Main Theme: General
Introduction
BiZact is used for tonsillectomy in only a small number of UK centres. No peer-reviewed UK study has compared it with conventional bipolar diathermy and intracapsular coblation in a paediatric population. With practice increasingly divided between these three techniques, comparative outcome data can be used to guide device selection.
Methods
Retrospective cohort study of 984 paediatric patients undergoing elective tonsillectomy at a single NHS centre (May 2024–November 2025): BiZact (n=184), bipolar diathermy (n=362), intracapsular coblation (n=438). Primary outcomes: post-tonsillectomy secondary haemorrhage and post operative pain-related events.
Results
Secondary haemorrhage rates were equivalent across all three devices (BiZact 4.9%, bipolar 5.8%, coblation 5.7%; p>0.80). Multivariable adjustment confirmed device type was not an independent predictor of haemorrhage; age was the only significant predictor (adjusted OR 1.57 per SD, p=0.001). Haemorrhage outcomes were independent of operating surgeon grade for all three devices. Coblation demonstrated significantly lower pain-related event rates than both BiZact (7.6% vs 2.7%; adjusted OR 0.33, 95% CI 0.15–0.74, p=0.013) and bipolar (6.9% vs 2.7%; corrected p=0.019). This advantage persisted after adjustment for surgeon seniority, patient age, sex and post operative analgesia prescribing.
Conclusion
BiZact achieves equivalent haemorrhage outcomes to both bipolar and intracapsular coblation, with surgeon grade-independent performance. Coblation confers a pain advantage over both extracapsular techniques independent of case-mix or operator factors. These findings support BiZact as a safe paediatric tonsillectomy device whilst confirming that coblation retains a meaningful pain benefit for children.