Mr William Flannery

Obstructive Sleep Apnoea in Children
Surgical Treatment

Coblation Tonsillectomy
Coblation is a technology which combines ablation and coagulation. Ablation melts away the tonsil tissue at the molecular level and coagulation stops the bleeding.

Coblation is really cool. The standard method of dissecting out tonsils relies on diathermy which operates at 400-600°C. Diathermy causes a thermal injury with vapourisation of the tonsil. In addition, the heat dissipated damages surrounding tissues. Coblation uses radiofrequency energy with saline to produce a plasma field. Coblation runs at 40-70°C removing tissue at the molecule level and causing very little bystander damage.

Unlike diathermy which can produce sparks, Coblation does not produce an ignition source for potential airway fires.

There are two ways Coblation can be used to remove tonsils. For over a decade, the established way has been to dissect the tonsils out of their beds with their capsules. This is called extracapsular Coblation tonsillectomy (see video).

Extracapsular Coblation tonsillectomy

The problem with extracapsular tonsillectomy is the large tonsillar blood vessels crossing between the tonsil bed and the tonsil itself. Two such vessels can be seen being coagulated in the video.

Intracapsular Coblation Tonsillectomy
This technique leaves the capsule attached to the tonsillar bed so avoiding the large vessels that supply the tonsil. Intracapsular Coblation simply means ablating the tonsil back to its capsule rather like scooping out the flesh of an avocado and leaving the green skin behind.

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Intracapsular Coblation Tonsillectomy (cont)
Avoiding the large vessels passing through the capsule has a marked impact on complications and recovery times. The secondary haemorrhage rate, which is the incidence of bleeding more than 24 hours after the operation, falls from 1.5% to 0.4%. Recovery time is greatly reduced from 2 weeks to 7 days, the operation can be performed as a day case and post-op pain is also reduced.

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