Pediatric Adenoidectomy: A Comparative Study Between Cold Curettage and Coblation Technique
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ORIGINAL ARTICLE
Pediatric Adenoidectomy: A Comparative Study Between Cold Curettage and Coblation Technique Vaibhav B. Hapalia1 • Ajay J. Panchal1 Ridham B. Verma1 • Neel D. Parmar1
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Rakesh Kumar1 • Parth B. Kapadia1 • Mitanshi A. Bhiryani1
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Received: 5 October 2020 / Accepted: 24 October 2020 Association of Otolaryngologists of India 2020
Abstract The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4–17 years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra—operative blood loss, and post –operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1 week and after 1 month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19 mL Vs 28.5 mL) and lesser post operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3 min Vs 15.5 min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.
Keywords Pediatric adenoidectomy Cold curettage Coblation
Introduction The word Adenoid is derived from two words ‘‘adenos’’ (= gland) and ‘‘idos’’ (= form) [1]. The enlarged adenoids often manifest with clinical features like nasal obstruction, snoring, decreased sense of smell and pain in throat. In order to diagnose the enlarged adenoids a diagnostic nasal endoscopy (method of choice) or digital radiograph of lateral skull for nasopharynx is used. Though medical management has been found to be effective in bringing about marked improvement in a vast majority of patients, some patients need to undergo surgical removal of enlarged adenoids. Adenoidectomy can be accomplished with Curettes, Suction diathermy, Laser, Micro Debrider or Coblation [2]. The word Coblation is derived from ‘‘Controlled Ablation’’. The principle of Coblation is passing of energy in form of radiofrequency through a conducting media like isotonic sodium chloride solution and producing a plasma field. By Coblation the medium is dissociated into nascent sodium ions which are responsible for destroying intercellular bonds resulting in tissue dissociation. This is possible when temperature reaches 60
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