Powered intracapsular tonsillectomy

When the tonsils are removed with a microdebrider, it is called a powered intracapsular tonsillectomy. A microdebrider (pronounced "MI-cro-duh-BREE-der") is a powered instrument that has a very small rotating tip.

Typically, traditional tonsillectomy techniques remove the tonsil tissue completely, which exposes the underlying throat muscles to bacteria, thermal injury and inflammation. This is believed to cause the severe pain, slower recovery and higher rate of complications associated with traditional tonsillectomies.

But recent research has found that, in many cases, a near-complete (90-95%) removal of tonsil tissue provides a safe and effective treatment with considerably less pain and a faster recovery. The powered intracapsular tonsillectomy is based upon this evidence.

In this technique, the surgeon uses the microdebrider to precisely remove 90-95% of the tonsils. A thin layer of tonsil tissue is deliberately left intact as a protective shield for the delicate throat muscles, which helps reduce postoperative pain and recovery time.

Advantages

• Reduced postoperative pain
• Faster recovery and return to normal activity
• Fewer hospital readmissions for complications

In addition, the surgeon has to apply cauterization (heat) directly to the exposed muscles to stop any bleeding. All of this contributes to the severe pain associated with a traditional tonsillectomy, which sometimes causes dehydration.

But the powered intracapsular tonsillectomy protects the delicate throat muscles from exposure because a thin layer of tonsil tissue is left intact. This significantly reduces the amount of pain most patients experience after surgery.

Faster recovery and return to normal activity
Because the throat muscles are protected and the pain is greatly reduced, the recovery is typically twice as fast. Children who undergo the powered intracapsular technique can expect to return to normal activity in 2.5 half days.¹

This means parents can go back to work sooner after their child's operation. In contrast, children who have traditional tonsillectomies usually need seven to ten days to recuperate with a parent or guardian taking care of them. The most minimal radiofrequency techniques generally take 5 days before the patient returns to normal activity. Pain medications usually will be consumed for 4 days with the intracapsular technique and 6.5 days with the low power technique.¹

Fewer hospital readmissions for complications
Dehydration and bleeding are the two main complications associated with traditional tonsil surgery. Dehydration can occur when the pain upon swallowing is so severe that it inhibits normal drinking and eating.

Readmissions for standard technique tonsillectomies have been reported at up to 4% for bleeding and nearly 4% for dehydration. According to Koltai et al, tonsillectomies using the powered intracapsular technique have a complication rate of about 1% for bleeding and 1% for dehydration. Other studies have reported similar results. ²

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Disadvantages

According to a presentation at a May 2003 national meeting of ENT (ear, nose, and throat) specialists, the incidence of regrowth was 0.56% in 892 patients who underwent a powered intracapsular tonsillectomy.

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1. Derkay CS, Darrow DH, Welch C. Sinacori, J. Post-tonsillectomy morbidity and quality of life in pediatric patients with obstructive tonsils and adenoid: microdebrider vs electroautery. Otolaryngology Head Neck Surgery 2006: Jan: 134(1):114-20.

2. Cook SP, O'Reilly RC, Bernat R, Otto T, Lawless ST, Reilly JS. Outcome and satisfaction of intracapsular tonsillectomy in children: one-year follow-up. Presented at: Nineteenth Annual Meeting of the American Society of Pediatric Otolaryngology: May 2-4, 2004; Phoenix, AZ.

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