Intracapsular Microdebrider-Assisted and Coblation Tonsillectomy

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Introduction

Tonsillectomy remains one of the most common surgical procedures performed on children. In contrast to several decades ago when infectious indications were common, the reason most children undergo tonsillectomy today is to relieve upper airway obstruction. Traditional “extracapsular” tonsillectomy remains a fairly morbid procedure. Children routinely require several days off from school, and parents are often forced to take time off from work. Despite advances in surgical technology, a significant reduction in postoperative pain after this procedure has eluded surgeons. This is evidenced by the wide array of techniques available to the surgeon. Furthermore, the rate of postoperative hemorrhage has remained fairly stable despite the technique practiced. Partial “intracapsular” tonsillectomy seeks to significantly reduce postoperative pain and hemorrhage risk while effectively treating upper airway obstruction. The “intracapsular” tonsillectomy can be performed with the microdebrider or with Coblation techniques.

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Patient Selection

Patients suffering from upper airway obstruction secondary to tonsil hypertrophy are candidates for partial tonsillectomy. Caregivers are fully informed of the differences between total and partial tonsillectomy and the rationale for each procedure. The potential for tonsil regrowth and the risk for development of chronic streptococcal tonsillitis need to be addressed (see Postoperative Management and Complications ) during the informed consent process.

Relative contraindications to the performance of intracapsular tonsillectomy include a history of chronic tonsillitis and tonsil regrowth after a previous partial tonsillectomy.

The safety of intracapsular tonsillectomy in the young patient has been studied. Bent et al. found no significant difference in the rate of readmission, pain, oral intake, or analgesic requirements in patients younger than 3 years of age who underwent partial tonsillectomy compared with a control group. Chang found that children who underwent intracapsular tonsillectomy had significantly less pain on postoperative day 5 and 6 compared with matched subcapsular tonsillectomy patients, were more active, and were eating more.

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