Comparative study of conventional versus microdebrider assisted endoscopic sinus surgery in sinonasal polyposis

Abstract

INTRODUCTIONSinonasal polyp refers to edematous projections of nasal mucosa extending through nasal cavity and paranasal sinuses. Prevalence is 4% in general population. 1 Functional endoscopic sinus surgery, conventional or with powered instruments is standard surgical modality in sinonasal polyposis refractive to medical therapy. Microdebriders are the most commonly used powered instruments in endoscopic sinus surgery and continues to evolve in rhinologic surgery. 2 The aim of study was to evaluate the utility of microdebrider in endoscopic sinus surgery versus conventional instruments and to compare ABSTRACT Background: Functional endoscopic sinus surgery, conventional or with powered instruments is the standard surgical modality in sinonasal polyposis refractive to medical therapy. The recent modality, microdebrider assisted endoscopic sinus surgery offers better therapeutic approach for patients when compared to endoscopic sinus surgery with the conventional instruments. The objective was to evaluate the utility of microdebrider in endoscopic sinus surgery versus conventional instruments and to compare the intraoperative and postoperative results in both the methods. Methods: A prospective, randomized, comparative study was conducted on 30 patients with bilateral sinonasal polyposis. The subjects were selected by applying all the inclusion and exclusion criteria and divided into two groups i.e. the right and left side of nose were operated and compared for efficacy of microdebrider and conventional instruments. Each patient served as his or her own control. This study emphasizes the utility of microdebrider. It compares the intraoperative and postoperative results in the conventional and microdebrider assisted endoscopic sinus surgery. Results: The intraoperative mean blood loss and duration of surgery were significantly higher in the conventional group (p-value <0.001) as compared to microdebrider group. Postoperative symptom and endoscopy scores (discharge, scarring, crusting and polyp recurrence) were significantly higher in the conventional group (p-value <0.001) as compared to the microdebrider group in 6 months follow up. Conclusions: Microdebriders are more effective as compared to conventional endoscopic sinus surgery due to lesser intraoperative bleeding (relatively bloodless) and duration of surgery, better postoperative endoscopic and symptom scores, combine cutting and suction in a single tool, enabling accurate and precise tissue removal without damaging the surrounding mucosa , less scarring/synechiae, fewer complications.

The Outcome of endoscopic sinus surgery using microdebrider versus conventional instruments in chronic rhinosinusitis.

“…But they used the VAS for nasal obstruction and smell affection mainly. (9)(10)(11)(12) We used of SNOT22, it includes 22 items involving nasal, aural, sleep problems, physical and social performance for more accurate evaluation. The follow up schedules varied between the different studies.…”

“…Bellad et al followed their patients at 1, 3, and 6 months (10). Ghera et al's follow-up regimen was 1 week, 3, and 6 months (11). While the follow-up duration adopted by Kaipuzha et al was 6 months postoperative without a definite schedule for the follow-up visits (9).…”

Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

“…3 Numerous advantages of microdebriders over traditional techniques have been cited, including reduced operative time, decreased intra-operative and post-operative bleeding, improved visualisation and precision for tissue removal, decreased traumatisation to tissue with mucosal preservation, decreased crusting and synechiae formation, reduced ostial re-occlusion, and overall faster mucosal healing. 4,5 There are no studies done on different sinonasal diseases and comparison of outcome among individual pathologies.…”

Modeling microdebrider-mediated ophthalmic damage: a word of caution in endoscopic sinus surgery

“…(5) The microdebrider, which utilizes a vacuum rotatory design to precisely target and resect diseased mucosa (6) , has been shown to reduce intraoperative blood loss and surgery duration while promoting faster postoperative healing. (7) Early in-vitro studies advocated for the safety of microdebrider use in FESS, especially around delicate structures located in the paranasal sinuses. (8) However, this concept has been challenged as evidenced by numerous case studies that have shown that, when misplaced, the indiscriminate aspirating function and limited tactile feedback of the microdebrider can lead to major surgical complications.…”