Initial experience with a rotating airway microdebrider

BACKGROUND: Our prior experience with microdebrider bronchoscopy treating central airway obstruction demonstrated that although the blades were extremely effective, they were not long enough to reach beyond the proximal mainstem bronchi in patients. As a result, the microdebrider could not be used in patients with disease beyond the mainstem bronchi. OBJECTIVES: In this report, we describe our experience with advancement of this technology: a microdebrider with a longer, rotating blade. METHODS: We employed a 45 cm in length, angle tip, and serrated rotating microdebrider blade in 20 patients from 2 academic medical centers with central airway obstruction requiring rigid bronchoscopy. We retrospectively reviewed the records of each patient over a mean period of 7.7 months of clinical follow-up to describe our experience with the new system. RESULTS: Dissection times ranged from 2 to 40 minutes (mean 12 min). Mild bleeding occurred in all cases and was controlled with tamponade with the rigid bronchoscope in 13 patients and with tamponade plus cautery in 7 patients. Complete patency of the airway was obtained in all patients. Eight patients required placement of a silicone airway stent at the end of the procedure because of associated airway malacia. There were no perioperative complications. CONCLUSIONS: The longer blade, 45 cm compared with 37 cm, allowed us to easily reach disease in the trachea, mainstem bronchi, and tributaries. Further, the ability to rotate the blade aperture in a 360-degree fashion allowed us to dissect with more precision. Additional experience with this system and microdebrider bronchoscopy in general will allow us to determine its role in routine practice.