1. Tonsillectomy: Coblation vs Electrocautery Amy Stinson MS IV KCUMB

2. Coblation vs EC Coblation passes a radiofrequency bipolar current through a saline medium which creates highly ionized particles that can “melt” the tissue at 40-70°C 1,2 EC uses thermal conduction and needs a temp of 400°C to cut and cauterize tissue 1,2

4. Let’s Compare: Time taken to remove tonsil Intra-operative blood loss Post-operative pain Post-operative hemorrhage Amount of healing at 2 weeks post-op

5. Tonsil Removal 1 Coblation set at 6 or 7 Needed 8.22 minutes for removal of 1 tonsil Removes tissue more effectively and completely 3 EC set between 20 & 25W Needed 6.33 minutes for removal of 1 tonsil

6. Intra-operative Blood Loss Coblation: 2.44ml per tonsil 1 EC: 5.39ml per tonsil 1

7. Post-operative Pain 70% of blinded patients reported less pain on side of coblation (p =.014) 1 Pain on days 1-3 significantly less Narcotic use: UP3 (7.6 ± 3.7) vs UP2 w/tonsil coblation (5.1 ± 1.8) 6

8. Post-operative Hemorrhage Coblation (n=844): 2.25% 4 EC (n=773): 6.19% 4 UP3 (9.1%) vs UP2 w/tonsil coblation (0%) 6

9. Healing at 2 Weeks Post-Op Coblation: pain 3.31/10 EC: pain 3.98/10 Return to normal diet: UP3 (8.7 ± 3.3) vs UP2 w/tonsil coblation (4.6 ± 2.0) 6 Foreign body sensation: UP3 (57.6%) vs UP2 w/tonsil coblation (23.3%) 6 UP3 exposes underlying muscles and neurovascular bundles – triggered when pt starts eating – UP2 leaves them intact

10. Other considerations Cost: EC $25, Coblation $125 Coblation wire thinning Water refraction Smoke production

12. References 1.Noordijz, JP.Affleck, BD. Coblation Versus Unipolar Electrocautery Tonsillectomy: A Prospective, Radomized, Single-blind Study in Adult Patients. Laryngoscope 2006. 116;1303- 1306. 2. Plant, RL. Radiofrequency Treatment of Tonsillar Hypertrophy. Laryngoscope 2002. 112: 20- 22. 3. Freidman, M. LaSavio, P. et al. Radiofrequency Tonsil Reduction: Safety, Efficacy, and Morbidity. Laryngoscope 2003. 113:882-887. 4. Bellasso, A. et al. Coblation Tonsillectomy versus Dissection Tonsillectomy: Postoperative Hemorrhage. Laryngoscope 2003. 113:2010-2013. 5. Divi, B. Benninger, M. Postoperative tonsillectomy Bleed: Coblation versus Noncoblation. Laryngoscope 2005. 115:31-33. 6. Freidman, M. et al. Uvulopalatoplasty: A modified Technique for Selected Patients. Laryngoscope 2004. 114:441-449.