The microdebrider, a step forward or an expensive gadget?

Background: Although the use of the microdebrider (shaver) is well known in endoscopic sinus surgery (FESS), there is lack of evidence from comparative studies focussing on the difference in operating time, intra-operative blood loss and user-friendliness between the microdebrider and traditional operating techniques. In this study we compared the use of the microdebrider to conventional instruments in FESS in these areas. Methods: A prospective randomised double blind controlled trial in 60 patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) undergoing bilateral FESS. Each subject received FESS using only traditional instruments (Blakseley forceps) on one side and the other side with the additional use of the microdebrider, this way serving as their own control. The primary outcome was operation time, intra-operative blood loss and user friendliness and secondly safety and postoperative healing with a follow-up period at different time points up to three months postoperative. Results: We found a 37% longer operating time when operating without a microdebrider. This difference was highly significant. The microdebrider scored significantly higher on every different parameter of user friendliness, except on the preparation of the instrument needed before surgery. For estimated blood loss during surgery we found no differences. Also there was no significant difference in postoperative healing at any point of time. Conclusions: This study demonstrates that operating patient with CRSwNP with the microdebrider is efficient and that the microdebrider at the same time is safe and easy to use