Laser tonsil treatment under local anesthesia: a patient-friendly effective alternative?

Abstract

This thesis investigates whether CO₂ laser tonsillotomy under local anesthesia (TO) can serve as a viable alternative to traditional tonsillectomy (TE) in adults with tonsil-related conditions. It begins with an introduction to tonsil diseases, their clinical indications for surgery, and the anatomical and immunological role of the tonsils.

Before initiating the randomized controlled trial (RCT), a systematic review was conducted to evaluate the existing evidence on tonsillotomy in adults. This review demonstrated encouraging outcomes regarding reduced postoperative morbidity and faster recovery compared to tonsillectomy, but also highlighted the lack of high-quality randomized trials. These findings provided the scientific foundation for the present RCT.

The core of this thesis presents the prospective RCT comparing CO₂ laser TO with classic dissection TE, assessing postoperative pain, recovery time, complications, recurrence of symptoms, and cost-effectiveness. The results show that CO₂ laser TO substantially reduces postoperative pain, recovery time, and complication rates, while maintaining effectiveness. Economic analyses further confirm that TO is significantly more cost-effective.

A video-assisted publication accompanies the thesis, demonstrating the surgical technique for CO₂ laser tonsillotomy. Collectively, this work supports the broader clinical adoption of TO and contributes to its recognition and inclusion in health insurance coverage in the Netherlands.