Coblation tonsillectomy or plasma coblation is a surgical procedure in which the patient's tonsils are removed by destroying the surrounding tissues that attach them to the pharynx. It was first implemented in 2001. The word coblation is short for 'controlled ablation', which means a controlled procedure used to destroy soft tissue. This procedure uses low temperature radio frequency during the operation, which was found to cause less pain for the patient than previous technologies used for tonsillectomy. Data collected from coblation tonsillectomy operations showed that the healing of the tonsillar fossa is much faster when this low temperature technology is used instead of a heat based technology, such as electrocautery tonsillectomy. Since coblation has been introduced to the medical field, more than 10 million surgical operations have been performed, but as of 2019, research is still ongoing to determine the positive and negative effects of this procedure. The process consists of five stages, which is significantly less than the traditional tonsillectomy method therefore allowing the technique of Plasma Coblation to the overall time required for the typical procedure, however there are also negatives associated with the device. which indicate that there is no clear advantage or difference in comparison to traditional surgical techniques today.
Technology
Plasma coblation is widely used in the medical world as a successful surgical technique. The technique is used as a method of treating tonsillectomy and adenoidectomy which is the surgical removement of tonsils and soft tissue found towards the back of a nose which causes blockage.
Components The equipment used for coblation tonsillectomy consists of a radio frequency (RF) generator, foot pedal control, irrigation system, and a tonsil wand. The generator provides radio frequency, which is essential for the procedure, and connects the foot pedal system to the tonsil wand. The foot pedals are colour coded to prevent confusion: one is yellow and is used for controlling the coblation, while the other is blue and used for controlling the radio frequency cautery. The wand is connected to the RF generator so it can be controlled with the pedals. The wand consists of a base electrode and an active electrode, which have ceramic and flowing saline between them. The radio frequency current that is produced by the generator travels through the saline, breaking the molecular bonds and forming ions. This creates a plasma field around the electrodes, which is used for removing soft tissue. There should not be any smoke produced while the coblation wand is being used during the operation; if this occurs, it is a sign that ablated tissue has entered the coblation wand's electrode area. This means that the current is not able to break down the saline into ions properly, so smoke is produced. When this happens, the coblation wand needs to be cleaned out before using it again.
Plasma field The plasma field has a radius of about 100μm-200μm around the electrodes and is kept stable within the head of the coblation wand by the continuous supply of saline. Furthermore, the plasma field is controlled by the bipolar energy between the negative and positive ions that are produced by the plasma in order to use a precise amount of plasma to prevent damaging healthy tissues around the tonsils. Plasma does not have a thermal effect on tissue: it only affects it on a chemical level. The plasma field produces positively charged hydrogen ions (H+) and negatively charged hydroxide ions (OH-), which enable plasma to destroy tissue. There is no or only minor damage done to nearby tissues during the coblation procedure because charged particles move between the generated plasma field and the ablated tissue, hence the molecules breakdown without the temperatures rising high. The temperature for coblation tonsillectomy ranged from 60 °C to 70 °C, while other tonsillectomy operation procedures, such as electrosurgery require temperatures ranging from 400 °C to 600 °C, which is much higher. Thus, coblation is considered to be a non-heat focused medical procedure that is much better at causing minimal thermal damage to untargeted tissues near the targeted area.
Reasons for surgery The need for removing tonsils of an individual using the coblation tonsillectomy surgical process can occur for four reasons. Firstly, the patient may have frequent long lasting tonsillitis. Secondly, tonsils can become swollen and inflamed which may cause breathing problems. Thirdly, blood loss can occur through the tonsils, which is a sign that they need to be removed. Lastly, in some cases tonsils get affected by rare diseases and viruses, which can only be treated by removing the tonsils.
Tonsillitis Tonsils are part of the first line of defense in the mouth as they create white blood cells in order to fight diseases, bacteria and viruses that enter through the mouth. Owing to being exposed to amounts of material that enter the mouth, tonsils can become infected, which is called tonsillitis. This occurs mainly in children as in this age group is when the tonsils are the key providers of immune system functions. By the time individuals reach adulthood, they have been exposed to many diseases, bacteria and viruses, so they have developed immunity against these infection causing micro-organisms. Thus, adults normally do not need the help of tonsils anymore. When tonsillitis occurs regularly, meaning about seven times a year then the removal of tonsils is needed, otherwise it can have detrimental effects on the individual's health. Furthermore, tonsil surgery may be required when antibiotic treatment does not help in getting rid of the bacteria, which causes tonsillitis.
Swollen tonsils After being exposed to several tonsil infections, tonsils have the tendency to become swollen and inflamed, but other factors may make them enlarged as well, such as genetics. Some of the significant problems that can arise due to having enlarged tonsils are breathing difficulties and the ability to swallow, thus the removal of tonsils is required.
Other conditions After having frequent tonsil infections or severe diseases, bleeding from the tonsils tissues can occur. Furthermore, cancer cells can develop in the tonsil tissues. These are mostly uncommon but can still occur and can only be treated by surgically removing the tonsils from the both sides of the back of the throat.
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