When I started using Laser in 90s, it was great fascination and I thought it was intrinsically better. But after doing many cases I found out that the older technique of Dissection method was easy and less time consuming.
However Laser has its place while doing OSA surgery, like vaporizing or debulking large tonsil mass. But complete vaporization is not possible in one sitting, so the need of revision.
Laser tonsillectomy has its advantages as it cause minimal bleeding and less painful .So too it can be performed in patients who has bleeding disorders.
Laser used in my clinic is Co2 laser. Laser beam both dissect tissue and coagulate blood vessels. Lasers can be used to completely resect (laser tonsillectomy-LT), reduce (laser assisted serial tonsillectomy-LAT) or vaporize (laser vaporization tonsillectomy-LVT) tonsillar tissues
Laser Tonsillectomy under Local Anesthesia
A routine blood count and Consent is taken before surgery.
You are wide awake during the procedure and seated on the special laser ENT chair. The procedure is carried out in the laser room. You will be provided with some laser safety goggles and the procedure will be explained to you in detail by your surgeon. Local anesthetic spray -Xylocaine 10% will be sprayed into the back of your mouth. You will be advised to swallow this or spit it out. It is bitter in taste. You may feel the throat numb and feel no sensation of air passing in the throat. This must be explained to the patient well in advance. The effect of the local anesthetic will wear off in 30-40 minutes.
The operation is an interactive procedure between surgeon and the patient. The procedure itself is started once you have taken a deep breath in and hold it. Lasering is done while you hold your breathe. A smoke evacuator is kept aside remove the smoke.
Post-operatively you are asked to avoid eating or drinking very hot food and drink for approximately one hour. This is because the area at the back of your throat will still be numb. 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. As you leave you will be given standard pain-killing medication, antibiotic and an antiseptic gargle. The gargle is to be used every six hours for the first seven days post-operatively; the painkillers should be taken as advised. 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.
Use saline-Salt in warm water gargle which will reduce the edema and wound heal fast.
Laser Tonsillectomy under General Anesthesia
This technique is performed with the patient asleep, under general anesthetic. Special laser protective endotracheal tubes are used by the anesthetist. These tubes are expensive.
Carbon dioxide laser in scanned mode is used to vaporize 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, tonsillolith, mucous cyst, pappilomas, and crypts
Its advantages lie in the fact that we are not completely exposing the nerves as in a traditional tonsillectomy, pain levels will be less.. Also, because the space between the tonsil and the muscle of the swallowing tube is not entered, the risk of severe bleeding either during or after the operation is minimal, since the major blood vessels lie in this area.
A further advantage lies in the fact that this is a no-touch technique. Therefore the risk of transmission of infected particles (eg HIV, Hepatitis) is in theory significantly reduced when compared with standard tonsillectomy.
Post operative care- On discharge pain killers, antibiotics, throat gargle are given.