Coblation is a chemical process,
not a thermal one that generates a precise plasma layer used to remove target
tissue whilst minimising damage to the surrounding area (figure 6 with courtesy
to Smith&Nephew®). Coblation
produces minimal thermal penetration into underlying tissues, gentle tissue
removal by dissolution as compared to electrocautery or laser. Coblation
technology includes irrigation, suction and ablation/coagulation
characteristics so it allows fewer working hands in the field. 8-11

Li HN
et al. presented Coblation endoscopic lingual lightening (CELL) technique to ablate tongue base hypertrophy in OSAHS patients by
performing midline glossectomy.6,7 However,
that technique did not provide tissue specimen to assess volume of resected
tissues and it aimed at removal of central part of the tongue base. Application
of CELL technique to ablate the whole tongue base consumed a lot of time with
risk to exposure to anesthesia in those critical patients. Vicini et al.
presented TORS for OSAHS in May 2008 and published first cases series in 2010
and second series in 2012.1,4 That technique proved to be effective, safe and
feasible in resection of the whole tongue base providing tissue specimen at the
end of surgery to assess resection limit.12 TORS for OSAHS was proved to be
highly effective in a multicenter study in 7 different centers in 5 different countries
all over the world. 13 In Egypt, as in many developing countries, we don’t
have TORS technology to treat those severe OSAHS patients with significant
tongue base hypertrophy.

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In this
study, Coblation technology was used in the same way as TORS was described with
similar exposure and operative technique at the level of tongue base. The
difference of this technique rather than CELL technique is the availability of
resected tissue specimen at the end of surgery to judge if resection is enough
or more resection required. Moreover, resection was found to be quicker to
remove tissues that its ablation so less operative time, less tongue
compression by mouth gag, less exposure to anesthesia in those critical ill
cases. Presence of irrigation kept tongue base tissues at the end of surgery
not warm (as in electro cautery even used in TORS) so less tongue base edema,
and less need to keep patient intubated at the end of surgery, and less
postoperative pain, early introduction of oral diet with less postoperative
morbidity.9