Suction modulation for the laryngeal microdebrider.

INTRODUCTION The design of a surgical rotary vacuum shaver as a predecessor to the microdebrider has been attributed to Urban in 1968. His targeted use of this device to assist in the removal of acoustic neuromas did not find general use. Powered shavers were subsequently adopted in the field of orthopedic surgery and reintroduced successfully in the 1990s into otolaryngology for use in endoscopic sinus surgery. Wider application of microdebrider technology has extended its use to range from tonsillectomy and adenoidectomy to the treatment of gynecomastia. The first description of endoscopic resection of laryngeal papilloma with the microdebrider was published by Myer et al. in 1999. These investigators predicted expanded use of microdebriders would follow anticipated improvements to include smaller blades with ‘‘less aggressive features’’ and angled tips. Increased use of this tool was confirmed in 2004 through a survey of members of the American Society of Pediatric Otolaryngology, indicating that the majority of responders to a questionnaire preferred the microdebrider over the CO2 laser. A more recent (2009) prospective comparative analysis following surgical treatment of children with laryngeal papilloma reported better voicing following treatment with the microdebrider than with the CO2 laser. Further support for the preferential use of the microdebrider was identified from data in this study correlating worsening voice quality with increased exposure to the laser. Expanded applications have resulted from modifications to the microdebrider to improve safety and efficacy. Recently reported innovations include 360degree rotation of the cutting blades, continuous tracking of the instrument using surgical navigation, and the capacity to control bleeding with bipolar energy. These sophisticated modifications have focused on the microdebrider apparatus itself without addressing modulation of the suction applied to the microdebrider. The amount of suction applied to the tissue engaged at the tip of the microdebrider is recognized as an important factor associated with surgical complications. Lunn et al. identified that inadvertent resection of normal tracheal tissue can occur when ‘‘vigorous suction is applied to the handpiece.’’ Bhatti et al. attributed the complication of restrictive ophthalmoplegia to the strong suction of the microdebrider pulling orbital contents into contact with the microdebrider blade in the course of performing endoscopic sinus surgery. Attention to the amount of suction applied by the microdebrider has been recognized as important in surgery of the vocal folds as well. Cheng and Soliman in 2010 employed the laryngeal microdebrider to gently resect subepithelial vocal fold lesions. These investigators identified that ‘‘meticulous technique, low variable oscillatory speeds, and low wall suction are necessary to avoid injury.’’ To date, the only published method permitting the surgeon direct control of the intensity of the suction is a modification to the foot pedal that fixes the blade at the microdebrider tip into one of three fixed positions: closed (no suction), open (full suction), and halfway open (partial suction). Suction regulators have been integral to the use of suction for medical use since its inception. However, we are unaware of publications reporting a method to provide the surgeon direct and instantaneous control of the amount of suction applied to the microdebrider as it is functioning. From the Department of Otolaryngology, University of Iowa, Iowa City, Iowa, U.S.A. Editor’s Note: This Manuscript was accepted for publication October 10, 2012. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Henry T. Hoffman, MD, Department of Otolaryngology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail: [email protected]