The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on electrosurgery (diathermy and coblation) for tonsillectomy.
It replaces the previous guidance on coblation tonsillectomy (Interventional Procedures Guidance no. 9, September 200) and interim guidance on diathermy for tonsillectomy that was issued jointly with the British Association of Otorhinolaryngologists - Head and Neck Surgeons.
Tonsillectomy consists of two stages: removal of the tonsil, followed by control of bleeding (haemostasis). In traditional ‘cold steel’ tonsillectomy, the initial incision in the mucosa is made with scissors, with the subsequent mobilisation of the tonsil usually carried out by some form of blunt dissection using either a specially designed dissector or dissecting forceps to manipulate gauze swabs or cotton wool to separate the tonsil from its bed. Bleeding vessels are initially controlled by pressure on a swab in the tonsil bed and any residual bleeding is controlled with ligatures. An alternative approach to dissection and haemostasis is electrosurgery (monopolar or bipolar diathermy). These techniques were introduced around 40 years ago. In the UK, bipolar diathermy dissection and haemostasis is more commonly used than monopolar. Diathermy can also be used for haemostasis following traditional ‘cold steel’ techniques for dissection, either additional to ties or as the sole technique for control of bleeding, and ties are occasionally used as an adjunct to diathermy for haemostasis. Coblation, a variation of electrosurgery that uses lower temperatures than diathermy, was introduced in the late 1990s. It employs a bipolar probe to generate a radiofrequency current through a solution of sodium chloride.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.