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Archive for Sunday, April 25, 2004

Haven’t got time for the pain

New tonsil surgery lets children go home sooner

April 25, 2004

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Two days after Abigail Carney had her tonsils out, the 3-year-old ate a grilled-cheese sandwich.

Her doctor credits a new, gentler surgical technique for Abigail's comparatively speedy recovery.

Dr. Ronald Saxon, who removed Abigail's enlarged tonsils on March 18, said the newer technique can cut recovery time in half and leaves patients more comfortable with less post-surgical bleeding.

Instead of using a hot electrical wand to burn away tonsil tissue, the newer technique surrounds the tonsil area with a salt-water solution, allowing removal of tissue at a lower temperature.

The newer technique, called Coblation, is also designed to protect surrounding healthy tissue from damage.

"With the old technique, everything looked black," said Saxon, an ear, nose and throat specialist in Bloomfield and Enfield, Conn. He has used Coblation to remove the tonsils from children and adults for about a year. "In this, everything looks pink."

Since the FDA approved Coblation -- short for controlled ablation -- almost three years ago, some doctors have raved about its superiority. But there still has been no large head-to-head test to determine if it really is better than more traditional methods of tonsillectomy, said Dr. Scott Schoem, a pediatric ear, nose and throat surgeon at Connecticut Children's Medical Center in Hartford.

"It's still at the point where some people really like it, and some people say it's not really better at all," said Schoem, who still generally removes tonsils using the hot electrical wand.

Special equipment makes the cost of Coblation roughly $75 to $100 more than that of older approaches. But Schoem and others agreed that a speedier recovery could justify the higher cost.

"It is more expensive in the short term, but the question is: If kids recover more quickly, and parents can go back to work quicker, is the cost for the family less?" said Dr. Udayan Shah, an ear, nose and throat surgeon at Children's Hospital of Philadelphia.

"What it really needs is a good study," said Shah, who also is an assistant professor at the University of Pennsylvania School of Medicine.

Saxon said he's convinced that Coblation is better, especially for patients such as Abigail. Abigail's tonsils had grown so large that they blocked her airway when she slept, causing a condition called sleep apnea.

While nobody is sure exactly how many children in the United States have sleep apnea, it is the leading reason for surgical removal of the tonsils and adenoids. Each year, more than 263,000 children have tonsillectomies, according to data from the National Center for Health Statistics.

The tonsils and adenoids are part of the lymphatic system and help the body fight infection. But if they are enlarged or prone to frequent infection, they can be more trouble than they're worth.

For patients such as Abigail, whose tonsils are healthy, Coblation allows the surgeon to remove most of the enlarged tissue but leave behind a thin film, preserving deeper blood vessels and muscle, Saxon said. The entire tonsils must be removed if patients have chronic infections.

Heather Carney, Abigail's mom, said she did not research the tonsillectomy options before her daughter's surgery but was glad she wound up with a doctor who chose Coblation.

Abigail had surgery on a Thursday morning and was back at home in Suffield, Conn., by late afternoon. She needed a few doses of Tylenol with codeine for pain the following day, but was eating normally by Saturday.

Shah said Coblation can be a good option. But the most important factor in a good recovery from tonsillectomy or any other surgery is a skilled and experienced doctor.

"The emphasis should be on selecting the best doctor for your child, rather than on choosing a specific technique," Shah said. "You should be able to trust the person you select to use the best technology."

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