Emerging role of powered instrumentation in airway surgery

Endoscopic removal of laryngeal and tracheal lesions generally is performed using laser technology or microlaryngeal instrumentation. A new development, the powered laryngeal shaver or microdebrider, has provided an alternative to conventional endoscopic surgery and laser resection of most airway lesions. Since its introduction to head and neck surgery in 1996, the laryngeal microdebrider has been used to resect endoscopically lesions ranging from laryngeal papillomas to obstructing endobronchial neoplasms. Advantages of the laryngeal microdebrider over conventional endoscopic laryngeal surgery include improved access to anterior commissure, subglottic, and tracheal lesions and reduced operative time. Relative to laser surgery, the laryngeal microdebrider is safer because it eliminates the risks of airway fire, thermal injury, and potentially infectious laser plume. This article reviews the development of the microdebrider, indications, surgical technique, and advantages and disadvantages relative to conventional microlaryngeal surgery.