The Use of the Microdebrider in Sinus Surgery

The microdebrider was originally patented in 1969 for the use of removing tumors around the acoustic nerve. Since that time, the use of the microdebrider was adopted as a surgical instrument for use in orthopedics and then for nasal and endoscopic sinus surgeries in the 1990s. This instrument is perhaps one of the most important innovations that have been brought into the field of rhinology.

Straightshot® M4 Microdebrider handpiece
Courtesy Medtronic, Inc.

The microdebrider is a cylindrical instrument that has a hollow tube with an inner and outer portion. At the end of the tube, both inner and outer portions of the tube have a blade that cuts tissue as the blades move back and forth. The catheter has continuous suction applied to the device so that cut tissue is captured and removed from the surgical area. The faster the blades move, the smaller the pieces, while the slower the blades are set, the larger the pieces. The quality of the cuts are good enough to be used by pathology if cancer or other disease-specific analysis needs to be performed.

Alternative Methods

Before the use of microdebriders, sinus surgery usually included the traditional use of curettes and forceps. This was a manual method for extracting bone and tissue from the nasal and sinus cavities. Power drills are also an alternate power tool that can be used in the surgical setting. We will explore the advantages that using a microdebrider has brought to the surgical world. However, in practice, surgeons will often use a combination of curettes, microdebriders, and forceps.

Advantages

Microdebriders have many advantages. The first includes the variety of tips that can be used. Depending on the type of procedure being performed, some available products can come with pre-bent tips, which allows for easier access to difficult surgical locations (like in paranasal sinuses). Some tips also allow for 360-degree rotation (like the Straightshot M4 in the picture above), which allows for more accurate approaches to the tissue needing to be removed.

Blades also can be adjusted with the microdebrider. Straight-edged blades are more precise and can be less traumatic than other blades. While serrated blades provide a better grip for the surgeon. These blades can have the speed changed to allow for tighter precision of cutting as well as to cut bone. Common procedures that may use this for bone purposes include:

While the use of a microdebrider will not reduce the risk of bleeding, continuous suction allows your surgeon's vision of the surgical site to remain clear for much longer periods of time. This can reduce the overall surgical time required to perform your surgery by reducing the number of time the surgeon needs to swap instruments. Some microdebrider manufacturers have added the ability to cauterize in the same instrument which further allows for less blood loss and less changing of instruments.

Disadvantages

One minor disadvantage associated with the use of the microdebrider in the surgical setting is the cost associated with both the unit and the replacement blades in comparison to more traditional tools. However, in actual practice, this is of little concern to you as a patient.

Complications associated with using a microdebrider are quite rare; however, it is important that you understand any of the risks that may be associated with your surgery. Due to the use of relatively high-powered suction, there are some reports of damage that has occurred. There have been two cases reported of eye injury speculated to be related to the power of the suction on the microdebrider as well as a single case of subarachnoid hemorrhage (bleeding in the space around the brain).

These types of reports are very rare and microdebriders are used throughout the world on a daily basis. In general, microdebriders are safe tools used for sinus surgery.

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  • Bruggers S, Sindwani R. Otolaryngologic Clinics of North America. 2009. 42(5), 781-787.