Search Results (11)

Introduction: Post-tonsillectomy hemorrhage is a serious complication that varies according to the surgical technique used, potentially compromising patient safety and recovery. Even though several techniques were frequently used, including cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy, there were certain discrepancies in hemorrhage rates in the literature. This meta-analysis aims to compare the rates of primary and secondary hemorrhage among these surgical techniques, with a focus on guiding clinical decision-making. Methodology: A total of 12 studies, published between 2005 and 2024, were selected from the PubMed, Web of Science, Scopus, and Cochrane Library databases, comprising 1684 participants from both pediatric and adult groups. Primary and secondary hemorrhage rates, surgical techniques, and study characteristics were extracted as data. Therefore, the aim of performing this meta-analysis with random-effects models was to calculate pooled estimates for hemorrhage rates and the heterogeneity index (I²). The techniques studied included cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy. Results: The pooled primary hemorrhage rate across all techniques was 1.0% (95% Cl: 0.5–1.4%), with insignificant heterogeneity (I² = 0.0%, p < 0.665). By contrast, pooled secondary hemorrhage occurred at a rate of 5.8% (95% CI: 3.9–7.6%). Cold steel tonsillectomy was associated with the lowest secondary hemorrhage rate of 3.7% (95% CI: 0.8–6.6%, I² = 43.558%, p = 0.115), while bipolar diathermy had the highest secondary hemorrhage rate of 8.6% (95% CI: 2.3–15.0%, I² = 86.448%, p < 0.001). Conclusions: This meta-analysis underscores the considerable variability in rates of post-tonsillectomy hemorrhage frequency among various surgical techniques. Cold steel dissection appears to be the safest regarding secondary hemorrhage, while coblation likely minimizes primary bleeding. Bipolar diathermy comes across as the technique with the highest risk for primary hemorrhage and requires special caution during its use. Such results emphasize the need for careful selection of the surgical technique concerning patients’ particular conditions and the need to enhance care periods to reduce the bearing of any hemorrhagic complications. Full article

Background: There is little research in the literature comparing the efficacy of coblation nucleoplasty with conservative treatment in the treatment of cervical discogenic dizziness and reporting the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom state (PASS) after surgery. This retrospective study aims to explore the patient-reported outcome measures (PROM) following coblation nucleoplasty for cervical discogenic dizziness and to compare the therapeutic effect of coblation nucleoplasty with prolonged conservative treatment. Methods: Sixty-one patients with cervical discogenic dizziness and a positive intradiscal diagnostic test eligible for single-level cervical coblation nucleoplasty were included in the study. Among these 61 patients, 40 patients underwent cervical coblation nucleoplasty, while the remaining 21 patients refused surgery and received continued conservative treatment. The primary PROMs were the intensity and frequency of dizziness and secondary PROMs were related to the neck disability index (NDI) and visual analog scale (VAS) for neck pain (VAS-neck) during a 12-month follow-up period. Moreover, the achieved rate of MCID and PASS in both groups was assessed 12 months after surgery. Results: Dizziness intensity, dizziness frequency, VAS-neck score, and NDI score were significantly improved from the baseline at all follow-up time points in both treatment groups, except for showing no significant improvement in dizziness frequency in the conservative treatment group at 6 and 12 months after surgery. However, at each follow-up time point, the above indexes were lower in the surgery group than in the conservative treatment group. In addition, the achieved rates for PASS and MCID in all indexes in the surgery group were significantly higher than those in the conservative treatment group at 12 months after surgery. Conclusions: Cervical coblation nucleoplasty significantly improved the intensity and frequency of dizziness, neck pain, and NDI in patients with cervical discogenic dizziness, and the results were superior to those from prolonged conservative treatment. Meanwhile, cervical coblation nucleoplasty is a good choice for patients with chronic neck pain and refractory cervical discogenic dizziness who have not demonstrated the indications for open surgery and have not responded well to conservative treatment. Full article

(1) Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway, leading to reduced or absent breathing during sleep. A nocturnal upper airway collapse is often multi-levelled. The aim of this communication is to describe a 3D multi-level surgery setting in OSA pathology, introducing new surgical approaches, such as 4K-3D endoscopic visualization for the tongue base approach with the aid of a coblator and exoscopic visualization in the palatal approach. (2) Methods: Seven patients affected by OSA underwent 3D Barbed Reposition Pharyngoplasty (BRP) surgery associated with transoral coblation tongue base reduction and nose surgery. (3) Results: No patients experienced intra-operative, post-operative or delayed complications. For OSA multi-level 3D surgery, it took less than 2 h: the median 3D system setting time was 12.5 ± 2.3 min; the overall procedure time was 59.3 ± 26 min. (4) Conclusions: The use of the 4K-3D endoscope and coblator for tongue base resectioning and of the 3D exoscope for lateral pharyngoplasty represents an excellent system in multi-level OSA related surgery that could reduce the time and the costs compared to those of robotic surgery. Full article

