Evaluating a Modified Coblation Technique in Adenoidectomy: A Single-Blind Randomized Study.

Abstract

Objective: To evaluate the clinical and histopathological advantages of a modified technique-In Saline Coblation Adenoidectomy (ISCA)-over conventional coblation adenoidectomy (CCA) in pediatric patients, with respect to intraoperative efficiency, tissue preservation, and postoperative outcomes.

Study design: This study was designed as a prospective, randomized, single-blind trial. Patients were randomly assigned to two groups, Group A "CCA" and Group B "ISCA," each consisting of 25 children. Following the approval of the Medipol University Ethics Committee, patients who underwent adenoidectomy or adenotonsillectomy were included in the study.

Setting: In Group A, adenoid tissue was ablated using the coblator's built-in irrigation system. For Group B, the nasopharynx and, partially, the oral cavity were continuously filled with saline solution delivered via the nasal passage. Excess fluid was aspirated from the mouth using a dedicated suction tip. This ensured that the endoscope and coblator tip remained immersed in saline throughout the procedure.

Methods: A prospective, randomized, single-blind study was conducted involving 50 pediatric patients who underwent either conventional coblation (Group A, n = 25) or ISCA (Group B, n = 25). Operative time, intraoperative blood loss, postoperative pain scores, and wand-related issues were recorded. Histopathological analysis of adenoid specimens was performed to assess tissue integrity and thermal injury. Patients were followed for 6 to 18 months postoperatively for recurrence and complications.

Results: ISCA significantly reduced operative time compared to CCA (24 ± 5.8 minutes vs 33 ± 8.5 minutes; P < .05). Wand tip clogging and secondary wand use were observed only in Group A. Histopathological analysis revealed greater epithelial preservation and reduced carbonization in Group B (92% vs 0%; P < .001). Postoperative complications such as transient velopharyngeal insufficiency and localized infection occurred exclusively in Group A, whereas no statistically significant difference in recurrence or residual tissue was noted between the groups.

Conclusion: The ISCA technique offers clear clinical advantages over conventional coblation by improving procedural efficiency, minimizing collateral thermal injury, and eliminating wand-related delays. These findings support its wider adoption in high-volume pediatric otolaryngology settings.