Microdebriders used in functional endoscopic sinus surgery: secondary analysis and validation of a new tissue model

Improved function of prototype 4.3-mm Medtronic Quadcut microdebrider blade over standard 4.0-mm Medtronic Tricut microdebrider blade

OBJECTIVE

Test performance of a new prototype microdebrider blade. The commercially-available, standard 4.0-mm Medtronic straight Tricut blade was tested against the new, prototype 4.3-mm Medtronic straight Quadcut blade in experimental surgical conditions utilizing both a nasal polyp (NP) analog (raw oysters) and an allergic fungal sinusitis (AFS) analog (minced beef cat food).

METHODS

Both sides of 5 thawed, fresh-frozen cadaver heads were utilized for NP analog removal. AFS analog was removed out of specimen containers. A total of 10 paired data points were collected for time of surgical removal and number of clogs comparing the 2 blades.

RESULTS

For simulated AFS debris, the prototype clogged less than the standard blade (0 vs 4.5, p < 0.0001). There were no clogs noted for either blade with the NP analog. Time for debris eradication was significantly improved for both AFS analog (147.4 vs 262.0 seconds, p < 0.0001) and NP analog (43.7 vs 112.1 seconds, p < 0.0001).

CONCLUSION

The prototype blade offers faster debris and polyp removal and clogs less in the setting of allergic fungal debris. As the new blade is faster and more aggressive, introduction into a surgical setting should be guarded with an appropriate degree of caution.

Use of microdebriders in common rhinologic disorders

Powered instruments have been introduced into otorhinolaryngology practice over the last decade. These instruments were accepted immediately by many institutions, and continuing development has led to the current use of microdebriders in a variety of surgical procedures in otorhinolaryngology. In clinical rhinology, they were first used in endoscopic sinus surgery to facilitate working on deep planes, but have subsequently been adopted in various conditions. This article presents an evaluation of the use of microdebriders in common rhinological disorders.

Progress in surgical management of chronic rhinosinusitis and nasal polyposis

Endoscopic sinus surgery (ESS) remains the treatment of choice for medically refractory chronic rhinosinusitis (CRS) with or without nasal polyposis (NP). ESS has undergone review, reassessment, and substantial refinement. Several advances (eg, powered instrumentation, image guidance, adjunctive intraoperative procedures) have expanded the scope of cases amenable to ESS, decreased operative time and intraoperative blood loss, and improved safety. Procoagulant nasal/sinus packing and refinements of technique have decreased the need for postoperative removal of packing, thus decreasing morbidity. Methods to reduce synechia formation (ie, mitomycin-c) have been explored, with mixed results. Novel methods of sinusotomy (eg, balloon catheter dilatation of the sinus ostia) have had limited but interesting short-term results. We can expect further advances in ESS with better patient outcomes. However, continued elucidation of the underlying pathophysiology of CRS and NP are essential to long-term improvement.

Efficacy of Gyrus diego microdissector at varying oscillation speeds

OBJECTIVE

To determine the efficacy of the Gyrus diego microdissector at increasing oscillation speeds, using an in vitro tissue model.

BACKGROUND

It had not previously been established whether microdissectors were more efficient at higher or lower speeds.

METHODS

We investigated the effect of varying microdissector oscillation speeds on the weight of material aspirated in a given time. A 4 mm straight blade was used with constant suction strength. Jelly and liver were used to simulate polyps and muscle plus connective tissue, respectively. Water was used as a control. Repeat readings were taken at speeds of 1000, 2000, 3000, 4000 and 5000 rpm. Data were analysed using linear bivariate regression.

RESULTS

The results showed significant linear trends in the cases of liver and jelly, with faster cutter speeds being associated with higher aspiration rates.

CONCLUSION

These results suggest that microdissector efficacy increases with speed, up to 5000 rpm.