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A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy

Published online by Cambridge University Press:  18 September 2015

M R Elbadawey*
Department of Otolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Tanta University Hospitals, Egypt
H M Hegazy
Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Tanta University Hospitals, Egypt Department of Otolaryngology and Head and Neck Surgery, Magrabi Eye and Ear Center, Riyadh, Saudi Arabia
A E Eltahan
Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Aswan University Hospitals, Aswan, Egypt
J Powell
Department of Otolaryngology and Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Address for correspondence: Mr M R ElBadawey, Freeman Hospital, University of Newcastle, Freeman Road, Newcastle upon Tyne NE7 7DN, UK Fax: +44 191 2231246 E-mail:



This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients.


A total of 120 patients aged 10–15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong–Baker FACES® pain scale.


The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml; p = 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml; p = 0.0001). Diode laser tonsillectomy had a shorter operative time (p = 0.0001) and less blood loss (p = 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p = 0.042) and coblation (p = 0.04) tonsillectomy groups.


Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

Main Articles
Copyright © JLO (1984) Limited 2015 

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1D'Eredità, R, Marsh, RR. Contact diode laser tonsillectomy in children. Otolaryngol Head Neck Surg 2004;131:732–5Google Scholar
2Hegazy, H, Albirmawy, O, Kaka, A, Behiry, A. Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy. J Laryngol Otol 2008;122:369–73Google Scholar
3Belloso, A, Chidambaram, A, Morar, P, Timms, M. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:2010–13Google Scholar
4Temple, R, Timms, M. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195–8Google Scholar
5Weingarten, C. Ultrasonic tonsillectomy: rationale and technique. Otolaryngol Head Neck Surg 1997;116:193–6Google Scholar
6Walker, RA, Syed, ZA. Harmonic scalpel tonsillectomy versus electrocautery tonsillectomy: a comparative pilot study. Otolaryngol Head Neck Surg 2001;125:449–55Google Scholar
7Principato, J. Cryosurgical treatment of the lymphoid tissue of Waldeyer's ring. Otolaryngol Clin North Am 1987;20:365–70Google Scholar
8Bergler, W, Huber, K, Hammerschmitt, N, Hörmann, K. Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage. Laryngoscope 2001;111:1423–9Google Scholar
9Isaacson, G, Szeremeta, W. Pediatric tonsillectomy with bipolar electrosurgical scissors. Am J Otolaryngol 1998;19:291–5Google Scholar
10Koltai, PJ, Solares, CA, Mascha, EJ, Xu, M. Intracapsular partial tonsillectomy for tonsillar hypertrophy in children. Laryngoscope 2002;112:1719Google Scholar
11Johnson, LB, Elluru, RG, Myer, CM. Complications of adenotonsillectomy. Laryngoscope 2002;112:35–6Google Scholar
12Pizzuto, MP, Brodsky, L, Duffy, L, Gendler, J, Nauenberg, E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol 2000;52:239–46Google Scholar
13O-lee, T, Rowe, M. Electrocautery versus cold knife technique adenotonsillectomy: A cost analysis. Otolaryngol Head Neck Surg 2004;131:723–6Google Scholar
14Martinez, SA, Akin, DP. Laser tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 1987;20:371Google Scholar
15Auf, I, Osborne, J, Sparkes, C, Khalil, H. Is the KTP laser effective in tonsillectomy? Clin Otolaryngol 1997;22:145–6Google Scholar
16Kulaskar, S. KTP-532 laser tonsillectomy – a potential day-case procedure? J Laryngol Otol 1996;110:205–7Google Scholar
17Wong, DL, Baker, C. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:917Google Scholar
18Shapiro, NL, Bhattacharyya, N. Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 2007;117:406–10Google Scholar
19Magdy, E, Elwany, S, El-Daly, A, Abdel-Hadi, M, Morshedy, M. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122:282–90Google Scholar
20Rakesh, S, Anand, T, Payal, G, Pranjal, K. A prospective, randomized, double-blind study of coblation versus dissection tonsillectomy in adult patients. Indian J Otolaryngol Head Neck Surg 2012;64:290–4Google Scholar
21Sedlmaier, B, Bohlmann, P, Jakob, O, Reinhardt, A. Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results [in German]. HNO 2010;58:244–54Google Scholar
22Havel, M, Sroka, R, Englert, E, Stelter, K, Leunig, A, Betz, CS. Intraindividual comparison of 1,470 nm diode laser versus carbon dioxide laser for tonsillotomy: a prospective, randomized, double blind, controlled feasibility trial. Lasers Surg Med 2012;44:558–63Google Scholar
23Chang, KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005;132:273–80Google Scholar
24Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–13Google Scholar
25Matin, M, Chowdhury, MA. Diode laser versus blunt dissection tonsillectomy. Bangladesh J Otorhinolaryngol 2012;18:114–18Google Scholar
26Divi, V, Benninger, M. Postoperative tonsillectomy bleed: coblation versus noncoblation. Laryngoscope 2005;115:31–3Google Scholar