Tonsils and Adenoids
What are they?
Tonsils and adenoids are small glands at the back of the throat and behind the nose. They are part of the body’s immune system.
They help trap germs (like bacteria and viruses) that enter through the mouth and nose, and help the body learn to fight infections—especially in young children.
They are most important in early childhood. As children grow, the immune system develops and they become less important.
Sometimes they become enlarged or infected, which can lead to:
- Snoring, mouth breathing (sleep disordered breathing).
- Recurrent tonsillitis.
- Ear problems (from enlarged adenoids)
The above are the main reasons we will consider removing tonsils and adenoids.
What is Coblation Intracapsular Tonsillectomy?
Coblation Intracapsular Tonsillectomy (CIT) is a modern surgical technique that removes tonsil tissue while carefully preserving the thin outer layer of the tonsil — known as the capsule. By keeping this protective layer intact, the underlying throat muscles, nerves, and blood vessels are shielded from surgical trauma.
This is in contrast to traditional "extracapsular" tonsillectomy, where the tonsil is removed entirely along with its capsule, exposing the surrounding muscles and resulting in greater post-operative pain and a higher risk of bleeding.
CIT is the preferred technique in children, and is particularly well-suited to patients with large tonsils causing airway obstruction or sleep-disordered breathing, as well as those with recurrent tonsillitis.
Coblation stands for "Controlled Ablation." It uses a specially designed wand that passes radiofrequency energy through a saline solution — creating a plasma field of highly energised ions that dissolve tissue at a remarkably low temperature, with less damage to surrounding tissues.
Surgical Steps
1. General Anaesthesia
The patient is placed under general anaesthesia with a mouth gag used to open and stabilise access to the tonsils.
2. Plasma Ablation
The Coblation wand — with continuous saline irrigation — is applied to the tonsil surface, dissolving tissue from the outside inward at low temperature.
3. Capsule Preservation
As the capsule is approached, power is reduced and the surgeon works meticulously to leave a thin protective layer of capsular tissue intact.
4. Haemostasis
The Coblation wand's coagulation setting is used to seal any bleeding points. Blood loss is typically minimal throughout the procedure.
5. Inspection & Completion
Both tonsil beds are carefully inspected to confirm near-complete tissue removal (>95%) and satisfactory haemostasis before the procedure is concluded.
6. Discharge and Recovery
Most patients are discharged the same day. Pain is typically well-controlled with regular paracetamol and ibuprofen for an average of 5–7 days. Most children start with a soft diet and we encourage normal diets as soon as possible.
Advantages of Coblation Intracapsular Tonsillectomy
From my personal experience, coblation intracapsular tonsillectomy has been a game-changer for tonsillectomy (and adenoidectomy) in children.
Yes, there is pain, but significantly better that the previous techniques. Quicker return to school and normal activities is a win for both child and parent.
Coblation Intracapsular Tonsillectomy is supported by robust international clinical evidence, including a 2024 systematic review and meta-analysis from the University of Auckland's Waikato Clinical Campus. See infographic for some interesting statistics.
