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Laser Tonsillectomy (in-out vaporisation)

This procedure can be carried out under local anaesthetic or general anaesthetic. If it is performed under local anaesthetic then at least three treatments are usually required.

Local anaesthetic procedure:

You are wide awake during this. The procedure is carried out in the laser room, in which there will be a chair for you to sit in. You will be provided with some laser safety goggles and the procedure will be explained to you in detail by your surgeon. Local anaesthetic spray (banana flavour) will be sprayed into the back of your mouth. You will be advised not to swallow this or spit it out for approximately one minute whilst it is absorbed into the lining of the mouth, numbing the whole area. After one minute your surgeon will ask you to spit out the spray, you will also be given a cardboard bowl to spit into and some tissues to wipe your mouth.

The procedure itself is started once you have taken a deep breath in and held it. Lasering will start as you are asked to say rrrrr, there is a sucking sound, which is simply the vapour evacuator, there will be some smell of vapour but most of it is extracted immediately at the point of lasering by this suction apparatus. The procedure is swapped from left to right approximately three or four times. Eventually the numb part of the tonsils has been removed and some slight soreness develops. At this stage the procedure stops and the area is left to heal.

Post-operatively you are asked to avoid eating or drinking very hot food/drink for approximately one hour. This is because the area at the back of your throat will still be numb and there is a slight risk of scalding, etc if this happens. After this period of time has passed you will be able to eat and drink entirely normally. Immediately post-operatively you are speaking normally and your ability to swallow is not affected. You are allowed to go home after one hour has passed and routine observations have been performed, during that time you will be given a cold drink and some sandwiches. As you leave you will be given standard pain-killing medication and an antiseptic gargle. The gargle is to be used every six hours for the first seven days post-operatively, the painkillers are only there should any pain occur, this is quite unlikely. After the operation there will be some whiteness in the back of your mouth which will stay for up to one week. This represents normal post inflammatory slough and is not a sign of infection, etc. Any subsequent procedures can be performed two weeks post surgery once the area has completely healed.

General Anaesthetic Procedure

The principle of this laser operation, is that the delicate carbon dioxoide laser in scanned mode is used to vapourise away tonsil tissue right down to the level of the capsule of the gland. This allows near-total removal of tonsil tissue, which may be causing problems such as sore throats, tonsil stones etc.It was first used by the clinic in 1999, following meetings in the USA and Germany. It is essentially a merging of two techniques, Steiner and tonsillotomy..

Its advantages lie in the fact that we are not completely exposing the muscle of the swallowing tube, as in a traditional tonsillectomy, pain levels are dramatically reduced. Also, because the space between the tonsil and the muscle of the swallowing tube is not entered, the risk of severe haemorrhage (bleeding) either during or after the operation, is minimal, since the major blood vessels lie in this area – which is why bleeding is relatively common with traditional tonsillectomy. We have operated on many famous footballers and singers with this technique, none of them have had any problems, voice alteration etc. All of the footballers were back in full training after 48 hours.

A further advantage lies in the fact that this is a no-touch technique. Therefore the risk of transmission of infected particles (eg HIV or CJD) is in theory significantly reduced when compared with standard tonsillectomy.

Over 400 patients have been treated with this technique by LLC surgeons. After a recent audit, we have found that in our hands, 70% of adult patients do not change their diet after this procedure. 100% of patients were treated as day cases (generally home at 6 hours post op), except when social circumstances necessitated overnight stay. No patients required a return to the operating theatre for bleeding, at any stage after surgery. The re-do (revision) rate is slightly higher than traditional tonsillectomy, at 1.5% as compared to 1%. The incidence of pain and bleeding is, in our experience, vastly better than conventional dissection tonsillectomy.

We feel that thje advantages in terms of bleeding and pain outweigh the increased revision rate (0.5%). Revision surgery is usually performed under local anaesthetic as in the tonsil reduction technique, after 12 months have passed from initial surgery.

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