1 Guidance

1 Guidance

This document replaces previous guidance on coblation tonsillectomy (NICE interventional procedures guidance 9) and interim guidance on diathermy for tonsillectomy that was issued jointly with the British Association of Otorhinolaryngologists – Head and Neck Surgeons.

1.1 Current evidence on the safety and efficacy of electrosurgery (diathermy and coblation) for tonsillectomy appears adequate to support the use of these techniques, provided that normal arrangements are in place for consent, audit and clinical governance.

1.2 Surgeons should avoid excessive use of diathermy during tonsillectomy. Surgeons using diathermy in tonsillectomy for dissection and/or haemostasis should be fully trained in its use and should understand the potential complications.

1.3 Use of coblation for tonsillectomy can result in higher rates of haemorrhage than other techniques and clinicians wishing to use coblation should be specifically trained. The British Association of Otorhinolaryngologists – Head and Neck Surgeons has agreed to produce standards for training.

1.4 Surgeons should ensure that patients or their parents/carers understand the risk of haemorrhage after tonsillectomy using these techniques. In addition, use of the Institute's information for the public is recommended.

1.5 Surgeons should audit and review the rates of haemorrhage complicating tonsillectomy in their own practices and in the context of the techniques they use. Publication of further information about the influence of different techniques and other factors (such as age) on the incidence of haemorrhage after tonsillectomy would be useful in guiding future practice.