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Laser Tonsillectomy under local anaesthetic spray or general anaesthetic
Laser tonsillectomy is one of the most effective and least painful treatments for tonsil problems
Mike Dilkes says: When you have spoken to another ENT surgeon who explains that laser tonsillectomy is no better than standard dissection tonsillectomy (a procedure that is 60 years old), according to the Royal College of Surgeons Audit Study, and only marginally better when looking at the NICE guidance, ask him or her one question: To which laser are you referring? They will inevitably go blank, as all lasers are lumped into one category in many ENT Surgeon's eyes. Some may say "KTP laser". In none of these studies was comparison made with the computerised pattern generated (CPG) Carbon Dioxide laser procedure, which is accurately intracapsular and completely different to the standard, or KTP laser tonsillectomy. This is what I do, as someone who has trained in lasers all over the USA and Europe since 1994, and wrote a higher degree Thesis on a related laser subject in 2000. Most of my colleagues did not do this, so are less able to comment.
Mike Dilkes, an ENT Surgeon based in London, is a renowned expert in treating tonsillitis, tonsil stones, bad taste and bad breath, having performed thousands of successful laser tonsillectomy procedures under local and general anaesthetic, using several different laser wavelengths. He now focuses almost entirely on the scanned Carbon Dioxide laser as it offers significant advantages over all other techniques, as it is an intracapsular procedure, using the vapourising quality of the carbon dioxide laser, delivered via a computerised pattern generator with a tissue (tonsil) dwell time of 1 millisecond. So no bleeding but minimal lateral heat spread..
Use this page to find out more about laser tonsillitis treatment and see our Tonsils FAQ page for answers to common questions related to tonsils, tonsillitis and laser surgery for tonsil treatment. Also watch our video guide to tonsillectomy to best understand symptoms, benefits and the procedure.
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Laser tonsillectomy and tonsillitis
What is tonsillitis?
In adults, tonsillitis is a very painful condition. It is associated with fever, swollen glands and difficulty in swallowing. Patients are usually too ill to go to work. All of these conditions can be caused by the tonsils – swellings of glandular tissue at the back of the throat.
Tonsillitis in adults can also be linked to other diseases such as psoriasis, bowel problems, mouth ulcers, joint aches, lethargy, Myalgic Encepahilits (ME) and chronic fatigue syndrome.
Mr Mike Dilkes provides the most up to date testing and treatment for tonsil and tonsil stones removal, based on medical research and consultations with leading experts in the USA and Germany.
Laser vapourisation micro-tonsillectomy usually involves minimal blood loss, and can be relatively safely performed in patients who are completely against possible blood transfusion (e.g. Jehovah’s Witness patients). It is done under intense bright light magnification using the operating microscope and micromanipulator when performed under general anaesthetic.
The intracapsular removal of approximately 95% of the tonsil tissue means that this procedure is effective. Also, since the tonsil capsule is intact, it is safer than dissection (bipolar, etc.) tonsillectomy, where the capsule is completely removed, as the major vessels to the side of the tonsils (paratonsillar vein, superior and inferior tonsillar arteries, ascending pharyngeal artery) are not exposed.
Laser and Micro-laser tonsillectomy for adults – an intracapsular technique
In adults, we recommend the intra-capsular flash scanned or computerised pattern generator (CPG) Carbon Dioxide laser procedure, either under local anaesthetic or general anaesthetic.
What is Laser Tonsillectomy under local anaesthetic?
Also called laser tonsillotomy, laser tonsil resurfacing, or laser tonsil cryptolysis, this is a partial removal of the tonsils under local anaesthetic (spray – no injections). This is a lunchtime treatment – go to work in the morning, have it performed at lunchtime and go back to work in the afternoon. There is usually little post-operative pain and usually no time off work is required at all. Painkillers are not prescribed, just over the counter medication is needed - Paracetamol and/or ibuprofen.
However, only 40-80% of the tonsils can be removed at any one time (depending on their size at the start – big tonsils need more treatment, and how easy the procedure is to perform), so more than one procedure can be required. A recent audit (Jan 2022) of 523 patients has shown that 66% of patients need only one procedure, 24% 2 procedures, 7% 3 procedures, 2% 4 procedures and 0.2% 5 procedures.
