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Coblator and laser surgery in ENT:Jubilee Hospital, Trivandrum, south India

Coblator Surgery Started in Jubilee Hospital, Trivandrum, South India by Dr.K.O.Paulose, FRCS DLO,ENT Surgeon.
OSA And Snoring Surgery, Tonsil Adenoid Surgery,Nasal Turbinoplasty for Sneezing and blockage,Sinus Surgery

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Coblator and laser surgery in ENT:Jubilee Hospital, Trivandrum, south India

  1. 1. Coblator and Laser Surgery in ENT Jubilee Hospital Trivandrum Dr.K.O.Paulose FRCS DLO Consultant ENT ,
  2. 2. Co2 Laser Surgery since October 2010
  3. 3. Laser Surgery IndicationsSnoring and Sleep ApneaAllergic RhinitisNasal BlockageOral lesionsFacial Moles, TattoosTongue Release
  4. 4. Laser Surgery under LA
  5. 5. Disadvantages of LaserFire hazardGA-Intubation, TubePost op painExplosion
  6. 6. Anesthetist Challenge
  7. 7. Laser Surgery:GA
  8. 8. LAUP GA
  9. 9. Less Collateral Thermal DamageUnlike inElectrocautery, thereis very little tissuedamage
  10. 10. Coblation TechnologyCoblation is not a heat-driven process; thereforeit does not char or burn healthy tissue likeconventional electro surgery and laser surgery.Coblation is derived from the term “controlledablation” It combines radiofrequency energy witha natural saline solution to gently and preciselyremove tissue leading to a fast and easierrecovery.
  11. 11. Coblation Technology-contdCoblation: a revolutionary medical technology developed andpatented by ArthroCare Corporation .It enables surgeons toprecisely dissect and ablate soft tissue while preserving the integrityof surrounding healthy tissue.Coblation technology uses electrical energy to excite theelectrolytes in a conductive medium, such as saline, creating aprecisely focused plasma.The energized plasma particles possess sufficient energy to breakorganic 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) aregenerated as a by product of the process.Coblation dissects or excises tissue while preserving the integrity ofsurrounding healthy tissue.
  12. 12. Coblation Plasma FieldCoblation 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. 13. How Coblation work?Energized particles,or ions, in theplasma havesufficient energy tobreak, or dissociate,molecular bondswithin soft tissue atrelatively lowtemperatures(typically 40°C to70°C).
  14. 14. Indications in ENTSnoring and Sleep apneaTonsil Adenoid surgeryNasal BlockageTongue Base ReductionTonsil channelingLingual TonsillectomyOral lesions
  15. 15. Coblator Machine
  16. 16. Coblator:Arthrocare
  17. 17. Coblator Wands
  18. 18. Saline Medium
  19. 19. Plasma Glow
  20. 20. A Cool TechnologyBecause RF current does not pass directlythrough tissue during the Coblationprocess, tissue heating is minimal. Most ofthe heat is consumed in the plasma layer,or in other words, by the ionizationprocess. These ions then bombard tissuein their path, causing molecular bonds tosimply break apart and tissue to dissolve.
  21. 21. Coblator wand for Tongue Base Reducrtion
  22. 22. Saline Gel
  23. 23. Disadvantages of CoblatorNeed Training and Learning curveWands are expensive1 wand can do 10 cases1 wand cost Rs 10,000 +Rs 1000 per patientLack of awareness about the new technologyNeeds Saline field? No Saline Gel in India
  24. 24. Snoring and Sleep ApneaSnoring can have significant social andmedical consequences.Snoring prevents loved ones from sharingthe same room.Snoring may also be a sign of sleepapnea, a medical condition associatedwith high blood pressure, diabetes andheart failure and stroke
  25. 25. Surgical Treatment of Sleep ApneaThe surgical treatment for sleep apnea is targeted to the upper airway structuresresponsible for causing obstruction during sleep. A detailed examination of the upperairway, including fiber optic evaluation, CT/MRI Imaging, is performed to identifynasal disorders, palate or uvular elongation, tonsil, adenoid or tongue enlargement, ortissue growths.Home Sleep studyA surgical plan is then developed after reviewing sleep study results.UPPP (uvulopalatopharyngoplasty) - removing a portion of the uvula, soft palateand sidewall of the pharynx.Tonsillectomy and Adenoidectomy - the most common treatment for sleep apneain children and young adults.Coblation® of the Tongue Base - Radiofrequency treatment of the tongue base toshrink it.Genioglossus Advancement/Hyoid Suspension - Advances the tonguemusculature forward with permanent sutures.Nasal surgery, like inferior turbinoplasty and septoplasty, does not in itself improvesleep apnea, but allows for improved compliance with other therapies like CPAP andoral appliances. Nasal surgery is also typically performed prior to or in conjunctionwith the surgical procedures to treat sleep apnea listed above.
  26. 26. Coblation Surgery Snoring and Sleep Apnea
  27. 27. Uvular Resection
  28. 28. OSA Surgery by Coblator
  29. 29. Coblation Turbinoplasty :LA
  30. 30. Pediatric Tonsillectomy by Coblator
  31. 31. Coblation Turbinate Reduction
  32. 32. Coblator Surgery Soft Palate
  33. 33. Coblator Turbinoplasty
  34. 34. Coblator Channeling
  35. 35. Coblator Machine in Jubilee
  36. 36. Connecting saline flow
  37. 37. Coblation Tonsillectomy
  38. 38. OSA:Snoring and Sleep Apnea
  39. 39. Coblator Turbinoplasty in Jubilee
  40. 40. Coblator surgery For OSA
  41. 41. Coblation Surgery in Jubilee
  42. 42. Tonsillectomy in Kids
  43. 43. OSA Surgery Using Coblator
  44. 44. Coblator Surgery GA
  45. 45. Laser assisted Uvuloplasty for Snoring
  46. 46. Coblator Surgery started in Jubilee Hospital 23-06-2012
  47. 47. Turbinate surgery by Coblator in Jubilee
  48. 48. Tonsil fossa Post Op
  49. 49. Coblation Nose In Jubilee
  50. 50. Nasal Surgery:Sneezing and Blockage
  51. 51. Laser Vs Coblator For NoseMy experience, if there are only allergicsymptoms, laser cautery is better, whereas if added nasal obstruction is also there,Coblation surgery is better.
  52. 52. Thanks to Jubilee Management23-06-2012:Followed by blessing by Fr Andrews, MD ofthe hospital, there was a demo and small work shop.My sincere thanks go to Most Rev Dr.Soosaipakyam theArch Bishop of Trivandrum, for his blessing and prayers.My Sincere thanks goes to Fr.Andrews Kosmos MBA,the MD of the Hospital.My Anesthetist ColleaguesOT StaffThe Arthrocare Team for their support and guidance.
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  54. 54.
  55. 55. THANK YOU By His Wounds We Are Healed Isaiah,