PEARLS AND PITFALLS OF ENDOSCOPIC SINUS SURGERY

―HOW TO USE MICRODEBRIDDER SAFELY AND EFFECTIVELY―

Abstract

　Endoscopic sinus surgery (ESS) has become widespread as a standard surgical method for chronic rhinosinisitis (CRS). By the development of various surgical devices such as microdebridder and navigation system, ESS became safer and more adequate compared with conventional sinus operations such as Caldwell-Luc procedure. Especially, microdebridder enables rapid resection and smooth mucosal healing.

　Radical and thorough as well as appropriate removal of the sinus pathology leads the patient recovery from the diseases. On the other hand, inappropriate and rough manipulation during the surgery may cause major complications such as orbital injury and CSF leakage. Above all, prevalence of orbital injury with the use of microdebridder, which resulted in permanent orbital dysfunction, has been increasing.
　Key points for safer and effective usage of microdebrider are as follows,

1. Understand anatomy, especially anatomical relations of basal lamellas and ethmoidal air
　 cells.

2. Examine pre-op CT.
3. Keep a clear and proper field of endoscopic view.
4. Always, watch blade endoscopically.

5. Crush ethmoidal cells with conventional forceps, then debride them with microdebridder.
6. Use debridder not only as blade but also as suction tube.
7. Never press orbital wall and skull base directly with blade.
8. Know about the complications which actually occurred, and then learn how to prevent it.
9. Try to do “mucosal preservation” with microdebridder.

　Microdebridder is very useful tools for smooth mucosal healing. OR time becomes shorter, and the stress for the patients are less. However, this "powered instrument" always have some risk of orbital and cranial complications, which tend to progress rapid. surgeon should first understand such features of this device, then carefully and effectively use it for the better outcomes.