Intracapsular versus Extracapsular Tonsillectomy in Modern ENT Practice: A Narrative Comparative Review of Clinical Outcomes and Energy-based Devices

Abstract

Tonsillectomy remains a frequently performed procedure in otorhinolaryngology for patients with recurrent tonsillar infection, chronic tonsillar disease, peritonsillar abscess and obstructive sleep-related breathing symptoms caused by tonsillar hypertrophy. This narrative comparative review examines intracapsular and extracapsular tonsillectomy in contemporary ENT practice, using secondary data from published clinical studies. The review focuses on operative time, postoperative pain, postoperative haemorrhage, recovery outcomes and the clinical relevance of energy-based devices, particularly Bizact™ and MiFusion® ENTceps®. The reviewed evidence indicates that intracapsular tonsillectomy is generally associated with reduced postoperative pain, lower secondary bleeding tendency and faster recovery, especially in paediatric patients undergoing surgery for obstructive indications. These outcomes are attributed to preservation of the tonsillar capsule, reduced exposure of deeper musculature and less local tissue trauma. Extracapsular tonsillectomy remains clinically relevant, particularly in adults and in patients with recurrent or chronic infection, because it enables complete removal of tonsillar tissue. Modern energy-based instruments used during extracapsular tonsillectomy appear to improve operative efficiency and haemostatic control when compared with conventional approaches. Bizact™ may offer advantages in operative efficiency through combined tissue dissection and bipolar vessel sealing, whereas MiFusion® ENTceps® may provide controlled thermal fusion with limited lateral thermal injury. However, the available studies are heterogeneous in design, population, outcome definitions and follow-up duration, which limits direct quantitative comparison. Overall, technique selection should be individualised according to indication, patient age, disease characteristics, surgical expertise, device availability and expected postoperative recovery. Further multicentre prospective randomised trials with standardised outcome reporting are needed to strengthen comparative evidence and guide evidence-based surgical decision-making.