Soon after they discovered Coblation-assisted tonsillectomy at an exhibit hall a couple years ago, our five surgeons were intrigued enough to trial it. Would the procedure's prospect of better outcomes, less pain and faster recovery hold up at our single-suite ASC specializing in throat surgery? It's hard to say who's been more pleased by the results, our surgeons or our patients (and their parents). Our tonsillectomy case times have dropped from 36 minutes to 13 minutes, revenue has increased by 2 percent - owing to the fact that we've increased our daily case output by six - and, most importantly, patient satisfaction has improved tremendously. I'd like to share with you the lessons that we've learned from our trial.

Technology on trial
Our surgeons first heard about the Coblation approach to tonsillectomies at the annual meeting of the American Academy of Otolaryngology in 2003. They experimented with the technology at the gathering and decided to trial the procedure at our center. The surgeons agreed as a group to examine the efficacy of Coblation, but one of our more cautious partners insisted on a complete report that carefully examined patient satisfaction, procedure times and cost.

We embarked on a 60-case trial period that spanned three weeks. During that time we were conscious of performing Coblation on a broad cross-section of patients - our sample ranged in age from 3 to 68 - and carefully looked at the pre-op condition of the tonsils, overall health of the patient and indications of increased post-op bleeding.

I developed a simple Excel spreadsheet, detailing the quality of case results for each patient. Next to patient names, I noted:

• procedure and room turnover times,
• the condition of the tonsil before surgery,
• the number of Coblation wands used,
• incidence of post-op bleeding,
• time spent in PACU,
• patient satisfaction and pain levels reported during a next-day post-op phone call and
• the number of days before the patient returned to eating solid foods.

Each surgeon received the data on a weekly basis so he could watch the trends before deciding on Coblation's place in our practice. Another important point: We continued to perform the standard tonsillectomy procedure during the trial. By also having a baseline group of patients, we were able to compare apples to apples because the Coblation and standard procedures were performed with the same staff and in the same OR environment.

Our surgeons speak
At the end of the three weeks, our surgeons were more than pleased with the trial's results. Procedure times at first took longer than the traditional tonsillectomy approach, but as our surgeons became more comfortable with the Coblation technique, the times soon matched and then surpassed the old method. Our procedure times dropped from 36 minutes to between 13 and 18 minutes, allowing our center to increase its daily case output by six, from 12 cases to 18 cases. In the world of outpatient surgery, an additional six cases are hugely valuable, and resulted in a 2 percent increase in daily revenue for our center.

The minimal amount of supplies and equipment required for a Coblation tonsillectomy also contributed to the time decrease. Instead of pulling and opening a bi-polar cord, ground pad, hand-controlled bovie tip, suction cautery, number 12 blades and the bismuth subgallate/adrenaline paste used to dry the tonsils, our surgical team simply attached a disposable coblator hand piece and bag of IV saline solution (used to irrigate the tonsil bed during the procedure) to the cautery unit. The cautery unit is attached to a foot pedal and small pump that ensures the proper flow of saline solution into the surgical field, improving visualization and preventing the coblator wand from clogging with tissue.

When comparing the cost of the disposable hand units (the manufacturer provides the cautery unit free) with the supplies needed for a standard tonsillectomy, we determined the case costs were a wash. The advantages of Coblation for us are quicker procedure times and, more importantly, the overwhelmingly positive feedback from our patients' parents.

The recovery time from a standard tonsillectomy is 10 days to two weeks of pain and liquid diets. In a majority of our post-op phone calls the day after Coblation surgery, parents want to know how to keep kids on, instead of off, the couch.

Follow-ups also revealed patients were eating baked potatoes, frozen food entrees and even cheeseburgers just two days post-op. That was remarkable, considering calls for additional pain medication and dehydration-induced trips to the ER are not uncommon after a standard tonsillectomy. Instead of instructing parents to avoid giving their kids solid food for two weeks while the scab in the throat heals, we now want children back on solids as soon as they're tolerated, while avoiding the three S's: foods that are scratchy, spicy or sour.

Picking up the pace
We facility managers are always looking for opportunities to improve patient flow and case efficiency. The decreased case times of this procedure was the impetus for change in our center. From admission to discharge, patients flowed through the surgical path in less time, and we needed to figure out how to keep up with the faster pace.

To wit, we made a subtle but effective change with the post-op instructions. We now give the directives to patients and parents during registration instead of at the pre-op bay. That might not seem like a big deal, but we've found the practice gets parents and children in the right mindset for surgery. We believe children need to be aware of what the surgery entails and what to expect when they awake in PACU. They are kids, yes, but they're also our patients. We treat them accordingly.

With the decreased case times and recovery lasting, on average, 15 minutes less than a standard tonsillectomy, patients and their families aren't in our facility for as long as before. That's a great thing, but it also means they need to be aware of post-op instructions sooner so they can have enough time to review our expectations and seek the answers to questions that might arise.

Best possible outcomes
We've been performing Coblation tonsillectomies for about a year-and-a-half, and the overall feedback has been very positive. Our surgeons are happy, parents are thrilled with how quickly their children return to normal activities and our staff is grateful for the opportunity to promote our center as one that provides the latest in tonsillectomy technology. Parents always want to provide their children with care that will produce the best possible outcomes. If your surgeons still use a cold knife with high-temperature cautery, you and your patients might be missing out.