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Coablation Tonsillectomy


By
Dr T Balasubramanian

Introduction:

Tonsillectomy is a commonly performed surgical procedure these days. With the advent of latest surgical equipments and innovations the risks involved in the surgical procedure has been considerably reduced. One such emerging technological innovation is the introduction of coablation technology which is currently being used to perform tonsillectomy.


Emerging technology – Current expectations:


Technological innovations in any surgical procedure should focus on the following parameters:


  1. Bloodless surgical field

  2. Reduction in the surgical time

  3. Reduced post operative pain

  4. Improved healing rates

  5. Affordability

  6. Safety


Coablation:

This is also known as “Controlled ablation” / “Cold ablation”. This technology uses bipolar high frequency electrical energy to exite the electrolytes in a conductive medium. This excitation creates a plasma field which is higly focussed. The ions present in the plasma field are highly energized and this energy is sufficient to break organic molecular bonds found in the living tissue. This energy dissolves soft tissue at relatively low temperatures, while preserving the integrity of surrounding tissue. Sodium chloride solution is commonly used as a conducting medium in coablation surgical procedures.


Advantages of coablation:


  1. It operates at relatively cool temperatures (40 – 70 degrees centigrade)

  2. Its cutting effect is very precise with very minimal effect on the surrounding tissue

  3. The plasma field which is generated by this equipment is about 100 – 150 microns thick. This is the reason for its precision


Plasma field:

This is the technology involved in coablation surgical procedures. Plasma field is defined as a collection of charged particles (equal amounts of positive and negative ions). Plasma field resembles gas physically in some respects, but show significant differences as well. Plasma field is a good conductor of electricity and is affected by the presence of magnetic field, where as it is not so with gases.


Crudely put plasma is a state of matter in which many electrons are free and unbound and move independently. Coablation technology utilizes this phenomenon by generating an electrical field between two small electrodes. This electrical field when made to pass through a medium like normal saline which conducts it rather well, the sodium and chloride molecules become energized and separate from the solution. These sodium and chloride ions are responsible for the formation of plama field.


The wand used in coablation surgical procedures has channels for suction and irrigation. Normal saline should flow through irrigation channel and central suction should be connected to the suction channel.


Below you will be seeing the video of coablation tonsillectomy:


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