Coblation versus other surgical techniques for tonsillectomy

Burton MJ, Doree C

Published Online:

January 21, 2009

The coblation technique is not associated with less postoperative pain and bleeding when compared with other surgical methods for tonsillectomy.

Surgical removal of the tonsils (tonsillectomy) is a very common procedure. Recovery usually takes about two weeks and can be quite painful. Some people experience bleeding from the part of the throat where the tonsils used to be and this can happen several days after the operation (secondary haemorrhage). This review found nine trials that investigated whether using coblation for tonsillectomy resulted in less pain and/or bleeding than other techniques. There is insufficient evidence to conclude that coblation tonsillectomy is associated with less pain and bleeding than other surgical methods for tonsillectomy.

Abstract (click to read)

Background:

Tonsillectomy is one of the most commonly performed surgical procedures. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated.

Objectives:

To assess the effectiveness of coblation tonsillectomy compared with other surgical techniques in reducing morbidity.

Search strategy:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to 2006) and EMBASE (1974 to 2006). The date of the last search was December 2006.

Selection criteria:

Randomised controlled trials of children and adults undergoing tonsillectomy by means of coblation compared with any other surgical technique for removal of the tonsils. Trials were assessed for methodological quality according to the method outlined in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.6.

Data collection and analysis:

Data were extracted using standardised data extraction forms. Authors were contacted where additional data were required.

Main results:

Nineteen studies were identified with sufficient data for further assessment. Four of these were excluded because intra-capsular tonsillectomy (i.e. tonsillotomy) rather than sub-capsular tonsillectomy was performed, and a further five studies because tonsils rather than participants were randomised. One further study was excluded because, although describing itself as a randomised trial, its participants turned out not to have been randomised to their intervention groups. Nine trials met the inclusion criteria, comparing coblation to other tonsillectomy techniques. All but two studies were of low quality and therefore a meta-analytical approach was not appropriate. In most studies, when considering most outcomes, there was no significant difference between coblation and other tonsillectomy techniques.

Authors' conclusions:

In terms of postoperative pain and speed and safety of recovery, there is inadequate evidence to determine whether coblation tonsillectomy is better or worse than other methods of tonsillectomy. Evidence from a large prospective audit suggests that it has been associated with a higher level of morbidity, in terms of postoperative bleeding. Large, well-designed randomised controlled trials supplemented by data from large prospective audits are needed to produce information on effectiveness and morbidity respectively.

This record should be cited as:

Burton MJ, Doree C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004619. DOI: 10.1002/14651858.CD004619.pub2

Assessed as up to date:

May 23, 2007

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Ear, nose, & throat > Pharynx > Tonsillitis (chronic)

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Coblation versus other surgical techniques for tonsillectomy

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