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Tonsil technology means less pain, faster recovery
Coblation uses nonheat process to cut and cauterize
Fewer instruments to handle, no risk of electrosurgical burns, less postoperative pain, and a speedier recovery are the advantages of a new tonsillectomy technique that uses radio frequency waves and salt water to remove tissue without damaging surrounding healthy tissue, according to surgeons performing the procedure.
"Patients who undergo traditional tonsillectomy using a cautery usually have a sore throat for eight to 10 days," says Ann K. White, MD, a pediatric ear, nose, and throat (ENT) surgeon in Alpharetta, GA. "With coblation, the sore throat lasts five to seven days," she says.
Because coblation utilizes a controlled, nonheat process that uses radio frequency waves and saline to cut tissue, there is less damage to surrounding tissue and less bleeding, White explains. Because it is not an electrosurgical cautery, there is no risk of arcing, or contact burns, she adds.
"Once you use coblation, you don’t want to go back to traditional cautery," says Ronald Saxon, MD, an ENT surgeon in Bloomfield, CT. Saxon uses coblation to treat adults and pediatric patients. "With coblation, I have the option to perform a subtotal tonsillectomy in which I leave a thin film of tonsil tissue," he says.
A subtotal procedure is performed in adults or children who suffer sleep apnea due to excess tissue that may be blocking the airway, Saxon explains. Because the tissue is healthy, there is no need to remove it, and leaving some decreases the amount of bleeding, he adds. "A subtotal tonsillectomy cannot be performed with traditional cautery because it is not as accurate," Saxon points out.
As the coblation instrument cuts, it seals the tissue, which reduces the need for extra instruments and reduces bleeding, White says.
She has performed more than 300 tonsillectomies in the past two years and has had three cases of excessive bleeding, or 1% of all cases performed, White points out. "This compares to my experience of 4% bleeding with traditional cautery," she adds.
White’s experience has been that postoperatively, patients experience less pain and require fewer narcotics, are able to drink sooner, recover more quickly, and require less nursing time in recovery.
"I didn’t tell the recovery room nurses that I was changing the equipment I used for tonsillectomies, but after I had been using coblation for two weeks, they started asking the operating room staff what I was doing differently," she says. "There was a noticeable difference in the recovery rate of my patients."
In addition to saving time in recovery, use of coblation saves time in preparation for surgery by the operating room staff, White notes. Using only one hand piece means less equipment to pull for each procedure, she explains. This reduced equipment translates to a quicker turnover time for the operating room, White adds.
From the surgeon’s point of view, coblation is an advantage because of fewer instruments to handle, Saxon notes. "You have the machine, which is usually provided by the company, and the disposable wand," he says. "You don’t need a ground pad, cautery equipment, or suction. The coblation wand does it all."
Another advantage to the surgeon is fewer calls to the office for refills of pain medications, White adds. "Patients don’t experience the same level of pain, and over-the-counter medication is usually enough after the first day," she states.
The procedure itself is quicker, says White. For a tonsillectomy and adenoidectomy, White can finish in 11 minutes, or two or three minutes faster than with traditional cautery that requires manipulation of more than one piece of equipment, she adds.
From a cost perspective, the same-day surgery program doesn’t have to invest in the machine. It usually is provided by the manufacturer, so the only cost is between $110 to $120 for the disposable wands, says White. (See resources for manufacturer information, below.) The cost for the procedure usually does not increase because you eliminate the cost for other supplies and equipment, she says. Because payers still are billed for tonsillectomy, reimbursement levels stay the same, she adds.
Training required to use the coblation equipment is simple, Saxon notes. "The surgical technique is not any different because the procedure is the same," he says. "You just learn to use a new piece of equipment."
There is, however, a learning curve, White warns. "With a cautery, you bear down on the tissue to seal the tissue, but coblation requires a very light touch," she says. "In fact, if you do apply the same amount of pressure required for cautery, you will cause excess bleeding."
Although there is no need for special certification to perform coblation, White recommends that surgeons work with a manufacturer’s representative or another surgeon who is experienced in coblation for at least five procedures. "It does take time to develop the light touch required, so a surgeon needs to be patient," she adds.
Patients benefit from coblation because they return to school or to work more quickly, Saxon says. In fact, some of Saxon’s patients have not heeded his advice to take it easy for a day or two, he admits.
"One patient told me that he ate veal scallopini for dinner on the day of his surgery, and another patient went mountain climbing the day after surgery," Saxon adds.
Sources and Resources
For more information about coblation, contact:
ArthroCare Corp. manufacturers the ENTec Coblator Plasma Surgery System that is specifically designed for ear, nose, and throat applications. For information, contact: