what is a microdebrider

7/31/2019 What is a Microdebrider

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What Is a Microdebrider?

The microdebrider is a tool consisting of three key components. The console, controlled by

a foot pedal, determines the speed and direction of the rotating blade. Blades can be rotatedin forward, reverse, or oscillating modes at various speeds.

The handpiece controls the blade and integrates suction to allow for rapid and simultaneous

removal of debris. It is compatible with blades of various sizes and configurations. Suction

tubing connects to the handpiece.

The blade (or bit) is a hollow metal tube with a port for suction. Blades can be smooth or

serrated and are available in various sizes. This design allows for simultaneous cutting and

removal of tissue. The device is designed for one-time use and is disposable.

Because of the diameter of the blades (5-7 mm) and the rigidity of the microdebrider, itcannot be used with a flexible scope; it must be used in conjunction with a rigid

bronchoscope or suspension laryngoscope.1

How It Works

The microdebrider works by employing suction to pull tissue into the aperture of the blade,which cuts the tissue. Suction is used to simultaneously remove tissue-and blood-from the

site, allowing much better visibility for the surgeon. The tool can be easily operated with

just one hand, allowing the operator more freedom of movement.

The only true risk identified by investigators involved with the use of the microdebrider is

the possibility of inadvertent resection of normal tissue, and potential injury to the patientas a result. This most commonly occurs when a drilling bur is used, but it can occur with

cutting blades as well. This risk can be virtually eliminated if the operator remembers to:

Avoid overzealous suction pressure (which can pull excessive tissue into the blade).

Always maintain adequate visualization of the blade or bur.2

Microdebridement of Obstructing Airway Lesions

Tracheobronchial obstruction will occur in an estimated 20% to 40% of lung cancer

patients. Airway obstruction can also occur from certain benign conditions such as

postintubation tracheal stenosis, relapsing polychondritis, and Wegener's granulomatosis.The obvious goal of debridement of an obstructing airway lesion in an acute situation is to

restore oxygenation to the patient. With the added risks associated with general anesthesia,the ideal intervention will be fast, effective, and carried out in a manner that poses the least

risk of additional injury to the patient.

Removal of the lesion may be diagnostic as well as palliative, so preservation of tissue for

pathological review may be desirable. In cases of malignancy, the debridement of an
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obstructing lesion can often buy extra time for the patient's oncologic team to put together a

comprehensive plan for oncologic, psychologic, and nutritional management before

beginning definitive treatment.3

William Lunn, MD, is Director of Interventional Pulmonology and Assistant Professor of

Medicine and Otolaryngology at Baylor College of Medicine. Dr. Lunn was primary authorof a study published in The Annals of Thoracic Surgery in September 2005, titled

Microdebrider Bronchoscopy: A New Tool for the Interventional Bronchoscopist. Dr. Lunnstated in a telephone interview that he saw a fellow otolaryngologist use the microdebrider

for sinus surgery in about 1998, and he and his colleagues thought this would be a great

tool to use in the airway. In this study, the authors reported their experience using themicrodebrider to treat central airway obstruction.

click for large version

Figure. Rotating-tip curved blades in Medtronic's microdebrider allow medial and lateral

cutting in the frontal sinus and more complete removal of polyps and mucin in themaxillary sinus.

Dr. Lunn et al. reported that obstructing airway lesions were rapidly removed using the

microdebrider in all 23 patients included in the study. Only mild bleeding occurred, even in

lesions that appeared to be quite friable and vascular. Bleeding that did occur wascontrolled by tamponade using the rigid scope or instillation of oxymetazoline

hydrochloride. All patients concluded the procedure free of ventilatory support. No further

intervention for airway obstruction was required in follow-up ranging up to 24 monthsfollowing the procedure.
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Steven Pletcher, MD

When thermal modalities are used for treatment of obstructing airway lesions, one of theprimary dangers is the possibility of an airway fire. Interventions can be quite prolonged

because the surgeon must debride, suction, and cauterize sequentially. There is also the

potential for causing injury to the airway or surrounding structures, which may require

further interventions to correct.

