Coblator and Laser Surgery in ENTCoblator and Laser Surgery in ENTJubilee Hospital TrivandrumJubilee Hospital Trivandrum

Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLOConsultant ENT SurgeonConsultant ENT Surgeon

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Co2 Laser Surgery since October 2010Co2 Laser Surgery since October 2010

Laser Surgery IndicationsLaser Surgery Indications

Snoring and Sleep ApneaSnoring and Sleep Apnea

Allergic RhinitisAllergic Rhinitis

Nasal BlockageNasal Blockage

Oral lesionsOral lesions

Facial Moles, TattoosFacial Moles, Tattoos

Tongue ReleaseTongue Release

Laser Surgery under LALaser Surgery under LA

Disadvantages of LaserDisadvantages of Laser

Fire hazardFire hazard

GA-Intubation, TubeGA-Intubation, Tube

Post op painPost op pain

Explosion Explosion

Anesthetist ChallengeAnesthetist Challenge

Laser Surgery:GALaser Surgery:GA

LAUP GALAUP GA

Less Collateral Thermal DamageLess Collateral Thermal Damage

Unlike in Unlike in Electrocautery, there Electrocautery, there is very little tissue is very little tissue damagedamage

Coblation TechnologyCoblation Technology

Coblation is not a heat-driven process; therefore Coblation is not a heat-driven process; therefore it does not char or burn healthy tissue like it does not char or burn healthy tissue like conventional electro surgery and laser surgery.conventional electro surgery and laser surgery.

Coblation is derived from the term “controlled Coblation is derived from the term “controlled ablation” It combines radiofrequency energy with ablation” It combines radiofrequency energy with a natural saline solution to gently and precisely a natural saline solution to gently and precisely remove tissue leading to a fast and easier remove tissue leading to a fast and easier recovery.recovery.

Coblation Technology-contdCoblation Technology-contd

Coblation: a revolutionary medical technology developed and Coblation: a revolutionary medical technology developed and patented by ArthroCare Corporation .It enables surgeons to patented by ArthroCare Corporation .It enables surgeons to precisely dissect and ablate soft tissue while preserving the integrity precisely dissect and ablate soft tissue while preserving the integrity of surrounding healthy tissue.of surrounding healthy tissue.Coblation technology uses electrical energy to excite the Coblation technology uses electrical energy to excite the electrolytes in a conductive medium, such as saline, creating a electrolytes in a conductive medium, such as saline, creating a precisely focused plasma.precisely focused plasma.The energized plasma particles possess sufficient energy to break The energized plasma particles possess sufficient energy to break organic molecular bonds, resulting in tissue dissection and ablation.organic molecular bonds, resulting in tissue dissection and ablation.Because the RF current does not pass directly through the tissue, Because the RF current does not pass directly through the tissue, with Coblation, relatively low temperatures (40°C to 70°C) are with Coblation, relatively low temperatures (40°C to 70°C) are generated as a by product of the process.generated as a by product of the process.Coblation dissects or excises tissue while preserving the integrity of Coblation dissects or excises tissue while preserving the integrity of surrounding healthy tissue.surrounding healthy tissue.

Coblation Plasma FieldCoblation Plasma Field

Coblation technology is Coblation technology is based on a controlled, based on a controlled, non-heat driven non-heat driven process that uses process that uses radiofrequency (RF) radiofrequency (RF) energy to excite the energy to excite the electrolytes in a electrolytes in a conductive medium conductive medium such as saline solution such as saline solution to create precisely to create precisely focused plasmafocused plasma

How Coblation work?How Coblation work?

Energized particles, Energized particles, or ions, in the or ions, in the plasma have plasma have sufficient energy to sufficient energy to break, or dissociate, break, or dissociate, molecular bonds molecular bonds within soft tissue at within soft tissue at relatively low relatively low temperatures temperatures (typically 40°C to (typically 40°C to 70°C).70°C).

