Title : BiZact versus bipolar diathermy and intracapsular coblation for tonsillectomy: A UK cohort study of 1,267 patients
Abstract:
Introduction: BiZact (Medtronic) is an electrothermal device used in a small number of UK centres. This study presents the first large-series UK comparative analysis of BiZact, bipolar diathermy and intracapsular coblation across adult and paediatric cohorts.
Methods: Retrospective cohort study of 1,267 elective tonsillectomies at a single NHS centre (May 2024–November 2025). Primary outcomes: secondary haemorrhage, post-operative pain driven re-attendance and all-cause hospital readmission.
Results: In 283 adult tonsillectomies (BiZact n=98, bipolar n=185), no BiZact patient required return to theatre versus 4.9% bipolar (p=0.030). All-cause readmission was lower with BiZact (14.3% vs 27.0%, p=0.039). Pain outcomes were identical (OR 1.07, p=1.000). BiZact operative time was consistent regardless of surgeon seniority (p=0.479), in contrast to bipolar diathermy where trainee operators took significantly longer than consultants (24.5 vs 41.0 minutes; p<0.001).
In 984 paediatric tonsillectomies (BiZact n=184, bipolar n=362, coblation n=438), haemorrhage rates were equivalent across all three devices (4.9%, 5.8%, 5.7%; all p>0.80). Coblation demonstrated significantly lower post-operative pain-related events than BiZact and bipolar (2.7% vs 7.6% and 6.9%; p=0.013), persisting after adjustment for surgeon grade and post-operative analgesia prescribing.
Conclusions: BiZact is associated with lower return to theatre and readmission rates than bipolar diathermy in adults, with grade-independent operative time suggesting a shallower learning curve. Paediatric haemorrhage outcomes are equivalent across devices. Coblation retains a pain advantage in children. These findings have implications for surgical training and device selection across ENT departments.
