. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;364:697–702Google Scholar
24Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–13Google Scholar
25Chan, KH, Friedman, NR, Allen, GC, Yaremchuk, K, Wirtschafter, A, Bikhazi, N. Randomized, controlled, multisite study of intracapsular tonsillectomy using low-temperature plasma excision. Arch Otolaryngol Head Neck Surg 2004;130:1303–7Google Scholar
26Pelishenko, TG, Vishniakov, VV, Klimenko, KE. Application of plasma-mediated cold ablation in otorhinolaryngology [in Russian]. Vestn Otorinolaringol 2009;3:25–7Google Scholar
27Sadikoglu, F, Kurtaran, H, Ark, N, Ugur, KS, Yilmaz, T, Gozdemir, M et al. Comparing the effectiveness of “plasma knife” tonsillectomy with two well-established tonsillectomy techniques: cold dissection and bipolar electrocautery. A prospective randomized study. Int J Pediatr Otorhinolaryngol 2009;73:1195–8Google Scholar
28Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–3Google Scholar
29Mösges, R, Hellmich, M, Allekotte, S, Albrecht, K, Böhm, M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011;268:807–16Google Scholar
30Polites, N, Joniau, S, Wabnitz, D, Fassina, R, Smythe, C, Varley, P et al. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 2006;76:226–9Google Scholar
31Santos, FX, Arroyo, C, García, I, Blasco, R, Obispo, JM, Hamann, C et al. Role of mast cells in the pathogenesis of postburn inflammatory response: reactive oxygen species as mast cell stimulators. Burns 2000;26:145–7Google Scholar
32Pinheiro, AL, Browne, RM, Frame, JW, Matthews, JB. Assessment of thermal damage in precooled CO2 laser wounds using biological markers. Br J Oral Maxillofac Surg 1993;31:239–43Google Scholar
33Pinheiro, AL, Browne, RM, Frame, JW, Matthews, JB. Mast cells in laser and surgical wounds. Braz Dent J 1995;6:11–15Google Scholar
34Gupta, K, Harvima, IT. Mast cell-neural interactions contribute to pain and itch. Immunol Rev 2018;282:168–87Google Scholar
35Pynnonen, M, Brinkmeier, JV, Thorne, MC, Chong, LY, Burton, MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017;(8):CD004619Google Scholar