Endoscopic Adenoidectomy with Microdebrider

Abstract

To describe endoscopic power assisted adenoidectomy and review the experience with the procedure demonstrating its safety and efficacy. Prospective study of 44 patients aged between 7 to 15 years undergoing power assisted adenoidectomy between Jan 2004 and July 2006. Tertiary care private teaching hospital. Forty four consecutive children with adenoid hypertrophy undergoing power assisted adenoidectomy. Therapeutic endoscopic adenoidectomy using microdebrider. Operative time, blood loss, complications, completeness and depth of removal, surgeon's satisfaction and recovery period. The average operative time was 12 min (range: 8-16 min) and average blood loss was 30 ml (range: 24-42 ml). Complete resection was possible under vision with few complications. The surgeon satisfaction was high and post-operative recovery good. Power assisted adenoidectomy is quick, precise and safe. There is good visualization during resection thus improving precision and ensuring complete removal of adenoid tissue.

Changing Trends in Adenoidectomy

“…In group A, the mean recovery period was 3.5 and 2.93 days in group B (p \ 0.05) [7]. Similarly, a study by Somani et al [12], showed less morbidity after endoscopic power assisted adenoidectomy. After the above discussions with reference to national and international studies, it is our impression that the adenoid tissue removed during endoscopic assisted microdebrider adenoidectomy is more acceptable as its use allows a more complete removal of the adenoid tissue and in a more precise manner compared with conventional methods.…”

“…With reference to national and international studies, the mean age of presentation in both the groups of our study coincides well with other studies. Adenoid hypertrophy can present with varied symptoms ranging from nasal obstruction, nasal discharge, post nasal discharge, snoring, ear ache, decrease hearing, sleep apnoea to delayed defective speech [11,12]. Hypertrophied adenoid tissue causing habitual mouth breathing may result in dentoskeletal malocclusions.…”

“…All these studies strongly mention that presence of significant residual adenoid tissue especially along torus tubaris and intranasal protrusions lead to persistence of the initial symptoms and may necessitate a revision adenoidectomy in future. Saxby et al study by Somani et al [12] reported an excellent completeness of removal of adenoid tissue following endoscopic power assisted adenoidectomy. Also Stansilaw et al [23] reported a more complete removal of adenoids with microdebrider.…”

“…A similar prospective study of 140 cases by Rodigruez et al [20] has evaluated various parameters like intra-operative time and amount of bleeding showing significant reduction in the surgical time in group B as compared to group A. A prospective study by Somani et al [12] (of 44 children) and a retrospective study by Costatini et al [21] (of 201 children) reported an operating time (with microdebrider assisted adenoidectomy) as 12.5 min each and the average blood loss of 30 and 28 ml respectively. These two parameters match significantly with our group B cases in which the intra-operative time and bleeding was 12.10 min and 35 ml respectively.…”

“…In a series by Feng et al [22] and Stanislaw et al [23] however there was a significant reduction in blood loss following endoscopic assisted microdebrider adenoidectomy as compared to conventional adenoidectomy. Post-operative nasal endoscopy has significant role in assessing the completeness of removal of hypertrophied adenoid tissue especially in areas of eustachian tube orifices and intranasal protrusions and assessing the intraoperative trauma caused by the operative technique [12]. The completeness of adenoid removal in both the groups of our study was assessed by nasal endoscopy at the end of procedure, revealing 100 % complete removal in group B as compared to only 75 % complete removal in group A, indicating a significant number of cases in group A showing residual adenoid tissue (p value 0.017) (Figs.…”