Indications in ENTIndications in ENT

Snoring and Sleep apneaSnoring and Sleep apnea

Tonsil Adenoid surgeryTonsil Adenoid surgery

Nasal BlockageNasal Blockage

Tongue Base ReductionTongue Base Reduction

Tonsil channelingTonsil channeling

Lingual TonsillectomyLingual Tonsillectomy

Oral lesionsOral lesions

Coblator MachineCoblator Machine

Coblator:ArthrocareCoblator:Arthrocare

Coblator WandsCoblator Wands

Saline MediumSaline Medium

Plasma GlowPlasma Glow

A Cool TechnologyA Cool Technology

Because RF current does not pass directly Because RF current does not pass directly through tissue during the Coblation through tissue during the Coblation process, tissue heating is minimal. Most of process, tissue heating is minimal. Most of the heat is consumed in the plasma layer, the heat is consumed in the plasma layer, or in other words, by the ionization or in other words, by the ionization process. These ions then bombard tissue process. These ions then bombard tissue in their path, causing molecular bonds to in their path, causing molecular bonds to simply break apart and tissue to dissolve.simply break apart and tissue to dissolve.

Coblator wand for Tongue Base ReducrtionCoblator wand for Tongue Base Reducrtion

Saline Gel Saline Gel

Disadvantages of CoblatorDisadvantages of Coblator

Need Training and Learning curveNeed Training and Learning curve

Wands are expensiveWands are expensive

1 wand can do 10 cases1 wand can do 10 cases

1 wand cost Rs 10,000 +Rs 1000 per patient1 wand cost Rs 10,000 +Rs 1000 per patient

Lack of awareness about the new technologyLack of awareness about the new technology

Needs Saline fieldNeeds Saline field

? No Saline Gel in India? No Saline Gel in India

Snoring and Sleep ApneaSnoring and Sleep Apnea

Snoring can have significant social and Snoring can have significant social and medical consequences. medical consequences.

Snoring prevents loved ones from sharing Snoring prevents loved ones from sharing the same room. the same room.

Snoring may also be a sign of sleep Snoring may also be a sign of sleep apnea, a medical condition associated apnea, a medical condition associated with high blood pressure, diabetes and with high blood pressure, diabetes and heart failure and strokeheart failure and stroke

Surgical Treatment of Sleep ApneaSurgical Treatment of Sleep Apnea

The surgical treatment for sleep apnea is targeted to the upper airway structures The surgical treatment for sleep apnea is targeted to the upper airway structures responsible for causing obstruction during sleep. A detailed examination of the upper responsible for causing obstruction during sleep. A detailed examination of the upper airway, including fiber optic evaluation, CT/MRI Imaging, is performed to identify airway, including fiber optic evaluation, CT/MRI Imaging, is performed to identify nasal disorders, palate or uvular elongation, tonsil, adenoid or tongue enlargement, or nasal disorders, palate or uvular elongation, tonsil, adenoid or tongue enlargement, or tissue growths. tissue growths. Home Sleep studyHome Sleep studyA surgical plan is then developed after reviewing sleep study results. A surgical plan is then developed after reviewing sleep study results. UPPP (uvulopalatopharyngoplasty) UPPP (uvulopalatopharyngoplasty) - removing a portion of the uvula, soft palate - removing a portion of the uvula, soft palate and sidewall of the pharynx. and sidewall of the pharynx. Tonsillectomy and AdenoidectomyTonsillectomy and Adenoidectomy - the most common treatment for sleep apnea - the most common treatment for sleep apnea in children and young adults. in children and young adults. Coblation® of the Tongue BaseCoblation® of the Tongue Base - Radiofrequency treatment of the tongue base to - Radiofrequency treatment of the tongue base to shrink it. shrink it. Genioglossus Advancement/Hyoid SuspensionGenioglossus Advancement/Hyoid Suspension - Advances the tongue - Advances the tongue musculature forward with permanent sutures. musculature forward with permanent sutures. Nasal surgery, like Nasal surgery, like inferior turbinoplastyinferior turbinoplasty and and septoplastyseptoplasty, does not in itself improve , does not in itself improve sleep apnea, but allows for improved compliance with other therapies like CPAP and sleep apnea, but allows for improved compliance with other therapies like CPAP and oral appliances. Nasal surgery is also typically performed prior to or in conjunction oral appliances. Nasal surgery is also typically performed prior to or in conjunction with the surgical procedures to treat sleep apnea listed above.with the surgical procedures to treat sleep apnea listed above.

