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Treating Chronic Nasal Congestion
Devices

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

1. SomnoplastyTM/SM: SomnoplastyTM/SM is a monopolar electrosurgery unit, which creates a small amount of heath to reduce the volume of tissues.  Scientifically speaking it causes rapid tissue heating, and vaporization of the cellular fluid into steam.  It then causes 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 (if you can imagine a mini football shape area which was created by this device) is produced in regions surrounding the target tissue site.  This leads to the creation of vacuolar degeneration in the affected tissue (basically draining the cell fluid by evaporation).  Over a course of several months following the initial treatment, firmer fibrous tissues forms reducing the tissue volume with less vibration. Generally temperature during this procedure does not exceed 85 degrees Celsius.

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 laser, 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. CoblationTM: The CoblationTM 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. (Very similar end results as SomnoplastyTM/SM). Once again scientifically speaking: CoblationTM probe is merged in a saline gel as a conductive medium and placed into the tissue. The unit setting is placed at 6 and held for about 10-15 seconds.  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. These particles then gain adequate energy to cause dissociation of the molecular bonds within tissue structures. (Simply the effect of the CoblationTM is to break large protein molecules into smaller molecules this finally leads to reduction of tissue volume)  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, CoblationTM enables volumetric removal of target tissue while producing minimal necrosis of collateral tissue.

Does radioablation technique create excessive heat? No. With radioablation treatment, a continuous mode of operation is used rather than the pulsed mode required for Excimer lasers. This is due to the fact that CoblationTM employs relatively low-temperature plasma, compared with the laser's high power density beam of photons and subsequent heat production.  In CoblationTM 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 CoblationTM 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 CoblationTM with laser or SomnoplastyTM/SM?
The method of CoblationTM uses plasma-mediated cold ablation to produce molecular dissociation this compared to the gradual and slow vacuolar degeneration produced by SomnoplastyTM/SM procedures. CoblationTM results in rapid and precise volumetric tissue removal with little or no collateral tissue damage. In addition, CoblationTM 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 CoblationTM method can simultaneously achieve coagulation of smaller blood vessels within few seconds rather than several minutes with a delayed response like SomnoplastyTM/SM.

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