Muller Journal of Medical Sciences and Research

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 10  |  Issue : 1  |  Page : 17--20

Functional endoscopic sinus surgery with microdebrider for chronic rhinosinusitis with nasal polyps


Ju-Song Choe, Kwang-Ho Choe, Nam-Il Ji 
 Faculty of Clinical Medicine, Pyongyang Medical College, Kim II Sung University, Pyongyang, Democratic People's Republic of Korea

Correspondence Address:
Dr. Ju-Song Choe
Pyongyang Medical College, Kim II Sung University, Pyongyang
Democratic People's Republic of Korea

Abstract

Objectives: The aim of this study was to compare the effectiveness and safety of functional endoscopic sinus surgery (FESS) with microdebrider for chronic rhinosinusitis with nasal polyps (CRSwNP). Patients and Methods: We evaluated surgical procedures of patients with CRSwNP who underwent FESS between November 2016 and December 2017 with either a microdebrider or forceps. They were randomly assigned to receive either FESS with microdebrider (n = 38) or conventional endoscopic removal (n = 35). Ours is the retrospective study. Results: Seventy-three patients underwent FESS. In the series of microdebrider group, the intraoperative time and blood loss were significantly reduced compared with the one of conventional endoscopic surgeries with forceps or snares. Resection with microdebrider provided more visible surgical field than conventional endoscopic surgery. Conclusion: We found that the effectiveness and safety of FESS with microdebrider for CRSwNP was more advanced than conventional endoscopic surgery.



How to cite this article:
Choe JS, Choe KH, Ji NI. Functional endoscopic sinus surgery with microdebrider for chronic rhinosinusitis with nasal polyps.Muller J Med Sci Res 2019;10:17-20


How to cite this URL:
Choe JS, Choe KH, Ji NI. Functional endoscopic sinus surgery with microdebrider for chronic rhinosinusitis with nasal polyps. Muller J Med Sci Res [serial online] 2019 [cited 2019 Oct 16 ];10:17-20
Available from: http://www.mjmsr.net/text.asp?2019/10/1/17/259254


Full Text



 Introduction



Nasal polyps have been a medically recognized condition since the time of the ancient Egyptians and their removal with a snare was described by Hippocrates, a method which persisted well into the second half of the 20th century.[1]

They are common disease rhinologists often deal with. Although many treatment methods have been introduced for nasal polyps, lots of patients have a severe enough course to be recommended surgical intervention.

In the mid-1990s, the advent of the microdebrider was among the most important surgical instrument inventions in ENT surgery, advancing the treatment of sinonasal disease in a more visible field through its suction-based rotating blade; the innovative device became widely used.[2]

Introduction of powered instrumentation radically changed the performance of endoscopic sinus surgery. This technology finds specific application in addressing chronic rhinosinusitis (CRS) with nasal polyposis in its various forms.[3]

With the introduction of microdebrider, ENT surgeons can significantly reduce the surgical burden on patients with chronic rhinosinusitis with nasal polyps (CRSwNP), intraoperative time, and blood loss.

We investigated the effectiveness and safety of functional endoscopic sinus surgery (FESS) with microdebrider compared with conventional endoscopic surgery for the first time in the DPRK.

 Patients and Methods



Patients

We conducted a retrospective chart review of 73 patients with CRSwNP who underwent either FESS with microdebrider or conventional endoscopic surgery between November 2016 and December 2017.

Thirty-eight (52.1%) of them underwent FESS with microdebrider and 35 (47.9%) patients received endoscopic forceps- or snare-assisted surgery.

In the former, 21 patients (55.3%) were male and the reminders were female (n = 17, 44.7%).

In the latter series, 19 patients (54.3%) were male and 16 (45.7%) were female.

There were no significant demographic differences between groups.

Data collected included sex, patient's age, preoperative diagnosis, intraoperative blood loss, surgical time, and any postoperative complications.

Exclusion criteria included insufficient documentation, age below 18 or above 66-year-old, history of consumptive diseases, hematological disorders, and a final pathology report containing evidence of anything other than benign inflammatory polyps.

Extent of diseases

We classified extent of diseases according to the Harvard CT stage [Table 1].{Table 1}

Surgical procedure

Before surgery, each patient had been treated with a standardized preoperative regimen of prednisone 30 mg/day beginning 5 days before surgery.

We blocked maxillary nerves of patients by injecting 5 ml of 2% lidocaine with 1/100,000 epinephrine at the beginning of every surgery.

For surface anesthesia, we administered 20 ml of 2% lidocaine with 1/100,000 epinephrine to intranasal mucosae, every 5 min, three times.

1% lidocaine with 1/100,000 epinephrine was submucosally injected into the middle turbinates and lateral nasal walls.

