Coblation Tonsillectomy
Coblation is a method used by otolaryngologists (Ear, Nose and Throat specialists) to perform tonsillectomy, adenoidectomy, and other surgical procedures, including turbinate reduction and the treatment of snoring. Unlike traditional electrocautery methods, Coblation methods use radiofrequency (RF) to remove tissue. RF is a form of energy like radio waves, but with a higher frequency. Coblation-based surgical procedures use RF energy in a precise and controlled manner to remove affected tissue while causing very little harm to healthy tissue.
The Coblation process was invented by Philip E. Eggers and Hira V. Thapliyal, who patented their “electrosurgical ablation probe” on May 11, 1999. [1] The technology was acquired by ArthroCare (founded in 1993), a California-based medical device company, which trademarked the technology under the term Coblation—a contraction of “controlled” and “ablation”. Coblation tonsillectomy received FDA clearance in 2001. The Coblation procedure is performed using specially designed hand pieces called Coblation wands. Coblation tonsillectomy involves either the complete (subcapsular) removal of the tonsil via dissection or the partial (intracapsular) removal of the tonsil in which the tonsil tissue is reduced by dissolving part of it away.
Clinical Studies: Tonsillectomy
Clinical studies published in peer-reviewed journals have shown Coblation tonsillectomy to have the following patient advantages compared to conventional electrocautery tonsillectomy:
- Significantly less pain and less frequent use of narcotics [1]
- Significantly faster return to normal diet (2.4 days vs. 7.6 days on average) [1]
- Less incidence of postoperative nausea and throat swelling [2]
Clinical Studies: Adenoidectomy
Similar to Coblation tonsillectomy, advantages have also been demonstrated for Coblation adenoidectomy, including:
- Less postoperative neck pain[4]
- Less incidence of dehydration[4]
- Minimal blood loss during surgery[5]
- Precision of tissue removal[5]
- Less damage to surrounding tissue[5]
Coblation: Turbinate Reduction
Coblation turbinate reduction is used to restore normal breathing for patients with turbinate hypertrophy. Turbinates are spongy bone structures that extend into the nasal passage. Turbinate hypertrophy is a condition in which the turbinates become swollen and obstruct the nasal passage. In some cases, this swelling can interfere with normal breathing and may require surgical reduction.
The efficacy and safety of Coblation-based surgical methods for turbinate reduction have been demonstrated in several clinical studies.[6][7][8] The procedure uses a method called “Coblation-channeling” to simultaneously remove and shrink submucosal tissue. Submucosal tissue is a layer of connective tissue located under mucous membranes. The action of Coblation results in rapid healing and reduction in the nasal obstruction.
Coblation: Treatment of Snoring
Coblation soft palate treatment is used to treat snoring. The soft palate is the soft tissue that makes up the roof of the mouth. Its vibration during sleep causes the sound known as snoring. Treatment of snoring can involve removal or reshaping of the tissue. The procedure typically takes less than fifteen minutes and many patients experience a reduction in snoring within six weeks. Studies published in peer-reviewed journals have shown Coblation soft palate treatment to have a number of clinical advantages.[9][10][11] These include:
- Significant improvement in Epworth Sleepiness Scales at both the 3 and 9.5 month postoperative visits[10]
- Significant reduction in snoring reported by both patient and bed partner at 3 and 9.5 month postoperative visits[10]
- Significant change in the distance between the tip of the uvula and the bottom of the sella indicating a retraction of the uvula[10]
- Minimal patient discomfort
- Immediate volumetric palatal tissue removal
- Continual symptomatic improvement over time due to tissue shrinkage and stiffening as a result of the submucosal lesion being formed
References
- ^ a b Temple RH, Timms MS. Paediatric Coblation Tonsillectomy. International Journal of Pediatric Otorhinolaryngology, 2001; 61: 195-198.
- ^ Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN. Pediatric total tonsillectomy using coblation electrosurgery compared to conventional electrosurgery: A prospective, controlled single-blind study. Otolaryngology, Head and Neck Surgery. 2004; 130 (6): 666-675.
- ^ a b Chinpairoj S, Feldman M, et al. A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model. Laryngoscope 2001; 111; 213-217.
- ^ a b c Glade RS, Pearson SE, Zalzal GH, Choi SS. Coblation adenotonsillectomy: an improvement over electrocautery technique? Otolaryngology, Head and Neck Surgery. 2006 May; 134(5):852-855
- ^ a b c Ghosh S. A Roper. Timms MS. Adenoidectomy with the Coblator: a logical extension of radiofrequency tonsillectomy. Journal of Laryngology and Otology. 2005 May; 119: pp 398-399.
- ^ Bhattacharyya N, Kepnes LJ. Clinical effectiveness of Coblation® inferior turbinate reduction. Otolaryngology, Head, and Neck Surgery. 2003; 129: 365-371.
- ^ Back LJ, Hytonen ML, Malmberg HO, Ylikoski JS. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment. Laryngoscope. 2002; 112: 1806-1812.
- ^ Bhattacharyya N, Kepnes LJ. Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy. Operative Techniques in Otolaryngology - Head Neck Surg. 2002; 13 (2): 170-174.
- ^ Belloso A, Morar P, Tahery J, Saravanan K, Nigam A, Timms MS. Randomized-controlled study comparing post-op pain between coblation palatoplasty and laser palatoplasty. Clinical Otolaryngology. 2006; 138–143.
- ^ a b c d Bäck LJ, et al. Bipolar RF Thermal Ablation of the Soft Palate in Habitual Snorers without Significant Desaturations Assessed by Magnetic Resonance Imaging. American Journal of Respiratory and Critical Care Medicine. 2002; 166: 865-871.
- ^ Rombaux P. Postoperative Pain and Side Effects After UPPP, LAUP, and RF Tissue Volume Reduction in Primary Snoring. Laryngoscope. 2003; 113: 2169-2173.
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