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. [http://www.patentstorm.us/patents/5902272.html] 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 Temple RH, Timms MS. Paediatric Coblation Tonsillectomy. "International Journal of Pediatric Otorhinolaryngology", 2001; 61: 195-198.]
*Significantly faster return to normal diet (2.4 days vs. 7.6 days on average) Temple RH, Timms MS. Paediatric Coblation Tonsillectomy. "International Journal of Pediatric Otorhinolaryngology", 2001; 61: 195-198.]

*Less incidence of postoperative nausea and throat swelling 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.]

*Less depth of thermal adjacent tissue necrosisChinpairoj 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.]

*Faster healing of tonsillar fossaeChinpairoj 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.]

*Less postoperative dehydrationGlade 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]

Clinical Studies: Adenoidectomy

Similar to Coblation tonsillectomy, advantages have also been demonstrated for Coblation adenoidectomy, including:

*Less postoperative neck painGlade 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.]
*Less incidence of dehydrationGlade 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.]
*Minimal blood loss during surgeryGhosh 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.]
*Precision of tissue removalGhosh 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.]
*Less damage to surrounding tissueGhosh 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.]

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.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.] 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.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.] 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.] These include:

*Significant improvement in Epworth Sleepiness Scales at both the 3 and 9.5 month postoperative visitsBack 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.]
*Significant reduction in snoring reported by both patient and bed partner at 3 and 9.5 month postoperative visitsBack 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.]
*Significant change in the distance between the tip of the uvula and the bottom of the sella indicating a retraction of the uvulaBäck 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.]
*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

External links

* [http://www.tonsilfacts.com Tonsillectomy Information Site]
* [http://aao-hns.org American Academy of Otolaryngology]
* [http://www.arthrocare.com/our_technology/ot_coblation_video.htm Coblation Video]