Coblation Versus Microdebrider in Pediatric Intracapsular Tonsillotomy: A Comparison of Efficiency, Bleeding, and Revision Surgery

OBJECTIVE: Intracapsular tonsillectomy or "tonsillotomy" is an increasingly popular alternative to extracapsular tonsillectomy due to decreased bleeding risk and pain. Coblation and microdebrider are most frequently used, but studies comparing them are limited. We aimed to compare efficiency, postoperative bleeding, and need for revision surgery between these techniques. STUDY DESIGN: Retrospective case series. SETTING: Quaternary children's hospital between 2018 and 2024. METHODS: This study included pediatric patients undergoing tonsillotomy with adenoidectomy using the microdebrider (13 surgeons) or coblation (2 surgeons). Logistic regression models were used to identify independent factors associated with postoperative bleeding and revision surgery. RESULTS: A total of 1734 tonsillotomy with adenoidectomy procedures were included (coblation = 385; microdebrider = 1349). The mean (SD) age was 4.95 (2.2) years and 948 (54.7%) were male. Median surgical time was significantly less (P < .001) with coblation (22 minutes) compared to microdebrider (24 minutes). There was no significant difference in the proportion of patients experiencing postoperative bleeding (OR 1.1, 95% CI [0.35, 3.47]) between coblation (1%) and the microdebrider (0.9%). There was no significant difference in the proportion of patients undergoing revision (OR 0.85, 95% CI [0.23, 3.15]) between coblation (0.5%) and the microdebrider (1%). Younger age was associated with need for revision surgery (OR 0.59, 95% CI [0.41, 0.85]). CONCLUSIONS: Coblation was more time efficient than microdebrider for tonsillotomy without a significant difference in postoperative bleeding or revision surgery. Younger age was noted to be a risk factor for revision tonsillectomy. Future directions to study include relative cost efficiency and differences in postoperative pain.