European Journal of Cardiovascular Medicine

The palatine tonsils are paired lymphoid structures situated within the tonsillar fossa of the oropharynx and form an integral component of Waldeyer’s ring. They play an essential role in immunological defense during childhood by participating in both humoral and cell-mediated immune responses. Recurrent or chronic inflammation of the tonsils, commonly caused by Group A beta-hemolytic streptococci, can result in significant morbidity, including recurrent throat pain, dysphagia, sleep disturbance, and reduced quality of life [1]. When conservative management fails, tonsillectomy remains the definitive treatment.

Tonsillectomy is one of the most frequently performed surgical procedures in otorhinolaryngology, particularly in the pediatric and young adult population. Conventional extracapsular tonsillectomy using cold dissection and snare technique has been the standard surgical approach for several decades [2]. However, this technique is often associated with considerable intraoperative blood loss, prolonged operative time, and significant postoperative pain due to extensive tissue trauma and thermal injury when electrocautery is used for hemostasis [3–5].

In recent years, various alternative techniques have been developed with the aim of reducing surgical morbidity while maintaining efficacy. These include monopolar and bipolar diathermy, laser tonsillectomy, ultrasonic dissection, radiofrequency surgery, and coblation tonsillectomy [6–11]. Among these, coblation tonsillectomy has gained increasing attention due to its proposed advantages of minimal thermal damage, reduced postoperative pain, and faster recovery.

Coblation technology uses bipolar radiofrequency energy delivered through isotonic saline, producing a plasma field that disrupts intercellular molecular bonds at relatively low temperatures (45–85°C). This is significantly lower than the temperatures generated by conventional electrocautery (400–600°C), thereby reducing collateral tissue injury [11,12]. The ArthroCare Evac 70 or Procise Max wand allows for precise tissue ablation with simultaneous suction, enabling both intracapsular and extracapsular dissection techniques.

Despite the increasing adoption of coblation tonsillectomy, controversy remains regarding its superiority over conventional tonsillectomy, particularly in resource-limited settings. While several studies have reported reduced postoperative pain and faster recovery with coblation, concerns regarding cost, learning curve, and postoperative bleeding persist [7–11].

The present study was conducted to systematically compare intraoperative parameters and postoperative outcomes between coblation tonsillectomy and conventional tonsillectomy in patients with chronic tonsillitis at a tertiary care centre. The primary focus was on operative time, intraoperative blood loss, and postoperative pain, while secondary outcomes included tonsillar fossa healing, return to normal diet and activity, and postoperative bleeding.

Study Design and Setting A prospective comparative study was conducted in the Department of Otorhinolaryngology at Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Kerala, from June 2023 to January 2025, after obtaining approval from the Institutional Ethics Committee. Study Population Sixty patients diagnosed with chronic tonsillitis and meeting the indications for tonsillectomy were included in the study. Patients were randomly allocated into two equal groups: • Group A: Coblation tonsillectomy (n = 30) • Group B: Conventional tonsillectomy (n = 30) Inclusion Criteria  Age : 5 to 40 years of both sexes  Chronic tonsillitis patients  Obstructive symptoms related to tonsil hypertrophy  Recurrent tonsillitis patients Exclusion Criteria • Malignancy of tonsil • Patients with comorbidities like uncontrolled diabetes, hypertension, heart diseases • Patients with history of a bleeding disorder or on anticoagulants • Patients with adenoid hypertrophy Surgical Technique All procedures were performed under general anesthesia in Rose’s position using a Boyle-Davis mouth gag. In the conventional tonsillectomy group, extracapsular dissection was performed using cold steel instruments with snare excision of the lower pole. Hemostasis was achieved using ligatures or bipolar cautery. Figures 1 In the coblation tonsillectomy group, extracapsular dissection was performed using the ArthroCare Evac 70 coblation wand. Tissue ablation and coagulation were achieved using controlled radiofrequency energy in a saline medium. Figures 2 Figure 1: performing conventional tonsillectomy. Figure 2: coblation tonsillectomy [image for reference, adapted from v, Annamalai & Sms, Palaniappan & a, Dlo. (2019). a comparison of coblation versus conventional tonsillectomy in a tertiary care center.. international journal of advanced research. 7. 569-581. 10.21474/ijar01/8855.] Figure 3.a: TONSILLAR FOSSA SLOUGH Figure 3.b: TONSILLAR FOSSA SLOUGH Outcome Measures Primary outcomes • Duration of surgery (minutes) • Intraoperative blood loss (milliliters) • Postoperative pain assessed using Visual Analog Scale (VAS) • Secondary outcomes • Tonsillar fossa healing (slough clearance on days 2 and 7) figure 3 • Time to return to normal diet (days) • Time to return to normal activity (days) • Postoperative bleeding Statistical Analysis Data were analyzed using appropriate statistical tests. Continuous variables were expressed as mean ± standard deviation. Intergroup comparisons were performed, and a p-value <0.05 was considered statistically significant.

