Skip to main content

Advertisement

SpringerLink
Log in

Intracapsular coblation tonsillectomy versus extracapsular coblation tonsillectomy: a systematic review and a meta-analysis

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To assess all available data regarding the comparative benefit of intracapsular coblation tonsillectomy (ICT) versus extracapsular coblation tonsillectomy (ECT) in children.

Methods

MEDLINE, the Cochrane Library and Springerlink databases as well as other sources were searched by two independent reviewers. Controlled studies comparing ICT versus ECT in paediatric patients with obstructive sleep apnea (OSA) or recurrent tonsillitis were included. Overall postoperative pain was the primary outcome. Secondary outcomes were postoperative hemorrhage, diet and activity, duration of operation and tonsillar regrowth. In case of homogenous, processable data (I2 < 60%), a meta-analysis was performed.

Results

Six studies met the inclusion criteria. The analysis showed significant difference between the two methods in terms of late postoperative pain with the ICT being less painful (SMD − 0.78, 95% CI [− 1.03, − 0.53]). However, there was no significant difference in early postoperative pain (≤ 48 h) between the two techniques (SMD − 0.18, 95% CI [− 0.47, 0.12]). All the rest of the secondary outcomes are presented in a qualitative synthesis due to published data limitations of the included studies.

Conclusion

Intracapsular coblation tonsillectomy appears to be a less painful operation in comparison to extracapsular coblation tonsillectomy. This seems to occur due to prevention of late pain flare up that normally happens several days after the procedure (described as postoperative dip) and not due to reduced pain at the immediate postoperative period. However, as all studies published are small sized, high-quality, large-sample studies need to be performed in the future for more concrete conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Koltai PJ, Solares CA, Koempel JA et al (2003) Intracapsular tonsillar reduction (partial tonsillectomy): Reviving a historical procedure for obstructive sleep disordered breathing in children. Otolaryngol Head Neck Surg 129(5):532–538. https://doi.org/10.1016/S0194-5998(03)00727-7

    Article  PubMed  Google Scholar 

  2. Zhang L-Y, Zhong L, David M, Cervin A (2017) Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 103:41–50. https://doi.org/10.1016/j.ijporl.2017.10.008

    Article  PubMed  Google Scholar 

  3. Leinbach R (2003) Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 129(4):360–364. https://doi.org/10.1016/S0194-5998(03)00729-0

    Article  PubMed  Google Scholar 

  4. Lowe D, van der Meulen J, Cromwell D et al (2007) Key messages from the national prospective tonsillectomy audit. Laryngoscope 117(4):717–724. https://doi.org/10.1097/mlg.0b013e318031f0b0

    Article  PubMed  Google Scholar 

  5. Hoey AW, Foden NM, Hadjisymeou Andreou S et al (2017) Coblation ® intracapsular tonsillectomy (tonsillotomy) in children: a prospective study of 500 consecutive cases with long-term follow-up. Clin Otolaryngol 42(6):1211–1217. https://doi.org/10.1111/coa.12849

    Article  PubMed  CAS  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  7. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  8. Arya AK, Donne A, Nigam A (2005) Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain in children. Clin Otolaryngol 30(3):226–229. https://doi.org/10.1111/j.1365-2273.2005.00970.x

    Article  PubMed  CAS  Google Scholar 

  9. Chang KW (2008) Intracapsular versus subcapsular coblation tonsillectomy. Otolaryngol Neck Surg 138(2):153–157. https://doi.org/10.1016/j.otohns.2007.11.006

    Article  Google Scholar 

  10. Duarte VM, Liu YF, Shapiro NL (2014) Coblation total tonsillectomy and adenoidectomy versus coblation partial intracapsular tonsillectomy and adenoidectomy in children. Laryngoscope 124(8):1959–1964. https://doi.org/10.1002/lary.24632

    Article  PubMed  Google Scholar 

  11. Lu Y-X, Gu Q-L, Wang Z et al (2017) Pediatric coblation total tonsillectomy: intracapsular or extracapsular? Acta Otolaryngol 137(11):1188–1193. https://doi.org/10.1080/00016489.2017.1341642

    Article  PubMed  Google Scholar 

  12. Braverman I, Nemirovsky A, Klein A et al (2015) Coblation intracapsular tonsillectomy and coblation complete tonsillectomy for obstructive sleep apnea. Int J Otolaryngol Head Neck Surg 04(05):350–355. https://doi.org/10.4236/ijohns.2015.45059

    Article  Google Scholar 

  13. Junaid M, Sood S, Walijee H et al (2019) Pain scores and recovery post tonsillectomy : intracapsular versus extracapsular coblation. J Laryngol Otol 19:1–7. https://doi.org/10.1017/S0022215119001610

    Article  Google Scholar 

  14. Walton J, Ebner Y, Stewart MG, April MM (2012) Systematic review of randomized controlled trials comparing intracapsular tonsillectomy with total tonsillectomy in a pediatric population. Arch Otolaryngol Head Neck Surg 138(3):243–249. https://doi.org/10.1001/archoto.2012.16

    Article  PubMed  Google Scholar 

  15. Acevedo JL, Shah RK, Brietzke SE (2012) Systematic review of complications of tonsillotomy versus tonsillectomy. Otolaryngol Head Neck Surg (United States) 146(6):871–879. https://doi.org/10.1177/0194599812439017

    Article  Google Scholar 

  16. Moorthy R, Scott A (2005) Double-blind randomized control trial of coblation tonsillotomy versus coblation tonsillectomy on post-operative pain in children. Clin Otolaryngol 30(6):571–571. https://doi.org/10.1111/j.1749-4486.2005.01116.x

    Article  PubMed  Google Scholar 

  17. Davies J, Coatesworth AP (2005) Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on post-operative pain. Clin Otolaryngol 30(6):572–572. https://doi.org/10.1111/j.1749-4486.2005.01117.x

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

Researchers did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, York Teaching Hospital, York, UK

    Dimitrios Daskalakis

  2. Department of Otorhinolaryngology-Head and Neck Surgery, G. Gennimatas General Hospital, Thessaloniki, Greece

    Dimitrios Daskalakis

  3. Department of Otorhinolaryngology-Head and Neck Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece

    Nikolaos Tsetsos

  4. Private Practice, Thessaloniki, Greece

    Stella Karagergou

  5. Department of Otorhinolaryngology-Head and Neck Surgery, Army General Hospital, 424, Thessaloniki, Greece

    John Goudakos

  6. 2nd Academic Otorhinolaryngology-Head and Neck Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Konstantinos Markou

  7. 1st Academic Otorhinolaryngology-Head and Neck Surgery Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Peter Karkos

Authors
  1. Dimitrios Daskalakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolaos Tsetsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stella Karagergou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Goudakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konstantinos Markou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Karkos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios Daskalakis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Code availability

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Daskalakis, D., Tsetsos, N., Karagergou, S. et al. Intracapsular coblation tonsillectomy versus extracapsular coblation tonsillectomy: a systematic review and a meta-analysis. Eur Arch Otorhinolaryngol 278, 637–644 (2021). https://doi.org/10.1007/s00405-020-06178-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06178-2

Keywords

Search

Navigation