Tonsillectomy Methods

You may be aware that there are several different methods for removing the tonsils and adenoids. The manufacturers of some of the high tech instruments that can be used for this surgery have done a good job of promoting their products with claims of superior results or decreased postoperative pain. However, there are pros and cons to using these higher tech instruments that make the surgeon's decision a little more complicated.

One example of a high tech instrument that is highly promoted by its manufacturer is the "coblator" used for "coblation" tonsillectomy. The coblator is a device that uses radiofrequency energy to dissolve tissue. Several studies have demonstrated a decrease in pain after surgery compared to using what their studies describe as "standard electrocautery" techniques.

We are experienced with coblation and have done considerable detailed reviews of the published results of clinical studies on this method to determine if the claims are justified. Unfortunately, most of these studies do not describe the power setting used for the "standard electocautery" patients that were compared to the "coblation" patients. When it was reported, the "standard electocautery" method was done at a high power wattage, which is known to result in increased pain after surgery. It seems clear that coblation offers an advantage over high wattage electocautery technique in terms of post-operative pain. However, some of our surgeons have found that performing tonsillectomy with the electocautery set at a very low wattage produces results similar to coblation, without some of the disadvantages.

Potential disadvantages of coblation are cost, possible increased surgical time (time under anesthesia), possible increased risk of aspiration of saline (salt water into the lungs), and possible increased risk of bleeding after surgery. Whether coblation tonsillectomy has more bleeding than low wattage tonsillectomy is controversial, but some experienced ENT surgeons have found that it does. Coblation is certainly a fine technique, but our surgeons always consider each of these factors.

To achieve an even lower degree of post-operative pain than with the methods above, the coblation technique can be modified to leave a small portion of tonsil tissue behind. This does indeed decrease pain, and there are a few situations where removing less than the whole tonsil in exchange for a modest decrease in postoperative pain is an acceptable trade-off. However, there are concerns about leaving tonsil tissue behind if past (or future) infection in that tissue is the reason for recommending surgery in the first place.

As you can see our surgeons have devoted a great deal of thought and experience to this topic. Our physicians are experienced with all techniques. As all patients and clinical situations are different, our physicians will be happy to discuss options to select the best method for you or your child.