The mean operative time was significantly shorter in the coblation tonsillectomy group compared to the conventional tonsillectomy group (p<0.001). Coblation allowed faster dissection and effective hemostasis, resulting in improved intraoperative efficiency. Table 1

Table 1: Comparison of Duration of Surgery Between Groups

Patients undergoing coblation tonsillectomy experienced significantly less intraoperative blood loss compared to those undergoing conventional tonsillectomy (p<0.001), reflecting superior hemostatic control with low-temperature plasma technology. Table 2

Table 2: Comparison of Intraoperative Blood Loss

Postoperative pain scores were significantly lower in the coblation group at all assessed time points. Reduced thermal injury and limited tissue trauma contributed to better pain outcomes and patient comfort. Table 3

Table 3: Comparison of Postoperative Pain (VAS Scores)

Patients in the coblation group returned to normal diet and daily activities significantly earlier than those in the conventional group. No postoperative bleeding was observed in either group. Graph 1,2; table 4

Table 4: Comparison of Recovery Parameters

Graph 1: Return to normal diet (days)

Graph 2: Return to normal activity (days)

Tonsillar fossa healing was significantly better in the coblation group compared to the conventional tonsillectomy group. The coblation group showed significantly less residual slough coverage on post-operative day 2 (70.0 ± 14.3% vs. 85.0 ± 13.3%) and post-operative day 7 (9.17 ± 13.8% vs. 36.17 ± 14.5%). Both differences were statistically highly significant (p < 0.001). table 5, graph 3

Table 5. Comparison of Tonsillar Fossa Healing Among Groups

Graph 3:COMPARISON OF SLOUGH COVERED IN TONSILLAR FOSSA AMONG GROUPS

The present study demonstrates that coblation tonsillectomy offers significant advantages over conventional tonsillectomy in terms of intraoperative efficiency and postoperative recovery in patients with chronic tonsillitis. These findings are consistent with the theoretical benefits of coblation technology, which minimizes thermal injury while maintaining effective tissue dissection and hemostasis [11,12].

One of the most notable findings was the significantly shorter operative time observed in the coblation group. The ability of coblation to simultaneously ablate tissue and achieve hemostasis reduces interruptions during surgery, allowing for smoother dissection. In contrast, conventional tonsillectomy often requires repeated hemostatic interventions, contributing to prolonged operative duration.

Intraoperative blood loss was also significantly lower in the coblation group. Reduced blood loss not only improves surgical field visibility but also decreases perioperative risks, particularly in pediatric patients. The lower temperatures generated by coblation minimize vascular injury and tissue charring, thereby limiting bleeding from the tonsillar bed.

Postoperative pain remains one of the most distressing complications following tonsillectomy. In this study, patients undergoing coblation tonsillectomy reported consistently lower pain scores at all postoperative time points. Reduced nociceptive stimulation due to limited thermal spread and preservation of surrounding tissues likely accounts for this observation.

Tonsillar fossa healing was superior in the coblation group, with faster slough clearance observed on postoperative days 2 and 7. Improved wound healing may be attributed to reduced tissue necrosis and inflammation, facilitating earlier epithelialization.

Early return to normal diet and activity is an important marker of functional recovery. The significantly faster recovery observed in the coblation group highlights its role in enhancing postoperative quality of life. Earlier oral intake reduces the risk of dehydration and promotes patient satisfaction.

No postoperative hemorrhage was observed in either group, suggesting that both techniques are safe when performed with proper surgical technique. This finding reinforces the reliability of coblation as a hemostatically secure method.

Overall, the results of this study support the use of coblation tonsillectomy as an effective alternative to conventional tonsillectomy, particularly in settings where rapid recovery and reduced postoperative morbidity are prioritized [21-25].

Coblation tonsillectomy demonstrated clear advantages over conventional tonsillectomy in patients with chronic tonsillitis. It was associated with significantly shorter operative time, reduced intraoperative blood loss, lower postoperative pain scores, faster tonsillar fossa healing, and earlier return to normal diet and activity. Both techniques were safe, with no postoperative bleeding observed. The findings of this study support the adoption of coblation tonsillectomy as a preferred surgical technique in appropriate clinical settings, particularly where minimizing postoperative discomfort and expediting recovery are essential goals.

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