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April 14, 2004KINDER, GENTLERNew tonsil surgery lets children go home soonerBy HILARY WALMANThe Hartford Courant Two days after Abigail Carney had her tonsils out, the 3-year-old ate a grilled-cheese sandwich. Her doctor credits a new, gentler surgical technique for Abigail's comparatively speedy recovery. Dr. Ronald Saxon, who removed Abigail's enlarged tonsils on March 18, said the newer technique can cut recovery time in half and leaves patients more comfortable with less post-surgical bleeding. Instead of using a hot electrical wand to burn away tonsil tissue, the newer technique surrounds the tonsil area with a salt-water solution, allowing removal of tissue at a lower temperature. The newer technique, called Coblation, is also designed to protect surrounding healthy tissue from damage. "With the old technique, everything looked black," said Saxon, an ear, nose and throat specialist in Bloomfield and Enfield, Conn. He has used Coblation to remove tonsils from children and adults for a year. "In this, everything looks pink." Since the FDA approved Coblation - short for controlled ablation - almost three years ago, some doctors have raved about its superiority. Mercy Hospital in Grayling is one of the hospitals nationwide where Coblation is available "Coblation patients enjoy quicker healing and can return to a normal diet faster than electrocautery tonsillectomy patients," said Dr. Keith Scharf, an otolaryngologist who has been specially trained to offer the Coblation process to his patients at Mercy Grayling. "They usually are back to their normal eating habits within three days, as compared to seven or eight days with the electrosurgical tonsillectomy process. That's a significant reduction of pain." But there still has been no large head-to-head test to determine if it really is better than more traditional methods of tonsillectomy, said Dr. Scott Schoem, a pediatric ear, nose and throat surgeon at Connecticut Children's Medical Center in Hartford. "It's still at the point where some people really like it, and some people say it's not really better at all," said Schoem, who still generally removes tonsils using the hot electrical wand. Special equipment makes the cost of Coblation roughly $75 to $100 more than that of older approaches. But Schoem and others agreed that a speedier recovery could justify the higher cost. "It is more expensive in the short term, but the question is: If kids recover more quickly, and parents can go back to work quicker, is the cost for the family less?" said Dr. Udayan Shah, an ear, nose and throat surgeon at Children's Hospital of Philadelphia. "What it really needs is a good study," said Shah, who also is an assistant professor at the University of Pennsylvania School of Medicine. Saxon said he's convinced that Coblation is better, especially for patients such as Abigail. Abigail's tonsils had grown so large that they blocked her airway when she slept, causing sleep apnea. While nobody is sure exactly how many children in the United States have sleep apnea, it is the leading reason for surgical removal of the tonsils and adenoids. Each year, more than 263,000 children have tonsillectomies, according to the National Center for Health Statistics. The tonsils and adenoids are part of the lymphatic system and help the body fight infection. But if they are enlarged or prone to frequent infection, they can be more trouble than they're worth. For patients such as Abigail, whose tonsils are healthy, Coblation allows the surgeon to remove most of the enlarged tissue but leave behind a film preserving deeper blood vessels and muscle, Saxon said. The entire tonsils must be removed if patients have chronic infections. Abigail had surgery on a Thursday morning and was back at home by late afternoon. She needed a few doses of Tylenol with codeine the following day, but was eating normally by Saturday.
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