Coblation, Cold Steel, and Diathermy Tonsillectomy: A Comparative Review of Surgical Outcomes

Tonsillectomy remains one of the most frequently performed otolaryngologic procedures, but postoperative pain and hemorrhage continue to represent important sources of morbidity.Several surgical techniques are available, including coblation, cold steel (traditional dissection), and diathermy (monopolar or bipolar electrocautery).Differences in intraoperative efficiency, postoperative morbidity, and cost have led to continuing debate regarding the optimal technique.This narrative review synthesizes the literature comparing the three techniques across operative time, intraoperative blood loss, postoperative pain, primary and secondary hemorrhage, and cost.Evidence from randomized trials, observational studies, systematic reviews, meta-analyses, and large national or regional datasets demonstrates substantial heterogeneity between techniques and patient populations.Coblation is consistently associated with reduced intraoperative blood loss and, in several studies, shorter operative time, but the evidence on postoperative pain is inconsistent, and multiple systematic reviews and meta-analyses report a signal of increased secondary hemorrhage risk with coblation relative to cold steel dissection.Cold steel dissection remains associated with the lowest secondary hemorrhage rates but the longest operative time and greatest intraoperative bleeding.Diathermy techniques, particularly bipolar dissection with hot hemostasis, offer a reasonable balance of operative efficiency and cost, although bipolar diathermy has been linked to higher secondary hemorrhage rates than cold steel with hot hemostasis in some analyses.Cost-effectiveness analyses suggest coblation and cold steel are broadly comparable, with the balance depending on local hemorrhage and readmission rates.Overall, technique selection should consider the surgical objective, patient age, intracapsular versus extracapsular approach, surgeon experience, hemostatic strategy, and institutional outcomes rather than reliance on a single universally preferred technique.