After initial encouraging results, we report our further experience with the microdebrider, a new airway tool, in treating both benign and malignant obstruction of the central airways.
From April 2002 to May 2005, 44 patients undergoing treatment of central airway obstruction were managed with the microdebrider. All procedures were done under general anesthesia with either a rigid bronchoscope (40 patients) or a suspension laryngoscope (4 patients). The microdebrider was employed in an oscillating mode with rotation speeds of 1000-3000rpm to resect obstructing tissue. Patients were followed for a range of 1-36 months.
Twenty-four patients had tracheal granulation tissue from prior intubation or tracheostomy, 4 had idiopathic subglottic stenosis, 4 had stent related granulation tissue, 1 had granulation tissue after surgical airway repair, 1 had papillomas, and 10 had malignant disease (8-non small cell, 1-small cell, 1-thyroid carcinoma). Obstructing lesions were rapidly removed in all patients with dissections lasting between 2 and 20 minutes. There were no episodes of significant airway bleeding and no other procedure related complications.
Microdebrider bronchoscopy is a new technique that is useful for both benign and malignant airway obstruction. The tool allows for precise, rapid, and safe removal of obstructing lesions, even those that are friable and considered at risk for bleeding.
The microdebrider provides physicians with an alternative to thermal modalities. Airway fires, tracheo-esophageal fistulas, and other complications of thermal modalities may thus be avoided.
William Lunn, Grant monies (from industry related sources) I have received grants from Karl Storz Endoscopy and Richard Wolf Endoscopy to support CME courses that I am directing at Baylor College of Medicine.