Surgeries were performed as described in the Messerklinger technique.

Nasal polyps were resected with forceps or snares in the control group and with microdebriders in microdebrider group.

The intranasal cavity at the end of surgery was gently packed with nasal sponges.

Postoperatively, patients were given a 7-day course of antibiotics and instructed to begin saline nose wash on the postoperative day 1, per routine.

Outcomes measures

The primary index we measured was intraoperative blood loss. As a secondary index, we examined intraoperative times.

In each instance, the surgical time was defined as the recorded “cut time” rather than the “in and out of the room time.”

Other protocols

Statistical analysis was performed with the unpaired Student's t-test.

 Results



There were no complications in either group.

All patients were discharged home after surgery. No patient required any postoperative intervention for bleeding such as cautery, packing, or an emergency department visit.

Amount of blood loss

The microdebrider group experienced significantly less intraoperative blood loss than did the control group [Figure 1].{Figure 1}

The mean amount of blood loss was 110.0 ml (±51.2) in the study group and 180.0 ml (±65.1) in the control group [Table 2], which represents an overall reduction of 38.8% (P = 0.012).{Table 2}

Amount of operating time

The patients in the microdebrider group also benefited from a significant decrease in intraoperative time [Figure 2].{Figure 2}

Their mean time was 30.9 min (±11.6), versus 49.4 min (±13.9) for the control patients (P = 0.021) [Table 2].

The 18.5-min difference represents a reduction of 37.4%.

 Discussion



This pilot study demonstrated a 39% decrease in blood loss as well as a 37% reduction intraoperative time when the microdebrider was used instead of conventional endoscopic surgical instruments that did not have suctioning capabilities.

However, while these results are statistically significant, they may not be clinically significant. The blood loss experienced by patients in both groups was not extensive, and it was obviously not associated with a demonstrable decrease in complications since no complications occurred in either group.

However, it is widely accepted that complication rates from endoscopic sinus surgery (ESS) are greatly impacted by bleeding and the accompanying obstruction of vision.[4],[5]

When considered in this context, any reduction in bleeding would be advantageous because it may serve to improve intraoperative orientation and maintain the continuity and pace of the operation.

The reduction in bleeding noted with the use of the microdebrider likely accounted for the decrease intraoperative time.[6]

Although in the past, other techniques are used to achieve hemostasis during sinus surgery, no other method provides for simultaneous dissection and hemostasis in one device such as microdebrider.

There are several drawbacks to using topical agents or temporary nasal packing to control bleeding intraoperatively.

These methods can take some time to work, and they can significantly disrupt the flow of the procedure. However, microdebrider can eliminate or reduce a procedure to control bleeding by simultaneously dissecting and suctioning during operation.

It is natural for surgeons who use any microdebrider to bear in mind that although major complications of ESS are rare,[7] those that do occur when a microdebrider is employed tend to progress more quickly because of the powered nature of this device.

This study has several significant limitations.

These include the relatively small patient population and the lack of randomization.

Thus, our methodology did not allow us to arrive at firm conclusions, and our findings should be regarded as representing the personal experience of a senior surgeon with emerging technology.

Having said this, we note that it is exciting to consider that in addition to the established advantages of conventional microdebriders, newer generations of microdebriders may also reduce blood loss and shorten intraoperative times during surgery for nasal polyps.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Wright J. History of Laryngology and Rhinology. St. Louis: Lea and Febiger; 1893. p. 57-9.
2Chou TW, Chen PS, Lin HC, Lee KS, Tsai HT, Lee JC, et al. Multiple analyses of factors related to complications in endoscopic sinus surgery. J Chin Med Assoc 2016;79:88-92.
3Boone JL, Feldt BA, McMains KC, Weitzel EK. Improved function of prototype 4.3-mm medtronic quadcut microdebrider blade over standard 4.0-mm medtronic tricut microdebrider blade. Int Forum Allergy Rhinol 2011;1:198-200.
4Ecevit MC, Sutay S, Erdag TK. The microdébrider and its complications in endoscopic surgery for nasal polyposis. J Otolaryngol Head Neck Surg 2008;37:160-4.
5Stankiewicz JA. Complications of endoscopic sinus surgery. Otolaryngol Clin North Am 1989;22:749-58.
6Kumar N, Sindwani R. Bipolar microdebrider may reduce intraoperative blood loss and operating time during nasal polyp surgery. Ear Nose Throat J 2012;91:336-44.
7Dalziel K, Stein K, Round A, Garside R, Royle P. Endoscopic sinus surgery for the excision of nasal polyps: A systematic review of safety and effectiveness. Am J Rhinol 2006;20:506-19.