According to Dr. Lunn, the traditional methods of debridement of airway lesions require

three instruments in the airway: a telescope, forceps or a cutting device, and suction. Using

the microdebrider, the surgeon can hold the debrider in his or her dominant hand, and theother hand is free to hold the scope.

The advantages of microdebrider surgery for airway obstruction cited in The Annals of

Thoracic Surgery study include:

The ability to rapidly remove obstructing tissue.

The ability to simultaneously remove tissue debris and blood allowing for bettervisualization of the field.

The ability to precisely limit the effects of the modality without fear of combustion

or perforation of the airway.

Another advantage cited by Dr. Lunn is that the rigidity of the tool allows for a tactile feelof the airway wall. It is possible to simply stop the rotation of the blade and use the blade to

touch and feel the airway, something that can't be done with the filament of a laser.

When asked if there are cases of airway obstruction in which use of the microdebrider

might be contraindicated, Dr. Lunn responded, No. There's really nothing. If I need toremove the tissue anyway, I think the debrider is the most delicate way to do it.

Partial Tonsillectomy

Tonsillectomies are performed on more than 300,000 patients annually in the United States,primarily for chronic obstruction or infection. In traditional tonsillectomy, the removal of

the capsule enclosing the tonsil leaves the throat muscles, large blood vessels, and nerves

exposed. Bleeding is generally controlled by electrocautery. This process leaves the patient

with severe pain and swelling, frequently requiring the patient to take pain medications forseveral days. This pain and swelling can also lead to decreased oral intake, causing

dehydration that may in some cases even require further hospitalization. These effects can

significantly delay the patient's return to normal activity.


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In a study published in Otolaryngology-Head and Neck Surgery in January 2005,

researchers concluded that use of a microdebrider for partial tonsillectomy resulted in less

pain for patients and shorter recovery times. The study, supported by an unrestricted grantfrom Medtronic, introduced the powered intracapsular tonsillectomy and adenoidectomy

(PITA) technique utilizing a microdebrider tool. Using this technique, physicians removed

90% to 95% of the tonsils, leaving the capsule in place to protect the throat muscles, bloodvessels, and nerves.

In this study, patients' caretakers were asked to record pain levels, doses of pain

medications, time of return to normal activity, and time of return to normal diet following

tonsillectomy. Patients who had partial tonsillectomy utilizing the microdebrider were threetimes more likely to not require pain medicine three days following surgery, and almost

twice as likely to have resumed normal activity levels than patients receiving traditional

tonsillectomy.4

Sinus Surgery

Sinusitis can have a significant impact on quality of life and is an extremely common

health problem in the United States. An estimated 37 million Americans suffer sinusitis

attacks lasting for at least 12 weeks or recurring frequently. Although most individuals whosuffer from sinusitis can be treated with medications, about 10% of sufferers require

surgery to obtain relief. Sinus surgery has a long-standing reputation of being especially

brutal for patients, requiring external incisions and nasal packing, and leaving patients withpain and bruising for weeks following the procedure. Use of the endoscope has made sinus

surgery much less traumatic, eliminating the need for external incisions. Use of the

microdebrider can allow for even more delicate tissue removal, reducing the need for

separate grasping and cutting instruments.5

Steven Pletcher, MD, Assistant Professor in the Department of Otolaryngology-Head and

Neck Surgery, Division of Rhinology, at the University of California, said that the

advantage of the microdebrider is that cutting and suctioning can be accomplished

simultaneously with one hand. This can be helpful when performing sinus surgery, when,as Dr. Pletcher said, You're operating in a deep cavity and you have room for only one

single-handed instrument.

