Technical report

The microdebrider technique is a precise and controlled approach to adenoidectomy, using a rotating blade under endoscopic guidance or mirror visualization. It can be performed either transorally or transnasally. A unique feature of the technique is the integrated pedal system, which allows the surgeon to control the speed and direction of the blade during the procedure. Additionally, the built-in suction mechanism removes debris, maintaining a clear surgical field and improving visibility [40].

This technique, which will be described in more detail, demonstrates several advantages over the suction cautery, coblation, electrocautery, and curette techniques. Unlike suction cautery, the microdebrider technique is associated with a lower risk of thermal damage to surrounding tissues, allowing for more precise tissue removal [35,41]. Similarly, the microdebrider's controlled, directly visualized approach reduces the risk of bleeding and damage to surrounding nasopharyngeal structures. This, therefore, ensures more complete resection and fewer complications. Additionally, the microdebrider technique is associated with a decreased risk of airway fire due to its limited use of electrocautery. Finally, the cost of the equipment also made coblation less accessible in some healthcare settings when compared with the microdebrider technique [35,39].

Microdebrider Technique Steps

The patient is laid supine on the operating room table; anesthesia is induced, and a Ring-Adair-Elwyn (RAE) endotracheal tube is placed. A shoulder roll is placed for children. The Crowe-Davis or McIvor mouth prop is placed, and suspension is applied. The oral commissures are coated with a water-based lubricant. A rubber, silicone, or plastic catheter is placed into the nasal cavity, passed down to the pharynx, brought out through the mouth, and clamped over a rolled 4x4 gauze sponge to suspend the palate and improve visualization of the nasopharynx. The microdebrider adenoidectomy blade (RADenoid small blade, 11x4 cm, 40 ° blade tip, ref 1884008; Medtronic Xomed, Inc., Jacksonville, FL) is fit onto the handpiece and tested. Rotations are set to 2,000-2,500 per minute. A dental mirror is used to visualize the adenoid tissue in the nasopharynx (Figure 1). The microdebrider is used to remove the tissue, taking care to avoid abrading the peri-Eustachian tube tissue, the torus tubarius. Placing the cutting edge of the microdebrider into the choana and cutting toward Passavant's ridge allows for complete excision of tissue filling the choanae (Figure 2). The most proximal part of the adenoid, closest to Passavant's ridge, is left intact. The cut edge is beveled so that the entire cut surface can be seen with the dental mirror.

Figure 1: View of the adenoid via mirror placed transorally.Large arrow: adenoid; small arrow: posterior vomer

Figure 2: Starting the dissection with the microdebrider.The adenoid blade is placed anterior to the adenoid, near the choana, cutting away from the nose.Large arrow: adenoid; small arrow: microdebrider

The nasopharynx is then packed with gauze tonsil balls lightly covered with oxymetazoline nasal spray. These are left in place for at least a minute and then removed. The area is irrigated with saline water and suctioned clear. Suction cautery set at between 30 and 40 W is used for hemostasis (Figure 3). The catheter and mouth prop are removed, and the patient is returned to the anesthesia team for awakening. The complete surgical technique is demonstrated in Video 1.

Figure 3: Completing the microdebrider adenoidectomy.Bleeding was controlled with the suction cautery.Large arrow: suction cautery; small arrow: tonsil fossa; small dashed arrow: cauterized adenoid beds; large dashed arrow: dental mirror

Video 1: Microdebrider adenoidectomy technique.This video shows the complete transoral microdebrider adenoidectomy procedure.

Video 1: Microdebrider adenoidectomy technique.This video shows the complete transoral microdebrider adenoidectomy procedure.