Less Patient Bleeding with Coblation Assisted Tonsillectomy
The method of tonsillectomy has evolved over the past 20 years from a cold technique, using a scalpel to cut the tonsil tissue out, to an electrocautery technique, which uses heat to decrease blood loss during the surgical procedure. Unfortunately, electocautery can damage nearby tissue and increase post-operative pain. Therefore, surgeons continue to seek a solution providing excellent control of bleeding, both intra-operatively and post-operatively, with minimal pain in the post-operative period allowing for a rapid recovery.
A researcher suggests that Coblation electrosurgery, a patented process employing bipolar radiofrequency technology to achieve precise and rapid tissue removal with minimal thermal damage to collateral tissue, meets that need. Coblation is a non-heat driven process in which radiofrequency energy is applied to a conductive medium (usually saline) causing a highly focused plasma field to form around the electrodes. The plasma field is comprised of highly ionized particles. These ionized particles have sufficient energy to break organic molecular bonds within tissue. Instead of exploding tissue, Coblation causes a low temperature molecular disintegration, resulting in minimal tissue damage to surrounding areas.
Coblation Assisted Tonsillectomy appeared in operating rooms approximately three to four years ago. Past research suggests that the technique offers a less painful and more rapid recovery than other tonsillectomy procedures. A new study has been completed that compares the post-operative course of children undergoing low-wattage electrocautery tonsillectomy to children undergoing Coblation assisted tonsillectomy, all performed by a single surgeon.
The author of "Pediatric Tonsillectomy: Coblation vs. Electrocautery," is David L. Walner MD, from the Department of Pediatric Otolaryngology, at Lutheran General Children's Hospital, Park Ridge, and Assistant Professor, Department of Otolaryngology/ Bronchoesophagology, Rush University Medical Center, Chicago, all in IL. His findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.
Methodology: This study was a prospective randomized study evaluating 80 children who underwent tonsillectomy or tonsillectomy and adenoidectomy between March 2003 and October 2003. Each surgery was performed by the author at one of three locations (a tertiary care Children's Hospital, a community hospital, or a community surgery center). Forty were done with a Coblation technique and 40 were done with an electrocautery technique. Each procedure was performed under general anesthesia which was administered by an attending pediatric anesthesiologist.
Following the surgery, each parent was asked to complete a survey post-operatively to follow their child's recovery. The survey questions included the number of days with severe pain following surgery, the number of post-operative days with pain scores greater than or equal to five (on a scale of 1-10 with 1 indicating no pain and 10 indicating the most severe pain), the number of post-operative days that any quantity of codeine was needed, the number of post-operative days until a regular diet was resumed, and the surgeon's rating of the patients recovery (scored 1-3 with 3 being an excellent recovery 2 being an average recovery and 1 being a poor recovery). The surgeon score was based on the theory that an average recovery was 6-7 days.
Results: The average age for the Coblation group vs. the electrocautery group was 5.16 years and 6.03 years respectively. The number of days with severe pain following surgery was 4.15 for the Coblation group vs. 5.90 for the electrocautery group. The number of post-operative days with a pain score greater than or equal to 5 was 3.60 in the Coblation group vs. 4.75 in the electrocautery group. The number of post-operative days that codeine was needed was 2.45 in the Coblation group and 2.93 in the electrocautery group. The number of post-operative days until a regular diet was resumed was 5.23 in the Coblation group and 6.15 in the electrocautery group. The surgeon's rating of recovery was 2.43 in the Coblation group and 1.88 in the electrocautery group.
Conclusion: The author suggests that Coblation Assisted Tonsillectomy offers the surgeon many advantages over electrocautery tonsillectomy. The intra-operative experience with Coblation is excellent in that it is a faster procedure with little to no bleeding. These findings revealed that the intra and post-operative experience with Coblation causes less bleeding and allows quicker patient recovery with less overall pain.
Note: Note: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) represents the nation's 11,000 otolaryngologist-head and neck surgeons. These specialists diagnose and treat disorders of the ear, nose, and throat and related structures of the head and neck. Learn more about the specialty and otolaryngic disorders at the AAO-HNS Internet web site, http://www.entnet.org.
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Mai puþin de pacienþi cu hemoragii Coblation Asistatã Tonsillectomy - Less Patient Bleeding with Coblation Assisted Tonsillectomy - articole medicale engleza - startsanatate