What is the mechanism of action of Coblation^TM and how does it differ from laser and other radiofrequency devices?

1. Somnoplasty^TM/SM: In conventional monopolar electrosurgery such as Somnoplasty^TM/SM, a current from the electrode causes electrical arcs to form across the physical gap between the probe and the target tissue.  At the contact point of these arcs, rapid tissue heating occurs. Consequently, cellular fluid rapidly vaporizes into steam, causing the release of cellular fragments and producing a layer of necrosis or dead cells along the pathway of the probe.  As a result of this heating, collateral tissue ablation is produced in regions surrounding the target tissue site.  This leads to the creation of a vacular degeneration in the affected tissue.  Over a course of several weeks following the initial treatment, firmer fibrous tissues forms reducing the tissue volume with less vibration.

2. CO₂ and Nd Yag Laser: Both of these lasers work in a different way.  The mechanism of laser surgery is based on its effect on the treated tissue and it depends on the laser’s wavelength, pulse duration, and cycle of the applied energy. Carbon dioxide lasers, like standard electrosurgical tools, operate by the generation of extreme heat to cause cellular explosion and pyrolysis.  Basically, laser devices are used to remove tissues using extreme heat.

3. Ultraviolet laser: Also known as Excimer lasers, ultraviolet laser achieves what is now commonly referred to as cold ablation.  Cold laser causes disintegration of individual cells and hence removal and reduction of tissue. The photons emitted at the wavelengths at which these types of lasers operate have sufficient energy to effect photo-dissociation (dissociation of cells due to energy of light) of human tissue.  Through this mechanism, large organic molecules as well as water can be disintegrated. However, to prevent excessive secondary heating within the plume of ablation products, Excimer lasers generally must be operated in a pulsed mode wherein very brief pulses are separated by periods of 50 to 100 milliseconds to allow the ablation plume to dissipate. If the period between pulses becomes too short, excessive heating within the plume causes an increase in collateral tissue damage as well as a decrease in the rate of ablation.

4. Coblation^TM: The Coblation^TM method replaces the extreme heat of laser and standard electro surgery with a gentle heating of the tissues causing physical reduction and shrinkage of the affected site. This is achieved by molecular disintegration via a cold ablative process most closely resembling that of Excimer lasers. Coblation^TM occurs when the tip of the probe is merged in a saline gel as a conductive medium and placed over the tissue. Upon applying a sufficiently high voltage difference between the probe and the tissues, the electrically conducting fluid is converted into an ionized vapor layer, or plasma. As a result of the voltage gradient across the plasma layer, charged particles are accelerated towards the tissue. At sufficiently high voltage gradients, these particles gain adequate energy to cause dissociation of the molecular bonds within tissue structures. This molecular dissociation produces volumetric removal of tissue. However, due to the short range of the accelerated particles within the plasma, this dissociative process is confined to the surface layer of the target tissue. In this way, Coblation^TM enables volumetric removal of target tissue while producing minimal necrosis of collateral tissue.

Does Coblation^TM technique create excessive heat?

No. With Coblation^TM treatment, a continuous mode of operation is used rather than the pulsed mode required for Excimer lasers. This is due to the fact that Coblation^TM employs relatively low-temperature plasma, compared with the laser's high power density beam of photons and subsequent heat production.  In  Coblation^TM treatment, no cooling period is required. Consequently, the efficiency of ablation is significantly increased and may be as much as an order of magnitude greater than that achieved with Excimer lasers.   Simultaneous with volumetric tissue reduction by shrinkage of the collagen, the Coblation^TM method is capable of producing coagulation of smaller blood vessels located adjacent to the zone of ablation. This is affected by the residual current flow in the tissue, which extends beyond the plasma/tissue boundary.

How do you compare Coblation^TM with laser or Somnoplasty^TM/SM?

The method of Coblation^TM uses plasma-mediated cold ablation to produce molecular dissociation this compared to the gradual and slow vacular degeneration produced by Somnoplasty^TM/SM procedures. Coblation^TM results in rapid and precise volumetric tissue removal with little or no collateral tissue damage. In addition, Coblation^TM can be performed in a continuous mode, distinguishing this method from the cold ablation achieved with Excimer lasers, which requires pulsing to avoid excessive heating and associated collateral tissue damage. Finally, the Coblation^TM method can simultaneously achieve coagulation of smaller blood vessels within few seconds rather than several minutes with a delayed response like Somnoplasty^TM/SM.

Would I have more bleeding with Coblation^TM?

No! The Coblation^TM method can simultaneously achieve coagulation of smaller blood vessels as well as reducing the tissue volume.  Bleeding is generally not expected with this procedure. The same technology, when operated in sub-ablation mode, is also capable of producing hemostasis in larger vessels as well as tissue contraction. In contrast with laser, which causes significant thermal damage, Coblation^TM is based on a none-thermal mechanism of action that produces volumetric tissue removal through molecular dissociation and is thus associated with a low potential for thermal damage.