Specialist ENT COBLATION

COBLATION

Introduction: Coblation is a short form for ‘controlled ablation’, means a controlled procedure used to destroy soft tissue. It is alternatively termed as electrodissociation procedure. It is direct extension of standard electrosurgical techniques.

Principle: Coblation uses low temperature radio frequency during the operation, which was found to cause less pain for the patient. It uses an oscillating electric current to disrupt the surrounding tissue.

History:

The discovery of the coblation procedure was by both Philip Eggers and Hira Thapliyal.

Components:

The equipment consists of a radio frequency (RF) generator, foot pedal control, irrigation system and a wand. The foot pedals are color 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 wands come in different sizes and shapes depending on the site of surgery. 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.

Specialist ENT Screenshot 2020 11 29 book near final miscellaneous6
Specialist ENT Screenshot 2020 11 29 book near final miscellaneous7

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. 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.

The temperature for coblation ranged from 60 °C to 70 °C, while in other 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. It also helps in  hemostasis by coagulation option.

Advantages:

  1. Requires less surgical time for the procedure to be completed.
  2. Largely minimizes thermal damage which occurs to surrounding tissue during the procedure compared to the traditional method. For example, 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
  3. Faster recovery of the patient after surgery. 
  4. Less operative pain as no incision is required to perform the procedure.

Disadvantage:

  1. Small field of view when removing tissue.
  2. Little depth perception.
  3. Poor mobility of removing tissue within the surgical site. 

Indications in ENT:

  1. Tonsillectomy and Adenoidectomy.
  2. Inferior turbinoplasty.
  3. Resection of nasal polyposis.
  4. Resection of nasal and anterior skull base tumors (e.g. angiofibromas)
  5. Uvulopalatoplasty. 
  6. Tongue base reduction.
  7. Excision of anterior and posterior glottic webs.
  8. Excision of arytenoid granulomata.
  9. Posterior cordotomy.
  10. Excision of Internal laryngoceles.
  11. Excision of laryngeal papillomatosis.
  12. Excision of laryngeal granulomata.
  13. Excision of Subglottic and tracheal stenosis.
  14. Resection of oropharyngeal malignancy.

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