Adenotonsillectomy

Added: 2026-05-23

[00:00:02]Uh?

[00:00:03]Ferris come came you know?

[00:00:07]Who?

[00:00:08]Ferris Ferris.

[00:00:11]Faris Faris Faris. Uh? No, I don't know.

[00:00:15]I think he has come. I'm not sure.

[00:00:22]Okay, I'm going to start my dear friends. See the moment here.

[00:00:26]So, this is blue blue blue blue blue blue blue blue. Okay? So, that's the first moment. The second moment is yellow.

[00:00:40]When I do the yellow, I will I will release the So, be you see the release of those head. It's the release of the head of the tonsil.

[00:00:50]So, the minute you release, you hold the head.

[00:00:55]And then what you do is see see can you see clearly?

[00:01:00]My dear friends.

[00:01:02]Yes, sir.

[00:01:05]See how clearly you can see that.

[00:01:37]So, the main main issue in a coagulation tonsil is getting the right plane.

[00:01:47]So, if you miss the plane, you will go enter into the tonsil.

[00:02:54]>> See, there is called extracapsular dissection.

[00:02:59]I'm going around the capsule.

[00:03:09]Hello, can you see me?

[00:04:37]>> Can you see?

[00:04:38]Hello.

[00:04:38]>> Yes, sir. Yes, sir.

[00:04:40]In the future generation textbooks, this tonsillectomy bleeding is will be nowhere nowhere complications. Yeah, yeah, yeah.

[00:04:48]Because of the coblation.

[00:04:52]No primary, no reactionary, no secondary bleeding.

[00:04:57]No, that we cannot say because that secondary is because of infection, no?

[00:05:01]>> Infection.

[00:05:02]So, if they eat something or do something that can be infection. We have on and off secondary hemorrhage on hold.

[00:05:10]See how big the tonsil is? Can you see clearly? Grade four. Grade four.

[00:05:15]Yeah.

[00:05:22]Hello.

[00:05:23]Yeah.

[00:05:24]This Satya. Satya, good morning. Sir, good morning, sir. Yeah, Satya.

[00:05:30]Even primary if done with an inexperienced uh coblation technique can be very high.

[00:05:39]Yeah, yeah, yeah. If you hit the muscle, it'll continuously bleed.

[00:05:43]Superior constrictor.

[00:05:46]Correct, la?

[00:05:48]No, primary I don't agree. Reactionary can be there.

[00:05:52]You know, sometimes you can go into the muscle, it will bleed like continuously.

[00:05:56]>> No, no, if it bleeds also, see, any vessel which supplies the tonsil can be controlled, that diameter can be controlled with a coblator.

[00:06:09]Okay. Oh, primary, even if it bleeds, no, it can be controlled with a coblator.

[00:06:14]So, the incidence of secondary hemorrhage will or reactionary hemorrhage will be slightly higher.

[00:06:24]Okay. Primary, because the coblator can control any See, the IMEX itself, it is able to uh coblate. So, these vessels are far smaller than the IMEX.

[00:06:41]You get my point? Yes.

[00:06:45]If you look at the coblator, the coblator is good enough to control even the IMEX.

[00:06:56]Even if you have a primary bleed, you can control it with the coblator.

[00:07:01]So, that way See how beautifully you can see. Every fiber is seen.

[00:07:22]See that?

[00:07:44]This is pure extracapsular dissection.

[00:07:54]I'm peeling the muscle plane from the capsule.

[00:08:01]I'm not using the LO2 often.

[00:08:05]I'm just peeling it.

[00:08:09]See how I'm peeling? Can you see, my dear friend?

[00:08:15]See how I'm peeling it? Something like an elevator. I'm using it like an elevator.

[00:08:38]So, by doing this, what happens is that energy gone into the fossa is far less.

[00:09:13]So, that's it. So, you can see that the tonsils have been removed.

[00:09:18]Now, I want to tell you that the same thing has to be done in the adenoid also.

[00:09:25]Many people think that adenoid is intracapsular dissection. No.