Advantages of hot devices for tonsillectomy, represented by coblation, have been highlighted in recent years. During hot technique tonsillectomy it is important to identify and coagulate the vessels of the tonsillar capsule, especially at the lower pole of the tonsil. Hot technique tonsillectomy under microscope or endoscope has therefore been recommended to achieve accurate identification of the microstructure of the surgical field. We have applied ORBEYE, a three-dimensional surgical exoscope system, to coblation tonsillectomy. Advantages of using ORBEYE include high definition and high magnification images, and flexibility of camera position and angle. This means there is an improved surgical view and working space, particularly at the lower pole during performance of coblation tonsillectomy. Here, we demonstrate that ORBEYE can be an effective surgical instrument in coblation tonsillectomy. Full article

Purpose: To observe the therapeutic effect of low-temperature plasma ablation in treating patients with recurrent corneal erosions (RCEs). Materials and Methods: From 2020 to 2022, 35 participants with unilateral RCEs voluntarily enrolled. Here, 35 eyes of 35 patients were treated with low-temperature plasma ablation (coblation). All surgeries were performed by the same doctor (X.H.). The coblation went back and forth over the entire erosion area around five times for about five minutes. After the operation, patients were scheduled for follow-up visits at the outpatient clinic after 1 month, 3 months, 6 months, and 12 months, and at the end of the trial. During every visit, each patient underwent an evaluation of their ocular symptoms utilizing the following: pain score, intraocular pressure, slit lamp biomicroscopic examination, dry eye analysis, corneal topography, and corneal in vivo confocal microscopy (IVCM). Results: The mean follow-up time was 12.4 ± 6.1 months, ranging from 6 to 29 months. Of the 35 patients who had low-temperature plasma ablation, 32 eyes (91.43%) were completely symptom-free and three (8.57%) eyes had repeated episodes of recurrent corneal erosions after the surgery, at 3, 10, and 12 months, respectively. The typical RCE morphologic abnormalities observed in IVCM included the deformation and relaxation of the corneal epithelium, disorganized stromal fibers, reduced nerve fiber density, and disordered organization. After low-temperature plasma ablation, the loose cysts disappeared, and the epithelium became solid and tight. There was no obvious difference in the intraocular pressure (p = 0.090) or corneal astigmatism (p = 0.175) before and after treatment. The mean pain score decreased significantly, with a preoperative score of 7.7 ± 2.4 and postoperative score of 1.1 ± 1.8 (p < 0.001). The mean corneal thickness decreased from 562.6 ± 42.2 mm to 549.6 ± 26.9 mm (p = 0.031). The mean non-invasive keratograph tear meniscus height (NIKTMH) decreased from 0.210 ± 0.054 mm to 0.208 ± 0.045 mm (p = 0.001), and the mean TBUT decreased from 6.191 ± 2.811 s to 5.815 ± 2.802 s (p < 0.001), which manifested as a slight worsening of dry eyes. In one case, the patient’s corneal astigmatism became more severe, which may be related to the high instantaneous energy when the operation did not flush in a timely manner, and it was recovered after 6 months. Conclusions: Low-temperature plasma ablation is an effective and safe procedure to treat patients with recurrent corneal erosions. Full article

Many surgical instruments have been introduced and compared for safety and surgical efficiency in tonsillectomy. This study aimed to compare postoperative pain between coblation and conventional monopolar electrocautery tonsillectomy by intrapatient comparison in children. Thirty pediatric patients over six years of age undergoing tonsillectomies were enrolled. Coblation and electrocautery were used to remove both tonsils in one patient; one was removed by coblation and the other by electrocautery. The coblation side was randomly selected, and it was blinded to the patients. Each side’s daily pain scores were collected on the visual analogue scale (VAS) during ten postoperative days. On the day of surgery, 22 (73%) patients identified less pain on the coblation side, while others felt similar pain. The mean pain scores were significantly lower on the coblation side during the postoperative ten days (except for the 6th and 8th) than on the electrocautery side. The duration of severe pain (VAS > 5) was significantly shorter on the coblation side than on the electrocautery side (2.0 versus 3.7 days, respectively; p = 0.042). Coblation tonsillectomy induced less pain than electrocautery in pediatric patients; therefore, surgeons could choose the coblator as a surgical instrument for tonsillectomy to improve the pediatric postoperative quality of life. Full article

