(A913) CoblatorTM vs. Microdebrider in Pediatric Intracapsular Tonsillotomy: A Comparison of Efficiency, Bleeding, and Revision Rates

Introduction: Intracapsular tonsillectomy or “tonsillotomy” is an increasingly popular alternative to extracapsular tonsillectomy due to decreased bleeding risk and pain. The Coblator™ and microdebrider are most frequently used, but studies comparing these instruments are limited. Our study aimed to compare postoperative bleed rates, efficiency, and revision rates between these instruments.

Methods: A retrospective review was conducted on pediatric patients undergoing tonsillotomy with adenoidectomy using either the microdebrider (12 surgeons) or Coblator™ (3 surgeons) at a quaternary children’s hospital from 2018-2024. Logistic regression models were used to identify independent factors associated with postoperative bleeding and revision rates.

Results: A total of 1734 tonsillotomy with adenoidectomy procedures were included (Coblator™ = 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 < 0.001) with Coblator™ (22 minutes) compared to microdebrider (24 minutes). There was no significant difference in post-operative bleed rate (OR 1.1, 95% CI [0.35,3.47]) between the Coblator™ (1%) and microdebrider (0.9%). There was no significant difference in revision rate (OR 0.85, 95% CI [0.23,3.15]) between the Coblator™ (0.5%) and microdebrider (1%). Younger age was associated with need for revision surgery (OR 0.59, 95% CI [0.41,0.85]).

Conclusions: The Coblator™ was more time efficient than the microdebrider in performing tonsillotomy without a significant difference in bleeding or revision rates. Younger age was noted to be a risk factor for revision tonsillectomy. Future directions to study include cost efficiency between the two instruments as well as differences in postoperative pain.