Coblation Intracapsular Tonsillectomy (CIT) in adults
What are the Tonsils and why do we have them?
The tonsils are pads of lymphoid tissue at the sides of the throat. In very early childhood they form part of the immune recognition system and are important in teaching the immune system and protecting the body against infections by recognising harmful germs. In some individuals they can cause problems through infection and occasionally this can result in abscess formation (quinsy).
What are the main reasons for elective tonsil surgery as an adult?
Tonsillectomy in adults is primarily performed for problems with recurrent episodes of tonsillitis but can also be performed if individuals are troubled by frequent problems with tonsil stones.
What is a Coblation Intracapsular Tonsillectomy (CIT)?
Coblation is a technique which uses a special plasma derived from saline (salt water) to break down tissue in a very precise manner. The changes to tissue take place at around 40°C, resulting in very little heat transfer to the surrounding tissue, thereby reducing complications and pain.
An intracapsular tonsillectomy involves removal of tonsil tissue all the way up-to but not through a fibrous capsule that separates the tonsil from the muscle of the throat underneath. Unlike with traditional techniques (extracapsular surgery), the large blood vessels in the muscle beyond the tonsil capsule are not exposed, resulting in less risk of bleeding and discomfort. The recovery period is also faster than for a traditional tonsillectomy. The aim of this surgery is to use a meticulous surgical technique to remove virtually all the tonsil tissue up to the capsule thereby preventing future episodes of tonsillitis.
Is a Coblation Intracapsular Tonsillectomy the right choice for me?
Large scale studies in the UK, Europe and USA have supported the use of this technique particularly in children due to the reduced risk and enhanced recovery. The benefits of intracapsular tonsillectomy in children are so significant that the NHS now recommends this approach for tonsil removal in all children needing surgery as part of its “Getting It Right First Time” (GIRFT) programme, which focuses on improving the treatment and care of patients through an in-depth review of services. At the time of writing nearly 40% of all tonsillectomies in children in the UK are carried out with this technique. In adults the data is less clear but there is increasing evidence to support its use. UK national data has identified that adults undergoing conventional (extracapsular) tonsillectomy have a complication rate resulting in readmission to hospital of nearly 20% and an average recovery of 14 days. Our local data suggests that this can be reduced to a complication rate of less than 2% and a
recovery of approximately 10 days with CIT. International research studies have suggested that intracapsular techniques are just as good as conventional techniques in addressing symptoms of recurrent tonsillitis.
Deciding whether to have an intracapsular tonsillectomy or a conventional extracapsular tonsillectomy will be dependent on the discussion you have with your surgeon. Not all surgeons perform this technique in adults as it is technically more challenging than in children and if too much tissue is left behind, individuals may still be prone to symptoms. At ENT Surrey we have been performing CIT in children and adults since 2015 and have presented our outcome data both in the UK and internationally. Our outcome data suggests that in the right individuals this technique is superior to conventional surgery.
What are the complications of Coblation Intracapsular Tonsillectomy in Adults?
Bleeding
Bleeding is the most serious consequence of this type of surgery but occurs in less than 2% of cases. Bleeding can occur at any point in the recovery period and so it is important to be vigilant for signs of this. If significant bleeding is encountered, it is important to attend the Emergency Department at your local NHS Hospital immediately. It rare that an individual who has had an
intracapsular tonsillectomy will require further surgery to correct bleeding, but it is essential that they are assessed fully.
Infection
Infection is the commonest cause for increased discomfort and bleeding after surgery. The routine use of antibiotics following surgery does not reduce infection but can sometimes reduce discomfort and the unpleasant oral smell that is sometimes encountered. The tonsillar areas will normally appear white after surgery – this is normal and not a sign of infection. It can take 2-3 weeks for the appearance to return to a normal healthy pink colour.
Pain
Discomfort is common and is usually worst around day 3 following surgery. It is important to use regular painkillers for around 10 days after surgery. We normally recommend a combination of paracetamol, ibuprofen and “difflam spray”, with codeine being used for breakthrough pain.
Dental Trauma, or damage to the lips and gums.
This can occur very rarely from tonsil surgery. Please inform your surgeon /anaesthetist if your child has any loose teeth, before surgery. The risk of dental trauma is about 1 in 1000.
Taste disturbance
As pressure is placed on the tongue during surgery, some individuals can report a change in their sensation of taste. It normally improves very rapidly.
Residual tonsil tissue and ongoing problems with recurrent tonsillitis
After intracapsular surgery if tonsil tissue is left behind then there is a hypothetical risk of ongoing symptoms. Revision surgery can be carried out but in practice this is rare if the surgery is carried out by an experienced surgeon. It is important to note that no form of tonsillectomy will prevent sore throats in the future. The aim of tonsillectomy is to stop debilitating episodes of tonsillitis resulting in time off work or away from education.
What should I eat during the recovery period?
A normal diet is suggested after surgery. No special precautions are required.
How soon after surgery can we fly?
It is safe to fly 3-4 weeks after surgery but it is always worth checking with you travel insurance provider.
The following video show intracapsular surgery being carried out in an adult.
Please note that this video shows real surgery being performed and viewer discretion is therefore advised.