[00:09:29]Adenoid should also be extracapsular.

[00:09:32]If you can do the tonsil extracapsular, why not the adenoid extra capsular?

[00:09:39]I'll show you the extra capsular dissection of the adenoid.

[00:09:45]Oh, this trick was told by my son. Satya told me this.

[00:09:49]Uh, put the catheter while you have the Boyle-Davis mouth gag.

[00:09:58]In rose position, it's easy. Yeah, that is what I'm I'm now following that.

[00:10:03]After you told, I followed.

[00:10:07]Because once in supine, you know, we have to put 0°, then we have to put Yeah, yeah, yeah. It becomes a little more difficult.

[00:10:15]No, no, I agree and I've started following that. After you told only I'm following it.

[00:10:23]Good idea, Satya.

[00:10:26]Small small ideas, you see, you get from many people.

[00:10:30]Each brain works differently.

[00:10:39]We have to receive all the inputs and take the good things.

[00:10:43]Uh, put it.

[00:10:45]So, that's the uh small infant feeding tube.

[00:10:53]Now, I want to show you primarily the extra capsular dissection of the adenoid.

[00:10:59]So, that is the reason why I posted this case. Many many many people still are not doing this properly.

[00:11:05]Sir, sir, people are asking please show the position of the patient with external camera.

[00:11:13]If you If it is there. Can you show?

[00:11:16]This is the This is the external camera, boss. That's all I can show. Yeah, okay.

[00:11:20]Now, I'm going to put the patient in the reverse Trendelenburg position.

[00:11:25]Yes, sir.

[00:11:27]This is septum position.

[00:11:29]Now, main thing I wanted to show you why this one is the extracapsular dissection of the adenoid.

[00:11:35]Extracapsular What is the meaning of extracapsular?

[00:11:38]Extracapsular means you have to get the Of course, there is no capsule for adenoid, right? Tonsil has a capsule.

[00:11:48]Adenoid doesn't have a capsule.

[00:11:50]But if you go intracapsular, means go into the tumor, that is into the into the adenoid, there's every chance that you will leave behind a lot of adenoid.

[00:12:02]Which is not good. Why do you want to do that? So, I'm going to show you the end stage of an adenoidectomy. How your end stage of adenoidectomy should be.

[00:12:12]That's going to be the primary reason why I'm showing you this case.

[00:12:17]Because still I'm not able to see a good adenoidectomy being done in most parts, not in all parts, but most parts of the world, they do a bad adenoidectomy.

[00:12:32]So, I use the 70° telescope now.

[00:12:37]That's a 70° telescope being used.

[00:12:43]Am I on the white light off my room?

[00:12:47]Um specs good.

[00:12:51]Now, see here, my dear friends, there are so many so many ways of belling the cat. Many people start with the nose.

[00:12:59]Imagine if you go through the nose, the nose is very small. This kid is around 5 year old.

[00:13:04]And if you go through the nose, number one is you will traumatize the inferior turbinate septum, so you might have a synechia. That is one.

[00:13:13]Second is, very important is you start from the most deepest part of this adenoid.

[00:13:22]Yes.

[00:13:23]So, the plane you get is lost.

[00:13:27]So, that's why I developed this sort of, you know, I started doing this.

[00:13:33]And you see what I do in this. See, I have a assistant who is actually who is actually going to irrigate from above and put suction below. So, that is my assistant's job.

[00:13:48]Now, what I do if I use my 70° endoscope in one hand and my coblator in the other hand. See here, I start with the blue. See, that's the blue.

[00:14:01]And I know this is the inferior most part of the adenoid tissue.

[00:14:07]Coblator settings, sir?

[00:14:09]Uh?

[00:14:09]Coblator settings.

[00:14:11]It's a 9 pi and I use the blue.

[00:14:14]Okay. So, first of all, I See, this is very difficult when you do it from the nose. You don't know where it ends.

[00:14:21]Sometimes it can come here. Sometimes it can be above.

