The coblation tonsillectomy learning curve.

OBJECTIVE: To establish if there is a learning curve for coblation tonsillectomy. STUDY DESIGN: Regression analysis of data obtained from surgeons identified from the Australian Tonsillectomy Survey. SUBJECTS AND METHODS: Thirty otolaryngologists were invited to contribute audit data. Data were stratified into groups of 10 procedures and analysed with regression analysis. RESULTS: Nineteen (70%) surgeons responded. Complete data were obtained for 1700 cases and return to theatre data on 2062 cases. There was a significant learning curve with respect to both primary (P = 0.050) and secondary (P = 0.028) hemorrhage rates. Mean rates were 0.3% (95% CI 0.1% to 0.7%) and 2.1% (95% CI 1.5% to 2.9%) for primary and secondary bleeds, respectively, with return to theatre in 0.2% (95% CI 0.1% to 0.5%) and 1.3% (95% CI 0.9% to 1.9%), respectively. CONCLUSION: The introduction of coblation tonsillectomy into Australia was associated with a statistically significant learning curve with respect to both primary and secondary hemorrhage rates.

Tonsillectomy in Australia: an audit of surgical technique and postoperative care.

OBJECTIVE: To assess current tonsillectomy practice among Australian otolaryngologists. STUDY DESIGN: An audit based on an anonymous 19-item postal questionnaire on tonsillectomy technique and perioperative management sent to all Australian otolaryngology specialists. SUBJECTS AND METHODS: Two hundred eighty-four otolaryngologists registered with the Australian Society of Otolaryngology-Head and Neck Surgery database were sent the questionnaire. RESULTS: A 72.5 percent response rate was obtained. Monopolar diathermy was the most common technique for dissection (45%) and hemostasis (54%). Bipolar diathermy was used for hemostasis in 20 percent. Cold-steel dissection was routinely used by 36 percent, ties were used for hemostasis only by 11 percent of surgeons. The use of local anesthetic, dexamethasone, and postoperative antibiotics was 45 percent, 40 percent, and 20 percent, respectively. Seventy-six percent of surgeons always observed tonsil patients overnight. CONCLUSION: Australian surgeons still use monopolar diathermy as their preferred technique for tonsillectomy. Local anesthetic, dexamethasone, and postoperative antibiotics are used infrequently, and fewer than 1:4 surgeons perform day-case tonsillectomy.