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This article explores a large single-institution study of over 13,000 pediatric tonsillectomies performed over six years, documenting a progressive shift from total tonsillectomy (TT) to intracapsular tonsillectomy (IT). The transition correlated with a significant reduction in 30-day hospital returns. Qualitative insights reveal key surgeon motivators and barriers influencing adoption of IT, emphasizing departmental data transparency and shared culture as pivotal factors.