Coblation Versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis

Abstract

This study aimed to compare the outcomes of coblation versus bipolar diathermy in pediatric patients undergoing tonsillectomy. A systematic review and meta-analysis were performed per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. An electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Primary outcome measures were intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage, and post-operative pain. Secondary outcome measures included a return to a normal diet, effects on the tonsillar bed, operation time, and administration of analgesia. Fixed and random-effects models were used for the analysis. Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.27, P = 0.005) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. The coblation group improved analgesia administration, diet and tonsillar tissue recovery, and thermal damage for secondary outcomes. No significant difference was reported in terms of operation time. In conclusion, coblation is comparable to a bipolar technique for pediatric patients undergoing tonsillectomy. It improves postoperative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.

Keywords: bipolar diathermy; coblation; hemorrhage; post-operative pain; tonsillectomy.

Figure 1. Prisma Flow Diagram. The PRISMA diagram details the search and selection processes applied during the overview.

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest Plot of Coblation versus Bipolar Tonsillectomy – Intraoperative Bleeding.

Quantitative analysis showing the mean difference in the intraoperative bleeding reported as median by Roje et al. (2009) [16] and Konsulov et al. (2017) [18].

Figure 3. Forest Plot of Coblation versus Bipolar – Delayed Haemorrhage.

Quantitative analysis showing the odds ratio in delayed haemorrhage reported by Parker et al. (2009) [15], Roje et al. (2009) [16], Belloso et al. (2010) [17] and Konsulov et al. (2017) [18].

Figure 4. Forest Plot of Coblation versus Bipolar – Post-operative Pain by Day 7.

Quantitative analysis showing the odd ratio in delayed haemorrhage reported by Mitic et al. (2007) [14], Konsulov et al. (2017) [18], and Bhardwaj et al. (2019) [19].