[00:14:24]So, here, see, this is the longus capitis muscle. This is the longus capitis muscle.

[00:14:29]And so, what you do is you start with the yellow now. See, the minute you start with the yellow, see here, if I go like this, I'm missing the plane. I'm missing the plane. So, I'm telling you you should get the plane initially.

[00:14:49]First.

[00:14:50]Very, very, very, very important, my dear friends, that whitish thing is just the adenoid.

[00:14:55]So, how do you know you're getting the plane? You will see the bluish bluish perimysium.

[00:15:02]It's all adenoid tissue.

[00:15:05]Why are you doing horizontally, sir?

[00:15:07]Side to side? You should always do side to side, not up down, because you will enter into the muscle easily.

[00:15:15]Yes, sir.

[00:15:18]Uh, see, now I'm I'm I'm See that I'm getting the plane there.

[00:15:24]See, the main thing is many people don't get the plane. That is the problem. They They just say, "No, no, this is not cancer. You don't need to remove it fully."

[00:15:35]Then you don't remove a tonsil also fully. That is also not cancer.

[00:15:41]That's all bakwas. The people who don't know how to remove it is only they are taking talking like that.

[00:15:47]See here. This is the plane. This is the long of cat. This is the perimysium.

[00:15:52]The bluish perimysium should be defined.

[00:15:56]That is the first step of your adenoidectomy, please.

[00:15:59]Okay, don't say, "I will not do fully.

[00:16:02]You don't need to do fully." All that bakwas you don't tell me.

[00:16:07]See here.

[00:16:08]Now, you should not leave this plane.

[00:16:12]You should keep Now you see, the inferior part is less vascular.

[00:16:17]You will not get bleeding at all here.

[00:16:20]See, you will not get bleeding at all here.

[00:16:24]So, you're you're starting from a place where you're getting less bleeding.

[00:16:31]And then you're going to a place where you will have more bleeding, for sure.

[00:16:35]You see, when I go up, you will have bleeding.

[00:16:39]See, this is the perimysium. You see how we have got the plane.

[00:16:43]Now, as I go up, you do what is called internal debulking. Internal debulking means remove most of the big part. See here.

[00:16:54]I'm going to do internal debulking.

[00:16:56]Internal debulking means here you will have bleeding. 100% you will have bleeding.

[00:17:01]See, I'm going to show you.

[00:17:03]This is a vascular part of the adenoid.

[00:17:10]And people use the microdebrider.

[00:17:12]Everything they use.

[00:17:15]You just compare the micro debrider adenoidectomy with this.

[00:17:19]You just show me whether it is bloodless. It is very very bloody.

[00:17:24]Microdebrider adenoidectomy is extremely bloody.

[00:17:29]See, for a child which is 5 years old even one drop of blood means blood loss.

[00:17:38]So, see here. I've got the plane here.

[00:17:40]That's a periosteum.

[00:17:43]See the periosteum here. The perimysium, that is the periosteum.

[00:17:48]See how clearly we are getting the plane, the plane, the plane, the plane.

[00:17:53]The very very important, my dear friends.

[00:17:55]See that's the periosteum here.

[00:17:59]See how I'm getting the plane. See the plane.

[00:18:12]So, this is the commonest surgery you'll be doing now in your holidays.

[00:18:17]Nowadays, the adenoid is getting bigger and bigger. I'm seeing lot lot lot more cases of adenoid.

[00:18:24]Because of inappropriate use of antibiotics, because of biofilms, all that and patients are having repeated attacks of URI for which the pediatricians go on giving antibiotic antibiotic antibiotic. So, it develops massive resistance.

[00:18:46]So, all that is contributing to the increase in incidence of huge adenoids, grade four. Most of the babies now come earlier age. I'm seeing now 1 and 1/2 2-year-old children presenting with snoring.

[00:19:03]1 and 1/2 2-year-old children with snoring.

[00:19:07]Sir, what is the lowest age group in your series, sir? I have done for 2 year old. 2 year old. Okay.

