There are various ways to perform a tonsillectomy, ranging from a tonsillectomy under local anesthesia, which is carried out while the patient is awake in a sitting or semi-sitting position, to tonsillectomy under general anesthesia, where the patient is fully asleep. The surgical techniques and instruments also vary according to the surgeon's training and preference. Some surgeons still use the scalpel and snare, others use the coblator and some use the electric knife (Bovie electrocautery). Blood vessels are electrocoagulated / coblated, tied or sutured.
A common denominator to all these techniques is the dissection of the tonsillar capsule away from the surrounding muscles and achieving good hemostasis. With the popular use of electrocautery and coblation, blood loss has been reduced to a few milliliters and even to no bleeding at all. With no blood in the pharynx and no swallowed blood in the stomach, patients recover much better from anesthesia and vomit less. In addition, the use of coblation is becoming more popular because it seems to cause less post-operative pain.
In the picture above, the patient is in the Rose position (neck hyperextended and nasopharynx most dependent). A McIvor mouth gag props the mouth open and keeps the anesthesia endotracheal tube away from the surgical field. The right tonsil has been dissected with the coblator and retracted medially over the uvula. Note the dry tonsillar bed and total absence of blood in the field. The tonsil is finally severed from its attachement to the posterior pillar and removed.