--- title: "Tonsillectomy Part 2 - Tonsillectomy Techniques - Hot & Cold Methods" description: "ENT notes on Tonsillectomy Techniques - Hot & Cold Methods." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tonsillectomy-techniques-methods" categories: ["Pharynx", "Short Questions in ENT", "Surgery"] video: "https://www.youtube.com/watch?v=6xyf5ukBk5A" image: "https://media.theentresident.com/og-images/tonsillectomy-techniques-methods.png" --- # Tonsillectomy Part 2 - Tonsillectomy Techniques - Hot & Cold Methods ENT notes on Tonsillectomy Techniques - Hot & Cold Methods. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=6xyf5ukBk5A ## 🩺 Tonsillectomy – Techniques and Methods Continued from **Part 1** - [Tonsillectomy Definition, Indications and Contraindications](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-indications-definition-contraindications.md). In the previous post, we discussed **what is tonsillectomy** along with its **indications and contraindications**. In this post, we will focus on the **different techniques and methods of tonsillectomy**, which is a very commonly asked topic in **ENT exams and vivas**. --- ### 🔹 Classification of Tonsillectomy Techniques Tonsillectomy techniques are broadly classified into: 1. **Cold methods** 2. **Hot methods** 👉 **Hot methods** are those in which **temperature is used as a mode of dissection**. --- ### ❄️ Cold Methods of Tonsillectomy #### 1️⃣ Dissection and Snare Method - **Most commonly used method** - Standard and widely practiced > What are the steps of Tonsillectomy by Dissection & Snare method? --- #### 2️⃣ Guillotine Method - **Obsolete method** - Rarely used in modern practice --- #### 3️⃣ Intracapsular (Capsule Preserving) Tonsillectomy – Microdebrider - Uses a **45° angled microdebrider** - Speed: **1500 RPM** ✅ **Advantages** - Less post-operative pain - Faster return to normal diet ❌ **Disadvantage** - Increased intra-operative bleeding --- #### 4️⃣ Harmonic Scalpel (Ultrasound) - Uses **ultrasonic technology** to cut and coagulate tissue - Electrical energy is converted into **mechanical vibration** > What is the frequency and Vibration amplitude used in Harmonic scalpel Tonsillectomy? > What are the advantages of using Harmonic scalpel as a technique in Tonsillectomy? --- #### 5️⃣ Coblation (Plasma Mediated Ablation) - One of the **most popular modern techniques** - Uses **radiofrequency bipolar current** - Current passes through **normal saline** - Produces a **plasma field of energized sodium ions** 🛠️ **Instrument** - Coblator handpiece with: - Electrode - Irrigation channel - Suction channel > What is the mechanism by which Coblation works? > What are the advantages of using Coblation as a technique in Tonsillectomy? --- #### 6️⃣ Cryosurgery - Uses **liquid nitrogen** - Temperature: **–196°C** - Pressure: **22 psi** 🔬 **Technique** - Cryoprobe applied to tonsil - Two freeze–thaw cycles - Each application: **3–4 minutes** 🔍 **Outcome** - Tonsillar tissue undergoes necrosis - Tissue sloughs off later - Leaves a granulating surface ✅ **Advantage** - Minimal bleeding due to **vascular thrombosis** --- ### 🔥 Hot Methods of Tonsillectomy Hot methods use **temperature as the primary mode of dissection**. #### 1️⃣ Electrocautery ✅ **Advantages** - Reduced intra-operative blood loss - Shorter operating time ❌ **Disadvantages** - Increased post-operative pain - Higher secondary hemorrhage risk - Delayed healing --- #### 2️⃣ Laser Tonsillectomy - Uses: - **CO₂ laser** - **KTP laser** (most preferred) --- #### 3️⃣ Radiofrequency Tonsillectomy - Uses radiofrequency waves at **460 kHz** - Employs a **bipolar electrode** - Electrode contains a **temperature sensor** ✅ **Advantages** - Precise control of: - Tissue temperature - Energy delivery --- ### 📌 Final Tonsillectomy Methods Classification Recap | Cold Methods | Hot Methods | | --- | --- | | Dissection & snare (most common) | Electrocautery | | Guillotine (obsolete) | Laser | | Microdebrider | Radiofrequency | | Harmonic scalpel | | | Coblation | | | Cryosurgery | | --- ## 📌 Key Exam Pearls - **Dissection & snare** = most commonly used - **Coblation** = least postoperative pain - **Electrocautery** = faster surgery, more pain - Coblation works at **~60°C** - Cryosurgery uses **–196°C liquid nitrogen** --- 📚 **Next Part:** [Hot Tonsillectomy vs Interval Tonsillectomy](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-types-hot-interval.md) --- ## About This Note This free ENT note on Tonsillectomy Part 2 - Tonsillectomy Techniques - Hot & Cold Methods was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tonsillectomy-techniques-methods When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Pharynx: https://www.theentresident.com/ent-notes-lectures/category/pharynx.md - Short Questions in ENT: https://www.theentresident.com/ent-notes-lectures/category/short-questions-in-ent.md - Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. 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