Tonsillectomy

Tonsillectomy is a common ENT procedure. There are different methods for tonsil removal. The commonest are:

  • Cold steel: the tonsils are removed as a whole using sharp metal instruments. The bleeding is controlled with ties or sutures.
  • Monopolar or bipolar diathermy: the tonsils are dissected using diathermy, where an electric current raises the temperature of the tissue up to 450 °C. The bleeding is addressed in the same way or with ties.
  • Laser: now not so popular as the temperature of the tissue raises above 600 °C and causes severe pain after the operation.
  • Coblation (Radio-frequency): which is the dissection method of more than 35% of all tonsillectomies performed in the USA.

This method is preferred by the author (Anastasia Rachmanidou) who is a mentor for this technique in the UK.

The usual complications, following tonsillectomy are:

  • Bleeding ( the first hours following surgery or
    up to 12-15 days later)
  • Infection
  • Throat pain
  • Pain referred to the ears

Coblation Tonsillectomy

What is it? How does it work?

Coblation is no longer a novel dissection method. It was introduced in the UK in 2000 and Anastasia Rachmanidou has been using the tool since 2002.

Coblation is a radio-frequency dissection method that cuts and seals the wound at the same time. It is a bipolar system working through a medium of normal saline (cooling system and sodium ion provider) incorporated in a disposable wand. The wand has also a built-in suction. The system ‘cuts’ the tissue by breaking down the inter-cellular bonds (by excitement of sodium ions).

The presence of normal saline helps in keeping a low temperature in the tissue (between 60 and 70 °C) during the operation. Hence, the thermal damage is minimal, so is the pain afterwards.

The operation is performed under general anaesthesia and through the mouth (no external cut).

The tonsils are removed with the use of the disposable wand (less risk of infection with vCJD).

There is no need for diathermy (electro-cautery) use or routine use of sutures or ties during Coblation tonsillectomy and the blood loss is minimal (if any).

The system is operator-dependent and the more experienced the surgeon is with this technique, the better the results (Anastasia Rachmanidou has
performed, todate, over 1600 Coblation tonsillectomies).

The surgical time for tonsillectomy is short (approx 10 – 20 minutes) and allows for the use of short duration anaesthesia that is optimal for the procedure to be done as Day Case Surgery.

What happens after tonsillectomy?

After the procedure, the patient can eat and drink within 2 hours and go home (if there are no complications) 6 hours after surgery with a supply of antibiotics, local anaesthetic spray and pain-killers for one week.

The most common and significant complication after tonsillectomy is bleeding (post-operative haemorrhage).

This may happen within two hours from surgery (reactionary haemorrhage) or from 2 to 15 days after surgery.

It is rare but possible that this bleeding can be life-threatening (1 in 35, 000 can be lethal, in the UK). If bleeding happens, then the patient should go to the nearest hospital A&E department (or the Private Hospital, if private patient) for emergency treatment, that may need a second operation to stop the bleeding.

Anastasia Rachmanidou has a very low post-tonsillectomy bleeding rate that needs to return to theatre (0.9% compared with the national average of 4%).

The next day following tonsillectomy, there is a white coating at the bed of the tonsils. This is part of the normal healing process and not an infection.

There is variable pain at the back of the throat or even a sensation of a ‘lump in the throat’ that improves within a week to 10 days from surgery.

It is important to drink a lot of fluids after the tonsillectomy so that there is no risk of dehydration and raised temperature that may lead to infection.

Regular analgesia (Paracetamol & Ibuprofen) is advisable, particularly 45 minutes before meals, so that the patient in recovery will not reject eating.

The patient should refrain from work or school for 15 days, due to the risk of bleeding. Normal activities can start 15 days after surgery.