[00:19:14]Yeah, 2 year old I have done.

[00:19:17]Adenoidectomy alone, of course. Yes, sir.

[00:19:22]So, you see what is happening here.

[00:19:25]See the plane. See the plane.

[00:19:28]Concentrate on the plane here.

[00:19:31]This is the fossa of Rosenmüller.

[00:19:36]Of course, you don't expose the muscle, but definitely it's mandatory that you get this plane.

[00:19:46]I am not seeing this in even good good uh uh people who demonstrate adenoidectomy. They have a lot of adenoid tissue.

[00:19:57]At one place, they will show the plane, maybe, but I need to see the plane like this.

[00:20:10]And some people say by doing it you have pain, neck pain, this that. Nothing like that. We have done thousands and thousands, and there is nothing like neck pain and all. I do adenoidectomy itself, so don't tell all that bakwas here. See, that's the incision too.

[00:20:35]Can you see the plane, my dear friends?

[00:20:38]Yes, sir.

[00:20:43]Just touch your conscience and tell me how many how many of you do a proper adenoidectomy.

[00:20:50]Most of you will be doing a little bit here, little bit there.

[00:20:54]There'll be a little adenoid here, little adenoid there, and you will compromise saying that oh, you don't need to do it because it's not a malignant tumor, something like that you'll keep telling, but no. That means you have not done it properly. This is what When I see a demonstration, I want you to do it the right way.

[00:21:15]And I feel that unless you get a proper plane in any surgery for that matter, whether you do adenoid, whether you do uh thyroid surgery, anything, the plane is very, very important.

[00:21:29]Hey, take it out.

[00:21:31]Little D.

[00:21:37]See the end result. Can you see here clearly?

[00:21:42]See the end result, my dear friends.

[00:21:55]All right, you get it. You get it. You get it. You get it.

[00:22:05]Bring it.

[00:22:12]Such a simple surgery, you are not able to get the plane.

[00:22:16]What is the use of doing all the big skull base, this, that?

[00:22:26]The primary basic surgery we teach the uh post graduate.

[00:22:32]Somebody put the question that sir, is there any nasal pharyngeal insufficiency after this surgery?

[00:22:38]Nothing like that. Nothing.

[00:22:40]>> Who asked this question? Nothing like that. Nothing like that.

[00:22:55]See? How often do you decide just adenoidectomy?

[00:22:59]>> This is how you do the adenoidectomy.

[00:23:02]I don't do it. Oh. Yeah. Don't go to the We use the suction pump later.

[00:23:07]Yeah.

[00:23:08]No, but this is the way you should do it because you know, you you are telling that you're doing an adenoidectomy.

[00:23:17]This is the tonsil. Let me check what is happening here.

[00:23:29]Do you uh often remove tonsils for 5 years old?

[00:23:33]What? Hello. Yeah.

[00:23:36]How often do you decide to do just adenoidectomies instead of Very rare.

[00:23:41]Very rare.

[00:23:43]Okay. Very rare because See, these patients See, it's a lymphoid tissue basically.

[00:23:48]And that hypertrophy is the After 1 year, we'll have to do uh tonsil. Unless the patient says don't remove the tonsil, I don't I don't prefer doing only the adenoidectomy.

[00:23:59]Okay. Practiced a lot abroad.

[00:24:02]I see. Yeah, all these people See, I also practice abroad. And these people, they come back with uh tonsil. Yeah.

[00:24:13]So, in Dubai Oh, hold on a moment.

[00:24:21]So, see, I just want to show you because see, a basic surgery like adenoidectomy is not done properly.

[00:24:29]What is the use of teaching all the high-end pituitary surgery and things like that, boss? There's no use. Now, put it in tonsil position. That's it.

[00:24:38]So, tonsil position going to put it.

[00:24:43]So, I just want to uh Yeah. My tonsil position put it.

[00:24:54]Tonsil position put it.

[00:24:58]Hello, my dear friends. Hello, can you see?

[00:25:02]Blur one.

