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Microdebrider Bronchoscopy: A New Tool for the Interventional Pulmonologist

Harvard Medical School, Boston, MA

PURPOSE: Patients with obstruction of the central airways are dyspneic and often require urgent treatment to relieve shortness of breath and avoid respiratory embarrassment. The ideal technique to re-establish airway patency would be quick, effective, and free of complications. We prospectively evaluated the utility of an new airway tool, the microdebrider, in treating central airway obstruction due to malignant and benign lesions.

METHODS: From April 2002 to April 2004, twenty-three patients undergoing treatment of central airway obstruction were managed with the microdebrider. The patients ranged in age from 29 to 79 years (mean 63 years). There were 10 males and 13 females. Three patients had malignant disease (13%) and 20 had benign disease (87%). All procedures were done under general anesthesia with either a rigid bronchoscope (17 patients) or a suspension laryngoscope (4 patients). The microdebrider (Xomed, Jacksonville, FL) was employed in an oscillating mode with rotation speeds of 1000-3000rpm to resect obstructing tissue.

RESULTS: Sixteen subjects were treated as outpatients and 7 as inpatients. Fourteen patients had tracheal granulation tissue from prior intubation (61%), 6 had idiopathic subglottic stenosis (26%), and 3 had malignant disease (13%). Obstructing lesions were rapidly removed in all patients with interventions lasting between 2 and 15 minutes. There were no procedure related complications. One outpatient required hospital admission after surgery. This patient was found to have previously undetected bilateral vocal cord paresis after removal of tracheal granulation tissue and was discharged after placement of a tracheostomy tube. All of the inpatients were discharged home and were free of symptoms of dyspnea at the time of discharge. No patients required re-operation for airway obstruction in follow up ranging 1-24 months.

CONCLUSION: Microdebrider bronchoscopy is a new technique that allows for precise, rapid, and safe removal of lesions obstructing the central airways without the need for thermal modalities.

CLINICAL IMPLICATIONS: Central airway obstruction will be manged without thermal modalities resulting in less morbidity, mortality, and health care costs for these patients.

DISCLOSURE: W.W. Lunn, None.