Coblation Surgery Snoring and Sleep ApneaCoblation Surgery Snoring and Sleep Apnea

Uvular ResectionUvular Resection

OSA Surgery by CoblatorOSA Surgery by Coblator

Coblation Turbinoplasty :LACoblation Turbinoplasty :LA

Pediatric Tonsillectomy by CoblatorPediatric Tonsillectomy by Coblator

Coblation Turbinate ReductionCoblation Turbinate Reduction

Coblator Surgery Soft PalateCoblator Surgery Soft Palate

Coblator TurbinoplastyCoblator Turbinoplasty

Coblator ChannelingCoblator Channeling

Coblator Machine in JubileeCoblator Machine in Jubilee

Connecting saline flowConnecting saline flow

Coblation TonsillectomyCoblation Tonsillectomy

OSA:Snoring and Sleep ApneaOSA:Snoring and Sleep Apnea

Coblator Turbinoplasty in JubileeCoblator Turbinoplasty in Jubilee

Coblator surgery For OSACoblator surgery For OSA

Coblation Surgery in JubileeCoblation Surgery in Jubilee

Tonsillectomy in KidsTonsillectomy in Kids

OSA Surgery Using CoblatorOSA Surgery Using Coblator

Coblator Surgery GACoblator Surgery GA

Laser assisted Uvuloplasty for SnoringLaser assisted Uvuloplasty for Snoring

Coblator Surgery started in Jubilee Coblator Surgery started in Jubilee Hospital 23-06-2012Hospital 23-06-2012

Turbinate surgery by Coblator in JubileeTurbinate surgery by Coblator in Jubilee

Tonsil fossa Post OpTonsil fossa Post Op

Coblation Nose In JubileeCoblation Nose In Jubilee

Nasal Surgery:Sneezing and BlockageNasal Surgery:Sneezing and Blockage

Laser Vs Coblator For NoseLaser Vs Coblator For Nose

My experience, if there are only allergic My experience, if there are only allergic symptoms, laser cautery is better, where symptoms, laser cautery is better, where as if added nasal obstruction is also there, as if added nasal obstruction is also there, Coblation surgery is better. Coblation surgery is better.

Thanks to Jubilee ManagementThanks to Jubilee Management

23-06-2012:Followed by blessing by Fr Andrews, MD of 23-06-2012:Followed by blessing by Fr Andrews, MD of the hospital, there was a demo and small work shop.the hospital, there was a demo and small work shop.

My sincere thanks go to Most Rev Dr.Soosaipakyam the My sincere thanks go to Most Rev Dr.Soosaipakyam the Arch Bishop of Trivandrum, for his blessing and prayers.Arch Bishop of Trivandrum, for his blessing and prayers.

My Sincere thanks goes to Fr.Andrews Kosmos MBA, My Sincere thanks goes to Fr.Andrews Kosmos MBA, the MD of the Hospital.the MD of the Hospital.

My Anesthetist Colleagues My Anesthetist Colleagues OT StaffOT StaffThe Arthrocare Team for their support and guidance.The Arthrocare Team for their support and guidance.

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THANK YOUTHANK YOU

By His Wounds We Are HealedBy His Wounds We Are HealedIsaiah 53:5Isaiah 53:5

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