[00:25:04]Hello, Nageswara Rao Garu.

[00:25:07]Sir.

[00:25:08]Did you see the surgery?

[00:25:10]Yeah.

[00:25:11]Fully bloodless, fast, 100% accurate.

[00:25:15]Without any No, I think the teachers, who are teaching should teach the right >> I'm also doing >> public lessons but I'm not able to do like you.

[00:25:28]You are very You should strive hard to get the plane, my dear friends.

[00:25:33]What is the use of doing a surgery when you don't get a plane?

[00:25:38]Yes. You You tell me, boss.

[00:25:41]Uh will you do it for your children like that? It's not See, my residents also are doing like the same thing. Very nicely getting plane.

[00:25:49]So, this is how we teach adenoidectomy.

[00:25:54]Sir. There's a question where someone's asked do you bend the wand to reach the topmost part of the adenoids? Yeah, see for children, no. Very young children, you don't need to bend.

[00:26:08]But for a little adults, no.

[00:26:10]That That needs a little bend. It depends on the height of the nasopharynx.

[00:26:16]So, if it is a child five This is a 5-year-old child, you don't need to bend at all. It'll nicely reach because the height of the nasopharynx is not big.

[00:26:25]No.

[00:26:26]Does the size of the adenoids Sometimes the adenoids might go into the nose or something. Yeah, that also See, when you See, that that is seen only when you do it in the nasal position.

[00:26:38]Once you put it in this position, that is the uh uh reverse Trendelenburg position, that also will not be seen like going into the choana. Sometimes it'll obstruct the choana, but you can easily reach it from down. Correct. And how do you deal with fibrous adenoids?

[00:26:56]Yeah, yeah, see we have stones, adenoid stones, we have revision adenoids.

[00:27:02]All that you you have see the coblator is the best boss.

[00:27:06]There's no doubt about I've done all kinds. I've done debrider. All that is bleeding too much. And then you have to control it with the with the coblator. All that is I I feel these are all you know, waste of time.

[00:27:21]You have too much time actually uh you know, doing it.

[00:27:28]My my my take would be suction.

[00:27:33]I'm just seeing the tonsil just last time.

[00:27:39]When I mean I There's no bleeding.

[00:27:52]Okay, right.

[00:27:54]So Okay, so any any doubt you have?

[00:28:04]You can ask me.

[00:28:09]Dr. Nageshwar Rao Garu Hello.

[00:28:23]Satya Hello.

[00:28:27]Yeah, nowadays when we do live no Mhm.

[00:28:31]only some 30 35 people come. That's why I almost lost too much interest in live.

[00:28:38]So so previously at least 150 200 I I bought Zoom for 300 and now only 35 40 are coming. So, slowly slowly I'm decreasing the live.

[00:28:51]But I will do occasionally I will do live. Okay?

[00:28:56]Okay, man. Thank you.

[00:28:57]God bless you. One doubt, sir. Small doubt. Yeah.

[00:29:01]Sir, one kid was complaining of food regurgitating into the nose, sir. Also Ah. Ah. Why does it occur, sir?

[00:29:08]Initially it will occur, sir. Number one is submucous [snorts] cleft palate. You should You should rule out any cleft palate issues.

[00:29:15]Number two is >> sir? That is a very big adenoid. There's a chance of There's a chance of regurgitation it'll go off. In a few days it'll go off.

[00:29:25]Okay, sir. Thank you, sir. When the scarring occurs it'll go off. Yeah, this has happened in a couple of very big adenoids, grade four adenoids. Yeah, yeah.

[00:29:34]They were completely gone. When the scarring When the scarring occurs it'll go off. One month 15 days to one month it stopped. Yeah, yeah, yeah. Correct.

[00:29:42]Nothing to do with If you go to down so much it will cause certain problems.

[00:29:49]>> No, no, no, no. Nothing like that.

[00:29:50]Nothing like that.

[00:29:52]It stopped. It will stop usually.

[00:29:56]Okay, thank you very much. God bless you. Have a nice