Endoscope-Assisted Tonsillotomy (Partial Intracapsular Tonsillectomy): How We Do It

Objective. To describe our technique of performing tonsillotomy that increases visibility by providing a better view of the tonsils and related structures through the use of a 30-degree scope. Method. Patients had tonsillotomy with microdebrider with the aid of a 30-degree endoscope for both visualization and on-screen projection and magnification. Result. The endoscope-assisted technique provides a more detailed exposure of pharyngeal structures and their relationships with the tonsils. It is easier to clearly visualize the upper and lower poles. The magnification with the endoscope makes it easier to appreciate anatomic details and identify/deal selectively with minute bleeding points. Conclusion. The use of 30-degree endoscope in tonsillotomy provides better visualization of the upper and lower tonsil poles and may make the procedure easier for the surgeon and safer for the patient. 1. Introduction Tonsillotomy was initially practiced in the 19th century and has been revived in the early 1990s [1]. After years of heated arguments among surgeons of the last century, tonsillotomy was eventually abandoned in favor of tonsillectomy as a result of changes in the understanding of the pathophysiology of some diseases such as rheumatism, scarlet fever, and chronic heart disease, which were thought to originate from the “diseased” remnants of tonsil tissue [2, 3]. The modern day tonsillotomy revival was originally aimed at reducing postoperative pain, but this was also found to significantly reduce the incidence of postoperative bleed [4]. Increasingly, tonsillotomy (partial intracapsular tonsillectomy) is being recommended over tonsillectomy in children < 4 years with tonsil hyperplasia or obstructive sleep apnoea, those with body weight < 15？kg and those with increased risk of bleeding, but technical difficulties with access, clear anatomical exposure, and visibility still remains, and it could often be quite problematic to visualize the tonsillar poles (Figure 1). Figure 1: View without 30-degree scope. Vascular supply to the tonsils come mainly from the poles, and poor visibility in these areas could hamper the use of diathermy with precision during haemostasis. 2. Method/Procedure In undertaking the endoscope-assisted technique, patient is placed on the supine position and the oral cavity splinted open with a Boyle-Davies gag as in standard tonsillectomy. The uvula is retracted anteriorly by means of a stitch on a clip. Dry gauze packing is applied to the inferior aspect of the oropharynx to limit blood flow towards the supraglottis. A 30-degree