What is Micro-Laser Tonsillectomy under general anaesthetic?
Micro-laser tonsillectomy (so called because an operating microscope and micromanipulator is used to ensure accurate removal of the tonsil within its capsule) under general anaesthetic is a day case procedure where patients are kept in hospital under observation for 4 hours post-op. This technique removes around 95% of the tonsils in one attempt, so the need for a second procedure is much lower than the local anaesthetic laser tonsillectomy (1-2%). Time off work is kept to a minimum, generally it is 48 hours after surgery. There is some pain, which lasts around 7 days post-op, but as soon as the patient is over the anaesthetic, and if tolerating the prescribed painkillers well (Diclofenac and Co-Dydramol), then return to normal life is usually possible.
Ideally, general anaesthetic surgery is performed on a Friday, so the weekend is spent recovering, and Monday back to work.
Laser treatment for tonsils is less painful than traditional tonsillectomy
Our studies (in particular, a single blind, matched, controlled study) and patient feedback have confirmed to us that the intracapsular Carbon Dioxide laser tonsillectomy using a flash scanner or Computerised Pattern Generator (CPG) – in conjunction with an operating microscope and micromanipulator – is much less painful during the entire postoperative course compared to traditional tonsillectomy.
Post-operative pain lasts for 5-7 days, and patients usually eat normally (79% said their diet did not change in a review of cases), returning to work around 2 days after the operation. Furthermore, the post-operative bleeding risk is dramatically reduced.
Only two patients have needed to return to surgery for bleeding out of our series of over 1,000 people treated. Both of these patients bled despite having been well and at home for 5 days – they developed an infection, antibiotics don’t seem to help this (Cochrane review). They were both fine.
This dramatic pain reduction is due to the tonsil capsule being kept intact – meaning that the throat muscle and blood vessels around the tonsil are not exposed. The flash scanned Carbon Dioxide laser is the best instrument we know to do this, as it is quick and bloodless.
Very large tonsils may need a two-technique procedure, where the tonsils are debulked using monopolar diathermy, then lasered. This is more painful than a standard laser micro-tonsillectomy.
The only downside of this technique is that small remnants of tonsil tissue are left behind. These may need further surgery, although it is rarely that this is required (1:50 cases). All of our patients go home on the day of surgery, after 4 hours (DayCase surgery). Hospital-generated statistics show that our overnight stay is 0%, as is our readmission rate. Source: The Hospital of St John and St Elizabeth, Spire Roding Hospital.
Even more painful than tonsillitis, quinsy is an abscess on the outside of the tonsil, causing spasm of the jaw muscles, ear pain and an almost complete inability to swallow. It is usually on one side only, and is often triggered by tonsillitis. In acute cases, treatment is by draining pus and giving intravenous fluids and antibiotics. Hospital admission for a few days is required.
Surgical treatment of quinsy
We recommend a general anaesthetic and an intracapsular laser vapourisation tonsillectomy, in which the tonsil is vapourised using the flash scanned Carbon Dioxide laser. Vapourisation is extended into the abscess cavity to exteriorise it so that repeated infections cannot occur.
A tonsil which is enlarged on one side, persistently painful, sometimes with ear pain, bleeding and swallowing problems, might be cancerous and needs to be looked at urgently.
Initially an ENT consultation and an MRI scan are the minimum requirement. If these suggest cancer, a microscope controlled wide excision of the tonsil with the Holmium-YAG laser can be an effective way to completely remove the cancer in a rapid and bloodless manner. On many occasions, patients can avoid further treatment with more radical surgery, chemotherapy or radiotherapy.
Laser Tonsillectomy Fees
Laser Tonsillectomy (+/-dual technique)
Initial consultation, with endoscopy: £250
Tonsillectomy under general anaesthetic, including one follow up appointment: £3500
Laser Tonsillotomy (local anaesthetic)
Initial consultation, with endoscopy: £250
1st treatment including 1 post op follow up: £950
2nd treatment (1:4 chance) and 1 post op follow up: £750
3rd treatment (1:25 chance): £500
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