Richard PDF

DRUG/DEVICE CAPSULES
WILLIAM J. RICHTSMEIER, MD, PhD

Drug/Device Capsule Editor
ASSOCIATEEDITOR'SNOTE:Readers should be aware that since the acceptance of this manuscript into
our system, other companies have made available microdebriders. These companies include
Linvotec and Xomed-Treace. These microdebriders present a variety of features, which may
include bendable router blades, a variety of different levels of "aggressiveness" of router blades,
automatic irrigation systems, suction adjustment valves, and a variety of motor sizes providing
power for the units. Surgeons wishing to optimize their individual needs for their patient populations should be aware of differences and the assortment of microdebriders available.
Power microdebrider for functional endoscopic

sinus surgery
RICHARD L. GOODE, MD, Stanford and Palo Alto, California
Functional endoscopic sinus surgery (FESS) has

been a major advance in the treatment of chronic
sinusitis. This article describes a new instrument for
sinus surgery, the power microdebrider, manufactured by Stryker Corp. (San Jose, Calif.). The instrument was originally designed for small-joint arthroplastic surgery and later used in temporomandibular joint surgery. We have found it very useful
for the rapid and safe removal of abnormal nasal and
sinus mucosa, as well as the thin bone of the ethmoid
sinuses during FESS. It is approved by the Food and
Drug Administration for this purpose. The power
microdebrider system consists of a sterile handpiece
that holds an 8-cm-long, disposable, hollow cutting
blade that lies within a protective sheath (called the
cutter). A small opening in the side of the tip of the
sheath allows the blade to contact tissue while conFrom the Division of Otolaryngology-Head and Neck Surgery,
Stanford University School of Medicine; and the Veterans
Affairs Medical Center, Palo Also.
Presented at the Annual Meeting of the American Academy of
Otolaryngology-Head and Neck Surgery, San Diego, Calif.,
Sept. 18-21, 1994.
The author has no financial arrangement with Stryker Corp.
Stryker Corp. provided loan of a microdebrider for evaluation.
Received for publication Sept. 21, 1994; revision received Aug. 9,
1995; accepted Aug. 9, 1995.
Reprint requests: Richard L. Goode, MD, 300 Pasteur Dr. R135,
Stanford, CA 94305.
OTOLARYNGOLHEAD NECKSURG 1996;114:676-7.
23/75/68398
676
tinuous suction attached to the handpiece removes

mucosa and bone particles after resection. The cutter currently is available in two diameters, 2.5 mm
and 3.5 mm; the larger cutter is preferred. A 3.0mm-diameter cutting burr is also available that lies
within a sheath and contacts bone through a small
opening in the side of the sheath. It is useful for
drilling through thicker bone, such as when enlarging the sphenoid ostia. The handpiece containing
the motor is connected bY a cable to a power console,
which allows the surgeon to select either rotation or
oscillation of the cutter, as well as to control the
speed. The oscillation mode appears to be the most
useful for sinus surgery; the speed is set at the
highest level. The unit is turned on and off with a
foot switch. The handpiece and cutter are shown in
Fig. 1.
Before use, the handpiece is connected to wall
suction with a high negative pressure. Large suction
tubing with a three-way stopcock incorporated in the
suction line and a 60-cma syringe filled with saline
solution is available from Stryker Corp. This allows
the tubing and handpiece to be cleared of any
obstructing debris as necessary by turning the stopcock to the proper position and irrigating through
the handpiece and cutter with the syringe. Between
applications of the cutter, the suction passage is kept
open by regular suctioning of saline solution through
the system. Obstruction with bone and mucous
membrane particles does occur and occasionally
Otolaryngology Head and Neck Surgery

Volume t14 Number 4
GOODE
677
Fig. 1. A, Handpiece with cutter. B, Individual components of the cutter. C, The hollow, oscillating
inner b l a d e is serrated at the tip and enclosed in the 3.5-mm outer diameter outer sheath with an
opening at the side near the tip.
requires removal and cleaning of the cutter in addition to the use of the syringe. The syringe on the
suction tuning can be used to irrigate in the nasal
cavity and clean the lens of the telescope in vivo, if
desired.
In our usual FESS procedure, the middle turbinate is fractured toward the midline to expose the
middle meatus. The uncinate process is removed
with conventional instruments, and the 3.5-mm cutter is inserted. The opening in the outer sheath is
placed against the tissue to be initially removed,
usually polyps and abnormal thick mucosa. The
tissue is sucked into the cutter, where it is cut off and
carried out to the suction container. The bulla and
anterior and middle ethmoid cells are then entered
and cleaned out with the instrument. The natural
ostia is then enlarged with a backbiting forceps. This
process continues until the desired amount of diseased mucosa, polyps, and ethmoid air cells is completely removed. I prefer to "paint" with the instrument against the tissue to be removed, moving from
back to front, allowing for the gradual removal of
mucosa and bone. The cutter can be inserted into
the maxillary sinus through an inferior meatus or
anterior antrostomy for removal of diseased sinus
mucosa, mucoceles, or polyps. A prototype angled
3.5-mm cutter has been tested; the angulation makes
it easier for the instrument to reach into the hiatus
semilunaris and frontal recess areas. Attachment of
the handpiece to the high suction produced by a
liposuction vacuum pump also appears to reduce
clogging and improve performance. Visualization is

excellent because the suction removes blood and
tissue while cutting without tearing. Because the
tissue is sucked into the opening of the sheath before
being excised and because the device cuts on the side
of the blunt-tipped sheath, the precision of the
surgery is improved. The thin bones of the ethmoid
sinuses are able to be removed with the instrument;
debulking of the middle and inferior turbinates can
also be performed. The device is particularly good
for removing nasal polyps.
The cutter is not suitable to regularly remove
heavier bone, such as the uncinate process, agger
nasi cells, or anterior wall of the sphenoid. A more
powerful motor might make this possible in the
future. As previously mentioned, a guarded burr is
available that does provide this capability; however,
any mucous membrane on the bone should be removed before drilling, and conventional biting instruments are faster. Improvements in the burr may
make this component more effective for sinus surgery. A prototype angled cutter was found to be
advantageous for working in the middle meatus and
frontal recess and is under development. Larger
cutters (4.0 mm) might also have advantages.
On the basis of experience with the device in more
than 20 FESS cases to date, I believe that the
advantages of the microdebrider in FESS are real
and will continue to be demonstrated with further
experience so that it becomes a standard part of
FESS instrumentation.

Richard PDF

Uploaded by

Copyright:

Available Formats

Richard PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Richard PDF

Uploaded by

Copyright:

Available Formats

DRUG/DEVICE CAPSULES

WILLIAM J. RICHTSMEIER, MD, PhD

Power microdebrider for functional endoscopic

Functional endoscopic sinus surgery (FESS) has

tinuous suction attached to the handpiece removes

Otolaryngology Head and Neck Surgery

clogging and improve performance. Visualization is

You might also like