title: Coblation®intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up.
abstract: OBJECTIVE
  Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation®intracapsular tonsillectomy, for both obstructive and infective indications.
  
  
  METHODS
  Prospective case series, March 2013-January 2016, all with completed follow-up.
  
  
  METHODS
  Tertiary paediatric otolaryngological practice.
  
  
  METHODS
  A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation®intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT).
  
  
  METHODS
  Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure.
  
  
  RESULTS
  With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery.
  
  
  CONCLUSIONS
  Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A W
authors.identifier: http://orcid.org/0000-0001-8647-5856
authors.initials: AW
authors.lastname: Hoey
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Foden
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hadjisymeou Andreou
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Noonan
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Chowdhury
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Greig
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: E L
authors.initials: EL
authors.lastname: Sproson
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Allin
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Amin
authors.affiliation: Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Wouters
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: N E
authors.initials: NE
authors.lastname: Jonas
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Tweedie
mesh_terms: D055011:Ablation Techniques; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D014069:Tonsillitis / Q000601:surgery*; D016896:Treatment Outcome
keywords: adenoids; evidence-based medicine; outcomes; quality of life; research; sleep-disordered breathing; tonsils