Microdebrider Eustachian Tuboplasty

Dr. Pletcher coauthored a study presented at the American Academy of Otolaryngology-Head and Neck Surgery meeting titled Microdebrider Eustachian Tuboplasty: A

Preliminary Report. In this study, the microdebrider was used to treat patients with

eustachian tube dysfunction. The patients involved in the study all had concurrent sinonasaldisease and underwent endoscopic sinus surgery at the time of microdebrider eustachian

tuboplasty. The authors concluded that the procedure is safe and may provide relief from

symptoms of eustachian tube dysfunction. The researchers reported no surgical
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complications, and subjective symptoms of ear blockage improved in 70% of patients

included in the study.

click for large version

Figure. The microdebrider from Gyrus ENT features a 360-degree revolving nosecone andan ergonomically engineered handpiece to facilitate precise surgery.

Dr. Pletcher concluded, We did get good results, but the patients also had sinus surgery at

the same time. We didn't have the ability to determine if it was the sinus surgery or theprocedure that involved the eustachian tube specifically that made the symptoms resolve.

He and his coauthors determined that further studies will be needed to make this

determination.

As with others researching use of the microdebrider, Dr. Pletcher also cautions that becauseof the rapid removal of tissue, surgeons must be very careful about the tissue they are

targeting for removal. He states that the microdebrider can remove a great deal of tissue

very quickly, so the operator must be very cognizant of the location of the blade at all times

and maintain a healthy respect for the risks.

Cost

Because the microdebrider has disposable parts, it can be more expensive than other

surgical tools. However, Dr. Pletcher said that he feels he can operate more quickly usingthe microdebrider. He opined that whatever may be lost in the cost of the device itself is

made up and possibly saved in time.

Dr. Pletcher has encountered no difficulties with insurance coverage of the microdebrider

as an instrument in association with other procedure costs. He concluded, The cost issue isprobably negligible.

The Future of the Technology
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William Lunn, MD

According to Dr. Lunn, manufacturers plan to combine cautery with the debrider. Suppliersare working on developing debrider blades with cautery function, and at least one is

already in production. He stated that the development of such a combination tool would be

even more time-efficient, eliminating the need to switch tools when cauterization isrequired. He speculated, That would be really neat for the debriders. The device would

have three functions: cut, suction, and cauterize.

Dr. Lunn also reported that at least one company has recently started marketing longer

blades, which make it possible to reach deeper lesions. He said that with these longerblades it is now possible to go all the way down the length of the mainstem bronchus into

the segmental bronchi.

Studies have shown the microdebrider to be an effective surgical tool for many widely

diverse types of procedures. Researchers have deemed it a convenient and efficient tool,with many advantages and only one identified risk, albeit a potentially significant risk.

Dr. Pletcher summed up his opinion based on his experience: I think the most important

point with the microdebrider in terms of sinus surgery is that it's one of the most effectivetools, but potentially one of the most dangerous tools. The debrider needs to be used with

the appropriate respect for complications that can result from its use.

References

1. Lunn W, Ernst A. The microdebrider allows for rapid removal of obstructingairway lesions. CTSNet. Available at

www.ctsnet.org/sections/thoracic/newtechnology/article-6.html . Accessed 12/5/06.

[Context Link]2. Lunn W, Garland R, Ashiku S, et al. Microdebrider bronchoscopy: a new tool for

the interventional bronchoscopist.Ann Thorac Surg2005;80:1485-88.

[Context Link]3. Simoni P, Peters GE, Magnuson JS. Use of the endoscopic midrodebrider in the

management of airway obstruction from laryngotracheal carcinoma.Ann Otol

Rhinol Laryngol2003 Jan;112(1):11-13.[Context Link]

4. Medtronic news release 2/5/05. Available at

www.medtronic.com/Newsroom/NewsReleaseDetails.do?
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itemId=1139418429133=en_US . Accessed 12/5/06.[Context Link]

5. Saltus R. Breathing easier breakthrough surgery takes the agony out of repairingblocked sinuses. The Boston Globe. 12/5/2000. Available atwww.boston.com .

Accessed 1/1/07.

[Context Link]
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