Comprehensive study of microdebrider in endoscopic sinus surgery.

Mohana Karthikeyan, S (2010) Comprehensive study of microdebrider in endoscopic sinus surgery. Masters thesis, Madras Medical College, Chennai.


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Endoscopes have markedly improved visualization for sinus surgery, but expanding concepts of FESS have outplaced 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 do little short of 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 tend to strip the mucosa from the underlying bone. This approach predisposes to increased bleeding, which is the archenemy of the 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. Attention was therefore directed towards laser. However enthusiasm for the laser in endoscopic sinus surgery has waned due to increased post op scaring and necrosis. 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 to overcome the well recognized problem of blood pooling that increases the potential for operative morbidity. An understanding of technical aspects of powered instrumentation has led to optimise the choice of practicing surgeon in endoscopic sinus surgery. New understanding of the importance of mucosal preservation combined with new technology in imaging and instrumentation make our ability to deal with sinusdiseases in a safer and more effective way. The use of powered soft tissue shavers or microdebriders in endoscopic sinus surgery offers significant advantages over the use of conventional instrumentation. Increased safety, improved results, decreased bleeding are significant advantages by the use of this instrumentation. In this study of 60 patients, it was found that using microdebrider has reduced the blood loss in surgery. It has also improved the surgical field visibility. The duration of surgery was also reduced. The post-operative mucosal healing was good in this study group. In this study, microdebrider had precise, quick and nearly bloodless polypectomy without the need for pre-operative steroids. Unlike conventional, non-powered suction instruments, sinonasal soft tissue shavers have the advantage of evacuating tissue from the surgical site without the need to remove the instrument, providing potentially continuous suction of blood and resected tissue from the field with the opportunity for improved visualization and precision and less frequent interruptions during the procedure. The powered shaver offers significant advantages by virtue of its increased precision and real-time suction which improves visualization and decrease the risk of major complications. The sharp cutting action of the shaver as opposed to the tearing action of conventional instruments decreases operative bleeding and minimizes scarring, adhesions, and healing time by avoiding mucosal stripping. Mucosal preservation is essential to favorable results in FESS.

Item Type: Thesis (Masters)
Uncontrolled Keywords: endoscopic sinus surgery; microdebriders; powered soft tissue shavers
Subjects: MEDICAL > Otorhinolaryngology
Depositing User: Devi S
Date Deposited: 04 Jul 2017 09:50
Last Modified: 04 Jul 2017 09:50

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