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Why have Laser Tonsillectomy?

Classically, this is an operation associated with considerable amounts of postoperative pain when performed on adults. Using the latest in laser technology, it is possible to reduce suffering to minimal levels, using a combination of high powered laser systems, day surgery facilities and the best in postoperative medication.

Lasers used

• Dissection technique - Holmium-YAG laser
• Reduction technique - scanned or pulsed CO2 laser
• Laser Vapourisation technique - scanned or pulsed CO2 laser

The Procedure

Three different procedures are available for adult tonsillectomy:

• Dissection technique involves a one-off day case general anaesthetic procedure
• Reduction technique involves 3 or 4 separate procedures, under local anaesthetic (no injections)
• Laser vapourisation technique, this is an in-out process.

Dissection technique

For this procedure, the laser is to remove the entire tonsil. Using this system the total operative time is usually less than 5 minutes, in comparison with around 20 - 30 minutes for a standard non-laser procedure. This means that much less anaesthetic is needed for the operation, thus increasing safety and reducing recovery time. The procedure can therefore be carried out as a Day Case, around 6 hours of postoperative recovery is usually enough. During this time there is little of the suffering associated with standard tonsillectomy, since there is no blood, coughing etc., and as a consequence of laser surgery, little immediate postoperative pain is felt.

However, after the first 24 hours or so, pain does develop. For that reason, a complex series of painkillers is prescribed, which you will need to take regularly for a period of around 2 weeks. During this time we ask that you fill out a visual analogue pain score each day, since the Clinic is continually trying new analgesia regimes to reduce postoperative suffering to minimal levels. Following this procedure, it is advisable to take at least 7 days off work if possible, although if this is difficult, going to work is often conceivable as long as the painkilling regime is strictly adhered to. Postoperative complications include bleeding, which is occasionally (1%) severe enough to warrant re-admission to Hospital. The incidence of bleeding is kept to a minimum by correct analgesia, and adhering to a diet containing abrasive foods, such as toast etc., which keeps the operative bed free of slough, a whitish material that is entirely normal, and always appears at the back of the throat after these procedures.

Reduction technique

As its name suggests, this procedure involves a progressive lowering of the size of the tonsils, until they have virtually disappeared. The procedure is "walk in, walk out", and simply involves the application of local anaesthetic spray to the back of the throat, which has to be allowed to absorb into the tonsil area over a period of about 2 minutes. At this stage the surface of the tonsils is numb enough to vaporise or coagulate. Approximately 3-5 mm of tonsillar depth are taken with each procedure, which therefore needs to be repeated around 4 times to destroy 95% of the tonsils. This latter figure depends on the original size of the tonsils, very large tonsils may require more procedures to remove the majority of the tissue. The in - out laser vapourisation tonsillectomy is the same technique, except it is performed under a short general anaesthetic under microscope control, so that 95% of the tonsils are vapourised in one sitting.

Immediate and postoperative pain is minimal, in direct contrast to dissection techniques. It is entirely possible to return to work immediately after the procedure (or after 48 hours if a general anaesthetic has been given). No further time off should be required. Neither are any subsequent complications such as bleeding etc., likely. Because a small tonsillar remnant is left, it is possible that if the indication for surgery was recurrent tonsillitis, some small degree of this condition may remain. This would however be much reduced in severity since the majority of the potentially infected tissue has gone. Our experience and that of others performing this procedure world wide, is that this is not of any consequence to the patient, When the indication is for snoring improvement, the small residual volume is not significant.

Laser Vapourisation technique

As described above, this procedure is very similar to the sequential reduction tonsillectomy. Under the guidance of a high powered microscope it is possible to very accurately remove virtually all of the tonsil tissue whilst leaving the edge of the tonsil (tonsillar capsule) intact. This means that the delicate tissue below the tonsil is not exposed. A consequence of this is that there is very little pain during the postoperative period, particularly when the pain #after a standard tonsillectomy is considered. Our studies show that there is only around 20% of the total amount of pain suffered when compared to a standard non-laser dissection tonsillectomy. The procedure is both bloodless and quick. Occasionally ( less than 5%) a second stage procedure is needed if any small tonsillar remnants are left, this can usually be performed with a spray of local anaesthetic 12 months after the initial surgery. Usually, the removal of 95% of the tonsil equates well with standard tonsillectomy, since this can never truly be 100%, because of the fact that the tonsils make up only part of the total amount of tonsil - type glandular tissue in the throat. Therefore the difference between 100% of x (the total volume of this tonsil type of tissue in the throat) and 95% of x is likely to be small, and becomes relatively smaller the bigger x becomes. This procedure is associated with the minimum of time off work, since it is only the recovery from anaesthetic (24-48 hours) which keeps the patient at home.

Post Operative Care

Following your Laser Tonsillectomy, you will quickly recover from the anaesthetic, since it is a short duration technique with minimal bleeding.

You will be taken back to your room after a few minutes and it is usual to sleep for a few hours. On waking, you will be able to eat, drink and talk normally. After 6 hours you will be able to go home, although sometimes people prefer to stay overnight. The nurse or surgeon will check your throat before you leave and you will be given a prescription for painkillers. After a few hours the throat will become a little sore, so at this stage take the weaker of the painkillers prescribed. Each painkilling regime is tailor-made to suit the individual, there will usually be a weaker and stronger painkiller prescribed.

During the recovery period, which lasts for around 2 weeks (laser dissection tonsillectomy) or 5 - 7 days (in - out laser vapourisation tonsillectomy), you will want to avoid certain food and drink. These include all citrus-based products such as fruit juice, spicy food and fizzy drinks. Otherwise eat and drink whatever you like. It is often advisable to eat ‘sharp’ foods, such as toast, crisps etc as this will scrape off any white material gathering at the back of the throat. The white material is completely normal and does not represent any infection or complication. It usually disappears by approximately 7 days postoperatively. Laser dissection tonsillectomy: At around day 4 or 5 the pain will worsen and reach a peak and at this stage you will need to take the stronger of the painkillers prescribed. The pain is not continuous and occurs mainly on swallowing. During this time most people are able to go to work and function normally. Soon the pain begins to subside, and it usually disappears by around 14 days postoperatively. The pain following in - out laser vapourisation tonsillectomy is considerably less, wearing off after 5 - 7 days, and not being particularly uncomfortable during this time. With both techniques you will also be prescribed antiseptic gargles.

Postoperative complications are rare, their incidence is the same as with conventional surgery. Occasionally (10% of cases) slight bleeding may occur, if it becomes heavy or does not stop within a few minutes (using the gargle provided), you should make plans to go to your nearest Accident and Emergency Department. Please call your surgeon who will liase with the doctors at the Hospital. In our experience of over 100 cases treated, only one patient has needed to be admitted for further surgery to stop the bleeding. In most cases bleeding usually stops spontaneously. There are no further significant complications of surgery, to our knowledge. In - out laser vapourisation tonsillectomy has not been associated with any postoperative bleeding in our experience.

Outpatient follow up is at around 2 weeks postoperatively.

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