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Review
. 2023 Feb 17;7(1):e22.
doi: 10.1002/oto2.22. eCollection 2023 Jan-Mar.

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta-Analysis

Matthew J Sedgwick  1 , Christopher Saunders  1 , Neil Bateman  2
Affiliations
Review

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta-Analysis

Matthew J Sedgwick et al. OTO Open. .

Abstract

Objective: To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy.

Data sources: A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English-language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy.

Review methods: Qualitative synthesis and meta-analysis were used to compare outcomes between techniques.

Results: Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5-5.9; p < .0001), 4.1 (95% CI 2.7-5.4; p < .0001), 3.5 (95% CI 1.7-5.4; p = .0002) and 2.8 (95% CI 1.6-4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16-0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19-1.39; p = .19).

Conclusion: Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.

Keywords: obstructive sleep apnea; pain; posttonsillectomy hemorrhage; tonsillectomy; tonsillitis; tonsillotomy.

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Conflict of interest statement

Neil Bateman receives consulting fees from Smith+Nephew. Matthew J. Sedgwick and Christopher Saunders are both employees of Smith+Nephew.

Figures

Figure 1
Figure 1
PRISMA diagram for the review.
Figure 2
Figure 2
Absolute pain at 1 day (A), 1 week (B), and 2 weeks (C). CIT, intracapsular tonsillectomy using plasma ablation; TT, total tonsillectomy.
Figure 3
Figure 3
Time (days) taken to pain free (A), cessation of analgesia use (B), return to normal activity (C), and diet (D). CIT, intracapsular tonsillectomy using plasma ablation; TT, total tonsillectomy.
Figure 4
Figure 4
All posttonsillectomy hemorrhage events (A) and those requiring return to surgery (B). CIT, intracapsular tonsillectomy using plasma ablation; TT, total tonsillectomy.
See this image and copyright information in PMC

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