Microdebriders Offer New Surgical Options

Microdebrider surgery, a technology with its roots in the rotary vacuum shaver introduced by Urban in 1968 for removal of acoustic neuromas, is now being successfully utilized for many different types of procedures. The microdebrider has been used for several years by orthopedists for joint surgeries. Plastic surgeons are employing its use for liposuction. More recent research has shown the microdebrider to be an effective tool for several types of otolaryngologic procedures, including, but not limited to, sinus surgery and tonsillectomy.

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 rotated in 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, it cannot 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 patient as 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.