What are the advantages of the microdebrider in FESS?

Endoscopes have markedly improved visualization for sinus surgery, but expanding concepts of FESS have outpaced available operative instrumentation.  The surgical techniques are continually improving, but the basic concepts of the newer instruments have changed very little.  With currently available FESS instruments, surgeons often find that they cannot do the precise and delicate surgery demanded by the functional approach.  Consequently, the goals of meticulous cutting, a near bloodless field, unimpaired vision, and continuous removal of resected tissue remains elusive.  The instruments used so far are “grabbing” tools that grab and tear normal tissues along with the diseased tissues.  This grab and tear approach predisposes to increased bleeding, which is the archenemy of the FES surgeon, because it leads to decreased visibility, the cornerstone of complications.  The lack of continuous suction at the operative site is a technical limitation that compounds the stress for the surgeon and increases the inherent risk for the patient.

The microdebrider facilitates preservation of mucosa and vital structures by resecting only diseased, obstructive tissue with very limited blood loss.  Simultaneous continuous suction at the operative site is a marked benefit of this instrument, which helps overcome the well recognized problem of blood pooling that increases the potential for operative morbidity.  Since the normal tissues are not disturbed the healing time is cut by half.  There is no scar tissue formation and the function of the sinuses and the nasal cavities are restored to normal in a short time after surgery.

Nasal polypectomies are performed in a more precise manner with very little blood loss.  Because the blood loss is minimal and the operative field clear removal of the disease is complete.  Hence the recurrence rate is low when compared to conventional polypectomies.

The microdebrider has shown itself to be a safe and effective instrument for routine and complicated FESS.  It is increasingly replacing conventional instruments in FES surgery the world over.