1.
Coblator and Laser Surgery in ENT
Jubilee Hospital Trivandrum
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon
www.drpaulose.com , www.snorefreesleep.com

2.
Co2 Laser Surgery since October 2010

3.
Laser Surgery Indications
Snoring and Sleep Apnea
Allergic Rhinitis
Nasal Blockage
Oral lesions
Facial Moles, Tattoos
Tongue Release

4.
Laser Surgery under LA

5.
Disadvantages of Laser
Fire hazard
GA-Intubation, Tube
Post op pain
Explosion

6.
Anesthetist Challenge

7.
Laser Surgery:GA

8.
LAUP GA

9.
Less Collateral Thermal Damage
Unlike in
Electrocautery, there
is very little tissue
damage

10.
Coblation Technology
Coblation is not a heat-driven process; therefore
it does not char or burn healthy tissue like
conventional electro surgery and laser surgery.
Coblation is derived from the term “controlled
ablation” It combines radiofrequency energy with
a natural saline solution to gently and precisely
remove tissue leading to a fast and easier
recovery.

11.
Coblation Technology-contd
Coblation: a revolutionary medical technology developed and
patented by ArthroCare Corporation .It enables surgeons to
precisely dissect and ablate soft tissue while preserving the integrity
of surrounding healthy tissue.
Coblation technology uses electrical energy to excite the
electrolytes in a conductive medium, such as saline, creating a
precisely focused plasma.
The energized plasma particles possess sufficient energy to break
organic molecular bonds, resulting in tissue dissection and ablation.
Because the RF current does not pass directly through the tissue,
with Coblation, relatively low temperatures (40°C to 70°C) are
generated as a by product of the process.
Coblation dissects or excises tissue while preserving the integrity of
surrounding healthy tissue.

12.
Coblation Plasma Field
Coblation technology is
based on a controlled,
non-heat driven
process that uses
radiofrequency (RF)
energy to excite the
electrolytes in a
conductive medium
such as saline solution
to create precisely
focused plasma

13.
How Coblation work?
Energized particles,
or ions, in the
plasma have
sufficient energy to
break, or dissociate,
molecular bonds
within soft tissue at
relatively low
temperatures
(typically 40°C to
70°C).

14.
Indications in ENT
Snoring and Sleep apnea
Tonsil Adenoid surgery
Nasal Blockage
Tongue Base Reduction
Tonsil channeling
Lingual Tonsillectomy
Oral lesions

15.
Coblator Machine

16.
Coblator:Arthrocare

17.
Coblator Wands

18.
Saline Medium

19.
Plasma Glow

20.
A Cool Technology
Because RF current does not pass directly
through tissue during the Coblation
process, tissue heating is minimal. Most of
the heat is consumed in the plasma layer,
or in other words, by the ionization
process. These ions then bombard tissue
in their path, causing molecular bonds to
simply break apart and tissue to dissolve.

21.
Coblator wand for Tongue Base Reducrtion

22.
Saline Gel

23.
Disadvantages of Coblator
Need Training and Learning curve
Wands are expensive
1 wand can do 10 cases
1 wand cost Rs 10,000 +Rs 1000 per patient
Lack of awareness about the new technology
Needs Saline field
? No Saline Gel in India

24.
Snoring and Sleep Apnea
Snoring can have significant social and
medical consequences.
Snoring prevents loved ones from sharing
the same room.
Snoring may also be a sign of sleep
apnea, a medical condition associated
with high blood pressure, diabetes and
heart failure and stroke

25.
Surgical Treatment of Sleep Apnea
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
airway, including fiber optic evaluation, CT/MRI Imaging, is performed to identify
nasal disorders, palate or uvular elongation, tonsil, adenoid or tongue enlargement, or
tissue growths.
Home Sleep study
A surgical plan is then developed after reviewing sleep study results.
UPPP (uvulopalatopharyngoplasty) - removing a portion of the uvula, soft palate
and sidewall of the pharynx.
Tonsillectomy and Adenoidectomy - the most common treatment for sleep apnea
in children and young adults.
Coblation® of the Tongue Base - Radiofrequency treatment of the tongue base to
shrink it.
Genioglossus Advancement/Hyoid Suspension - Advances the tongue
musculature forward with permanent sutures.
Nasal surgery, like inferior turbinoplasty and septoplasty, does not in itself improve
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
with the surgical procedures to treat sleep apnea listed above.

26.
Coblation Surgery Snoring and Sleep Apnea

27.
Uvular Resection

28.
OSA Surgery by Coblator

29.
Coblation Turbinoplasty :LA

30.
Pediatric Tonsillectomy by Coblator

31.
Coblation Turbinate Reduction

32.
Coblator Surgery Soft Palate

33.
Coblator Turbinoplasty

34.
Coblator Channeling

35.
Coblator Machine in Jubilee

36.
Connecting saline flow

37.
Coblation Tonsillectomy

38.
OSA:Snoring and Sleep Apnea

39.
Coblator Turbinoplasty in Jubilee

40.
Coblator surgery For OSA

41.
Coblation Surgery in Jubilee

42.
Tonsillectomy in Kids

43.
OSA Surgery Using Coblator

44.
Coblator Surgery GA

45.
Laser assisted Uvuloplasty for Snoring

46.
Coblator Surgery started in Jubilee
Hospital 23-06-2012

47.
Turbinate surgery by Coblator in Jubilee

48.
Tonsil fossa Post Op

49.
Coblation Nose In Jubilee

50.
Nasal Surgery:Sneezing and Blockage

51.
Laser Vs Coblator For Nose
My experience, if there are only allergic
symptoms, laser cautery is better, where
as if added nasal obstruction is also there,
Coblation surgery is better.

52.
Thanks to Jubilee Management
23-06-2012:Followed by blessing by Fr Andrews, MD of
the hospital, there was a demo and small work shop.
My sincere thanks go to Most Rev Dr.Soosaipakyam the
Arch Bishop of Trivandrum, for his blessing and prayers.
My Sincere thanks goes to Fr.Andrews Kosmos MBA,
the MD of the Hospital.
My Anesthetist Colleagues
OT Staff
The Arthrocare Team for their support and guidance.

53.
www.snorefreesleep.com

54.
www.drpaulose.com

55.
THANK YOU
By His Wounds We Are Healed
Isaiah 53:5
www.drpaulose.com, www.snorefreesleep.com