The most common cause of children’s snoring is tonsillar and adenoid hypertrophy, and the common symptoms are nasal congestion, snoring, inattention, reduced learning ability, and a typical “adenoid face”. If bacterial infection occurs, it can easily lead to chronic sinusitis, middle ear fluid, bad breath, etc., which can have a great impact on the growth and development of children. Regarding tonsil and adenoidectomy, parents often ask, “How invasive is the surgery?” “Is it a minimally invasive surgery?” Is it a plasma radiofrequency surgery?” In response to these questions from parents, we will now talk about the surgical treatment of tonsils and adenoids. Tonsil and adenoidectomy is actually a simplified form of Uvulopalatopharyngoplasty (UPPP), which is the removal of the patient’s uvula, tonsils and part of the soft palate, with heavy postoperative reactions, easy wound bleeding and local pain. The postoperative reactions are more severe, the wound is more likely to bleed, and the area is more painful. The difference is that in children, the adenoids are often removed, but usually the uvula and soft palate are not removed, and a combination of suturing techniques to suspend the soft palate according to the size of the pharyngeal cavity can achieve good results. Regarding the sequence of tonsil and adenoidectomy, the practice in our hospital is to perform tonsil first and then adenoidectomy, i.e., to perform adenoidectomy after tonsil, and to observe the blood leakage from the tonsillar fossa during adenoidectomy for timely treatment. Let’s start with tonsillectomy. The traditional surgery for tonsillectomy is peeling, picking open the mucosa at the junction of the tonsils with the palatoglossal and palatopharyngeal arches, and the knife should not be too deep, otherwise it is easy to cut through the envelope, and the palatoglossal arch is cut and peeled off along the envelope. Later, electrocoagulation or low-temperature plasma radiofrequency hemostasis or direct anterior and posterior palatal arch suture can be used to close the wound. Extensive electrocoagulation hemostasis tissues are prone to thermal injury and heavy postoperative reactions. Low-temperature plasma radiofrequency surgery is performed with radiofrequency energy plus sodium ions in physiological saline as the medium, and hemostasis is performed at a slightly higher than normal temperature of 40-70°C. The postoperative reaction is relatively mild, but the disadvantage is that the boundaries of the tonsillar adhesions are unclear when they are heavy, and the normal shape of the palatal arch is not easily preserved, and the pseudomembrane is thicker after surgery, with the possibility of secondary bleeding. Another method is the currently popular low-temperature plasma radiofrequency adenoid tonsil surgery, which has the advantage that it can be done while coagulating, stopping bleeding at any time when there is active bleeding, and very little intraoperative bleeding. Some of the techniques of low-temperature plasma radiofrequency surgery include pulling the tonsils medially, operating along the tonsillar tegument, gradually ablating and separating the tonsils along the tonsillar tegument with the tip of the knife, and using the lateral edge of the knife to reach the tissue (with a light force, similar to stroking) to cut the tonsils intact. For children with simple tonsillar hypertrophy and less inflammation, low-temperature plasma radiofrequency excision can be used. For children with recurrent inflammation, heavy adhesions, or obese children with obvious narrow pharyngeal cavity, traditional peeling followed by radiofrequency focus on the site Hemostasis combined with palatal arch suturing can achieve better surgical results. Moreover, suturing the anterior and posterior palatal arches (usually with a portion of peritoneal tissue) is a simple method with positive results and avoids the possibility of postoperative pseudomembrane detachment for hemorrhage. After complete peeling of the tonsils, plasma RF spot hemostasis of the trauma (mainly at the root of the lingual artery, where we observed that most of the postoperative tonsillar bleeding was located), and suturing of the anterior and posterior palatal arches directly after excision, not only hemostasis but also elimination of the trauma, and the operation time is controlled in 20-30 minutes, which greatly reduces the occurrence of postoperative bleeding, and through the observation of more than 200 clinical cases, no secondary bleeding has occurred. The results are very satisfactory. For obese children, the benefit of suturing the pharyngeal cavity is that palatopharyngoplasty expands the pharyngeal cavity, and the postoperative effect is better than that of simply removing the adenoids and tonsils. Moreover, the injection of saline epinephrine into the peri-tonsillar space before stripping surgery can completely control bleeding to less than 10 ml. And again, adenoids surgery. Traditional adenoids scraping surgery is a blind scraping, which can easily cause postoperative bleeding, damage to the mucous membrane of the pharyngeal tube, pain, and dead space of the surgical lesion due to the limitation of the instrument, which is not easy to completely remove and cause recurrence, so it has been basically abandoned in large hospitals in China. At present, the commonly used procedure is “TV endoscopic adenoidectomy”, which is the best treatment for adenoid hypertrophy because it can be performed under direct vision, with accurate positioning, significantly reducing the operation time, postoperative bleeding, pain and scar granulation tissue, and achieving long-term symptom improvement. TV endoscopy using XPS planer or plasma radiofrequency resection, the surgical approach taken is a general anesthesia transoral approach, with an orifice, a suction tube to pull the soft palate, and 70° endoscopic surgery, which maintains a clear view from the beginning to the end of the operation, with a large margin of movement for the instruments and no damage to the nasal mucosa. There are usually two sites where adenoid surgery is prone to bleeding. One is located at the nasopharyngeal parietal wall near the posterior nostril, which is bilaterally and symmetrically distributed with small adenoid blood supplying arteries, and is prone to bleeding if excised too deeply; the other is located at the posterior pharyngeal wall at the junction of nasopharynx and oropharynx, where dilated small blood vessels are sometimes seen. There are also 2 types of TV endoscopic adenoidectomy, low temperature plasma radiofrequency surgery and XPS planer surgery. Cryo-plasma resection of the adenoids can be performed from the lowermost end of the adenoids to the superficial layer of the prevertebral fascia, and then in a bottom-up, left-to-right sequence along that level. When removing tissue during plasma surgery, it is important to keep the tip slightly away from the adenoid tissue and to use the lateral side of the tip for excision, with the dorsal side of the tip facing the adenoid tissue as the tip moves to minimize tip obstruction. When using the XPS shaver, the adenoids protruding into the posterior nostrils and pharyngeal orifice of the eustachian tube are carefully removed first, and then the adenoids in the roof and posterior wall of the nasopharynx are removed, which can significantly shorten the operation time. The adenoids need not be removed very thoroughly, as long as the prevertebral fascia is not injured. Intraoperative bleeding is slightly more, and there will be a small amount of blood oozing from the trauma after surgery. Hot saline gauze compression for 10 minutes is very effective in stopping bleeding, and if active bleeding is encountered, cryogenic plasma radiofrequency can be used to stop bleeding. When cutting the suction device to excise, pay attention to leave the adenoid tissue slightly, using the suction force of the suction device to remove the tissue that inhaled the tip of the knife, without hurting the deep blood vessels. Personally, I often use a planer to remove adenoids layer by layer to ensure the accuracy of excision and avoid accidental injury, and use plasma radiofrequency to stop bleeding after pressure hemostasis.