Coblation Tonsillectomy

Traditional tonsillectomies used lasers and electrocautery to dissect away inflamed tonsillar tissue, but these techniques often times damaged surrounding, healthy tissues. Consequently, patients had more prolonged and severe post-op discomfort. These days, coblation (“controlled ablation”) tonsillectomies have made the procedure as simple as a quick office visit.

“Using the Coblation wand device, the surgeon places the tip against the base of the tonsil to remove precisely the tissue attaching the tonsil to the throat. The surgeon then uses a foot pedal to control and activate the low-temperature, radio-frequency energy and saline conductive solution from the wand tip to the area around the tonsil. This action creates a plasma field that gently breaks down the targeted tissue. The wand also contains a coagulation feature that allows the surgeon to stop any bleeding quickly.” — UCLA Health

Here’s a short video which outlines what coblation tonsillectomy actually entails from a surgical perspective. You can clearly see how the coblation wand is deftly utilized to gradually excise away the tonsillar tissue.

A bilateral coblation tonsillectomy takes roughly 15 minutes and most patients are ready to go home within an hour with a few days of throat soreness post-op. Remarkable! 🙂

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  1. Makka2000 says

    Publications (and anecdotal evidence) show Coblation to be more painful than other technologies.
    Thermal Fusion (Microline) is truly almost painless

    1. Rishi says

      Thanks for the comment! I’ll have to read up on that technique.

  2. Steve W says

    Hello,
    I am very interested in this procedure. My wife and I have discussed visiting the college for the most current procedures, and this is exciting. I have been told by mulitiple doctors that I do qualify for tonsilectomy do to sore throats and tonsilites, as well as sleep issues. What is a contact number and department to contact for further information? Thnak you

  3. XRTMD says

    Also:

    1. All oncology patients are referred to RadOnc. Therefore, it is best to have cordial relationships with other oncologists and surgeons.

    2. At the initial consultation the patient is seen by the attending (sometimes preceded by resident and/or med student). At this time, the attending takes a full history and physical. Prior to the consult, appropriate labs, films, and medical history are reviewed. The attending gives the pt options and we go to the next step if pt wants to proceed with radiotherapy. The choice of treatment depends on what the current literature says, institutional hardware, and the attending’s own experiences.

    3. Pt is “simmed.” Rad techs position the patient in the machine and “simulate” an actual treatment. This way attending can verify the regional anatomy (both bony landmarks and soft tissue critical structures) and make adjustments as necessary.

    4. Pt is “planned.” Now that the images are on disk, the patient’s tumor volumes and critical structures are “contoured” by the resident and/or attending. Once the attending is satisfied with the area covered by radiation (including extra margins for tumor not apparent on imaging) then the plan goes to the dosimetrists.

    5. Dosimetrists (w/ or w/o resident) calculates plan including beam angles, doses, and fractionation. Generally, there is some degree of back and forth b/w the attending and dosimetrist with regard to plan optimization. Physics also looks at the plan and approves it.

    6. Pt is brought back for first treatment. Everything is set-up and pt is “simmed” one more time to ensure quality treatment. If everything looks good, pt receives first treatment.

    7. During the course of treatment pt receives so called “portal films.” (usually 1/week) These are images taken with the treatment machine to verify that you are actually irradiating the correct area. Also, patients see the attendings to report any side-effects or if they have any questions 1/week or so — though obviously immediately for pressing issues.

    8. Pt is seen @ follow-up clinics periodically for up to several years post-RT. Generally, the attending reviews scans to evaluate recurrence of disease as well as a physical exam.

    That’s more or less the sequence.

    1. Rishi says

      Thanks so much for all the information!! 🙂

  4. XRTMD says

    if interested at all, here is a good intro for anyone as to what RadOnc entails

    http://forums.studentdoctor.net/showthread.php?t=674353

  5. XRTMD says

    Well radiation oncology is quite different than radiology, it is a completely different specialty.

    1. Rishi says

      Point very well taken. I always thought that radiation oncology was a “subspecialty” of radiology, but truth be told, I really don’t know much about those specialties in general. What are your thoughts on the field?

  6. medfan says

    are you going to do a rotation in radiation oncology at some point? what are your thoughts on the field? im a fan of your blog, keep it up

    1. Rishi says

      I don’t foresee myself pursuing radiology, so it’s unlikely that I would do a clinical elective in radiation oncology (not even sure if that’s offered). 😀

      As far as my thoughts regarding the field… I have the utmost respect for those who research cancer, diagnose cancer, treat cancer, and above all, interact with cancer patients. Oncology requires a very different type of “doctor-patient relationship” from the norm, and unfortunately, it’s rare to find individuals best suited for this difficult yet rewarding position. I could go on and on, but I’ve got some reading to do before the NBA All-Star Game tonight, haha.

      Thanks for the comment! 🙂

  7. Gregory H. says

    Wow. It’s so cool seeing something that looks like it was taken straight out of a sci-fi book being used in real life.

    This may sound like a dumb question, but was a local anesthetic applied to the tonsil area before removal?

    1. Rishi says

      The patient was likely under general anesthesia during the operation. Local anesthetics are more common with procedures like wisdom tooth extractions, but a tonsillectomy is pretty hardcore in comparison. 🙂

  8. Kevin says

    Wow! That was a cool video! It’s awesome that the procedure is so quick now. I just spent the last 10 minutes looking for other videos like it on youtube. Never would have thought that kind of stuff would be up there! Thanks! 🙂

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