ENT MATTERS
Tonsillectomy

Tonsillectomy is a common ENT procedure. There
are different methods for tonsil removal. The
commonest are:

•        
Cold steel: the tonsils are removed as a whole
using sharp metal instruments.  The bleeding is
controlled with ties or sutures.
•        
Monopolar or bipolar diathermy: the tonsils are
dissected using
diathermy, where an electric current
raises the temperature of the tissue up to
450 °C.  The bleeding is addressed in the same way
or with ties.
•        
Laser: now not so popular as the temperature
of the tissue raises above 600 °C and causes severe
pain after the operation.
•        
Coblation (Radio-frequency): which is the
dissection method of more than 35% of all
tonsillectomies performed in the USA.

This method is preferred by the author (
Anastasia
Rachmanidou
) who is a mentor for this technique in
the UK.


The usual
complications, following tonsillectomy are:

•        
Bleeding ( the first hours following surgery or
up to 12-15 days later)
•        
Infection
•        Throat pain
•        Pain referred to the ears


Coblation Tonsillectomy

What is it?  How does it work?

Coblation is no longer a novel dissection method.  It
was introduced in the UK in 2000 and
Anastasia
Rachmanidou
has been using the tool since 2002.

Coblation is a radio-frequency dissection method that
cuts and seals the wound at the same time.  It is a
bipolar system working through a medium of normal
saline (cooling system and sodium ion provider)
incorporated in a disposable wand.  The
wand has
also a built-in suction.  The system ‘cuts’ the tissue by
breaking down the inter-cellular bonds (by excitement
of sodium ions).

The presence of normal saline helps in keeping a low
temperature in the tissue (between 60 and 70 °C)
during the operation.  Hence, the
thermal damage is
minimal, so is the pain afterwards.

The operation is performed under
general
anaesthesia
and through the mouth (no external cut).

The
tonsils are removed with the use of the
disposable
wand (less risk of infection with vCJD).

There is no need for
diathermy (electro-cautery) use
or routine use of sutures or ties during
Coblation
tonsillectomy
and the blood loss is minimal (if any).

The system is
operator-dependent and the more  
experienced the surgeon is with this technique, the
better the results (
Anastasia Rachmanidou has
performed, todate, over 1600
Coblation
tonsillectomies
).

The
surgical time for tonsillectomy is short (approx
10 - 20 minutes) and allows for the use of short
duration
anaesthesia that is optimal for the procedure
to be done as
Day Case Surgery.

What happens after tonsillectomy?

After the procedure, the patient can eat and drink
within 2 hours and go home (if there are no
complications) 6 hours after surgery with a supply of
antibiotics, local anaesthetic spray and pain-killers
for one week.

The most common and significant complication after
tonsillectomy is bleeding (post-operative
haemorrhage
).

This may happen within two hours from surgery
(
reactionary haemorrhage) or from 2 to 15 days after
surgery.

It is rare but possible that this bleeding can be life-
threatening (1 in 35, 000 can be lethal, in the UK).  If
bleeding happens, then the patient should go to the
nearest
hospital A&E department (or the Private
Hospital, if private patient) for emergency treatment,
that may need a second operation to stop the
bleeding.

Anastasia Rachmanidou has a very low post-
tonsillectomy bleeding rate
that needs to return to
theatre (0.9% compared with the national average of
4%).

The next day following
tonsillectomy, there is a white
coating at the bed of the tonsils.  This is part of the
normal healing process and not an infection.

There is variable pain at the back of the throat or
even a sensation of a ‘lump in the throat’ that
improves within a week to 10 days from surgery.

It is important to drink a lot of fluids after the
tonsillectomy so that there is no risk of
dehydration
and
raised temperature that may lead to infection.

Regular
analgesia (Paracetamol & Ibuprofen) is
advisable, particularly 45 minutes before meals, so
that the patient in recovery will not reject eating.

The patient should refrain from work or school for 15
days, due to the risk of bleeding.  Normal activities
can start 15 days after surgery.

Coblation Tonsillectomy Videos:

Pre-Surgery View
Removal of Right Tonsil
Removal of Left Tonsil
Post-surgical View