Background: Obstruction of the tongue is commonly seen in patients with obstructive sleep apnea (OSA). This study proposed whole tongue treatment using coblation ablation tongue (CAT) and aimed to explore the potential association between the dimensions of a tongue and the severity of OSA, to inspect volumetric changes of the tongue after CAT, and to search for factors that influence outcome of tongue volume change. Methods: The prospective study enrolled 12 OSA patients (all male, average age: 35 years, average apnea/hypopnea index (AHI): 45.5 event/h, average body mass index (BMI): 27.0 kg/m²). All patients received multi-level sleep surgery including septomeatoplasty, uvulopalatopharyngoplasty, and CAT. The CAT used a coblation wand to perform uniform multiple ablations (15 points, body −6, base −9) on dorsal tongue. Three dimensions of the tongue (length, height, and width) and tongue volume were measured from head and neck computed tomography. The perioperative changes in the tongue dimension/volume and AHI were assessed at baseline and 3 months after surgery. Result: The baseline tongue length and AHI had a significant correlation (r = 0.60, p = 0.02). The multi-level surgery significantly improved AHI (43.8 vs. 23.7, p = 0.008). The CAT significantly decreased tongue volume from 91.3 to 85.6 cm³ (p = 0.02), with an average tongue volume reduction of 5.7 cm³ per person and 0.38 cm³ per ablation. Further outcome analysis showed surgical success was significantly higher in patients with non-hypertrophic lingual tonsils (grade I/II) than in those with hypertrophic lingual tonsils (grade III/IV) (p = 0.02). Conclusion: Length of the tongue is associated with the severity of OSA. The CAT significantly decreased the tongue volume in OSA patients. A volumetric reduction of 0.38 cm³ per ablation could be useful in the optimal reduction of tongue for OSA. The CAT significantly enlarged the retroglossal airway volume, which is related to the non-hypertrophic lingual tonsil. Full article

We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015–2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18–70 years, body mass index (BMI) < 35 kg/m², apnea–hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m², and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery (p < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 (p < 0.05). The surgical success rate according to Sher’s criteria was 82.3%. The median follow-up was 23.3 months (range 12–36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS. Full article

Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved. Full article

Current treatment modalities for snoring may include mucosal removal, coblation or radiofrequency palatoplasty, injection snoreplasty and placement of palatal implants with described disadvantages. We introduce a new laser assisted method avoiding intraoral injury. A pilot study treating 13 loud snorers having an RDI < 8 was conducted. A diode laser coupled to a flexible fiberand a handle with curved needle was used. The fiber was introduced into the nasal surface of soft palate between palatoglossal and glossopharyngeal arches and advanced progressively anteriorly after pulling the uvula forward three times to create palatal scarring and stiffening. All responded to a phone survey. Six patients reported significant improvement, 4 had some improvement, 2 had mild improvement and one patient had no change. Pain score was moderate for 3 patients while the rest had mild pain. The laser harbors many advantages over other methods. Results with this technique are encouraging further studies. Full article

Nasopharyngeal angiofibromas are histologically benign but locally aggressive vascular tumors that can result in major morbidity and mortality. They exclusively affect adolescent male and are rare in patients older than 25 years. The management of nasopharyngeal angiofibroma is primarily surgical. Most small and medium sized tumors are resected endoscopically with a microdebrider. Our presentation demonstrates the role of radio-frequency coblation in the endoscopic management of angiofibroma that is confined to the nasal cavity, nasopharynx and paranasal sinuses. Through a brief video presentation, viewers will be able to appreciate the role of this instrument. We reviewed the case of an adult male patient who presented to our institute with nasopharyngeal angiofibroma. He underwent pre-operative embolization followed by endoscopic coblation of the tumor. A video demonstration is presented of a patient with nasopharyngeal angiofibroma who underwent successful transnasal endoscopic coblation. The coblator was used to resect the tumour attachment at the posterior end of the middle turbinate and the nasopharynx. The tumor was resected en-bloc and pushed into the oropharynx and eventually removed trans-orally. The natural ostium of the sphenoid sinus was enlarged and the residual tumor was removed. Absorbable nasal packing was inserted for haemostasis. Intra-operative bleeding was negligible. Radio-frequency coblation has a definite role in the endoscopic resection of small and medium sized nasopharyngeal angiofibroma. This technique is easy to learn and is extremely efficient. Tumors can be removed with minimal or no damage to surrounding tissues and intra-operative bleeding is negligible. Full article