Microdebrider bronchoscopy is quickly becoming a valuable addition to the interventional pulmonology armamentarium.
The microdebrider is an instrument with a rotating blade inside a hollow metal tube that is connected to suction. Coupled with rigid bronchoscopy, it allows for the precise removal of lesions obstructing the central airways in an efficient, blood-free matter that allows for greater visualization in the operative field.1,2
"It's a phenomenal tool," said David Feller-Kopman, MD, director of interventional pulmonology at Johns Hopkins Hospital in Baltimore and coauthor of the first study on microdebrider bronchoscopy. "There haven't been any studies comparing it to other techniques, but I do think it's an outstanding piece of equipment . It's very quick and provides good pathologic tissue for analysis."
Rotary vacuum/shaver technology was developed more than 40 years ago, but it did not start seeing increased usage until the '80s when orthopedic surgeons and otolaryngologists began using it for joint dissection and endoscopic sinus surgery, respectively.
Only four years have passed since the publication of the first study on microdebrider bronchoscopy, and interventional pulmonologists already have begun modifying the technology. Last year they increased the blade length from 37 cm to 45 cm, which not only extended the device's reach down into the trachea, mainstream bronchi, and tributaries, but also improved precision.3
Thus far, the technology primarily has been used for the excision of malignant tumors and treatment of non-malignant diseases like tracheal stenoses, according to Dr. Feller-Kopman. And while he said the device will see more widespread use in the future, he indicated his hope that its use would be controlled.
"All technologies are associated with a certain degree of complication, and the important thing to know is when to use it, and when to not to," he said. "I use it on approximately 25 percent of cases with central airway obstruction. [It is] ideal in tumors that are not too vascular."
- Lunn W, Garland R, Ashiku S, Thurer RL, Feller-Kopman D, Ernst A. Microdebrider bronchoscopy: A new tool for the interventional bronchoscopist. The Annals of Thoracic Surgery. 2005;80:1485-88.
- Kennedy MP, Morice RC, Jimenez CA, Eapen GA. Treatment of bronchial airway obstruction using a rotating tip microdebrider: a case report. Journal of Cariothoracic Surgery. 2007;2:16.
- Lunn W, Bagherzadegan N, Munjampalli SKJ, Feller-Kopman D, Ernst A. Initial Experience With a Rotating Airway Microdebrider. Journal of Bronchology. 2008;15(2):91-4.
Contact Frank Visco at email@example.com.
For more input from experts on the burgeoning field of interventional pulmonology, check out the accompanying webcast and slideshow. Also, read an industry report about the interventional pulmonology field and more articles on this growing field.