Microdebriders in ENT: Putting Safety and Efficiency First

01/19/2022

With healthcare professionals under increased pressure to save time and improve safety in the ENT operating room (OR), there has never been a better time to implement new medical technologies. So, what problems do ENT healthcare staff face in the OR? And how can a microdebrider with unique functionalities, such as Olympus DIEGO ELITE, help surgeons to improve patient safety and OR efficiency?

Ear, Nose, Throat
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ENT surgical procedures have advanced significantly in the last decade thanks to innovative medical technologies and the introduction of microdebriders (also called debriders or shavers), one of the most successful innovations in ENT healthcare. Their use is now commonplace in procedures such as functional endoscopic sinus surgery (FESS), turbinate reduction, and advanced sinus and skull base surgery 1 . Despite the widespread use of microdebriders in ENT, advances in design are few and far between.

Combining patient safety and increased efficiency in the ENT OR

The challenge to improve OR safety and efficiency within ENT is constantly evolving. Healthcare staff are looking for new and innovative ways to decrease operating costs, enhance surgical times, improve patient safety and reduce stress for OR staff. Though ENT procedures have advanced steadily over time, making improvements to key areas can improve value and quality in the OR — and, of course, impact patient experience and satisfaction.

Several surgeons reported that one of the most common challenges during ENT endoscopic nasal procedures is the management of intraoperative bleeding, which can place unnecessary pressure on surgeons and nursing staff, increases OR time and cause the surgeon to be less focused on the surgical area

A study by Dr. Sindwani and Dr. Kumar 2 demonstrates that intraoperative bleeding can interrupt procedure flow and increase complications. This is due to reduced visibility and the need to defocus from the surgical area when switching instruments to a cauterization device. With the DIEGO ELITE RF blades, the combination of suction, cutting and coagulation in the same device allows surgeons to remain constantly focused on the surgical area.

Dr. Sindwani and his team stated that, when using the Olympus DIEGO ELITE, ENT procedure times are reduced by 12 percent 2 thanks to innovative monopolar and bipolar RF blades that enable surgeons to dissect and induce hemostasis more accurately.

Additionally, Dr. Mirza 3 from Sheffield Teaching Hospital states that “The DIEGO ELITE bipolar microdebrider system is invaluable in endoscopic sinus surgery. It enables intraoperative hemostasis thereby reducing bleeding, which improves visualization. This makes surgery safer and allows more complete surgery in, for example, a sphenoethmoidectomy. Postoperative bleeding is also reduced, making patients more comfortable and more likely to be discharged the same day.”

Another problem reported by several rhinologists relates to the clogging of the microdebrider blade. The concern is that clogging may block the surgical action/flow and prevent the surgeon from properly focusing on the surgical area. Due to the proximity of important vessels, nerves and other delicate structures, any clog that has the potential to block the surgeon’s line of sight can lead to safety implications.

Typically, OR staff are required to manually unclog debrider systems by removing the blades and using a time-consuming combination of irrigation techniques and brushes to clean them.

Dr. Sindwani et al 4 noted that the pneumatic bulb declogging feature of the DIEGO ELITE helps decrease declogging time by up to 60 percent compared to traditional systems, reducing the total operative time and improving the operating team’s experience.

In addition, a study by Dr. Filippo Montevecchi reported that the combined use of the DIEGO ELITE’s bipolar blade and declog System in FESS minimizes disruption to surgical flow and reduces operative times to less than one hour, thanks to increased visibility and a low clog rate, even in patients with bilateral sinusitis with polyps5.

Transitioning from OR to Office

In order to save time and shorten waiting lists, several hospitals are looking to move some surgeries, like polypectomies and submucosal turbinate reduction, from the OR to the office. To properly drive this move, the management of intra- and post-operative bleeding is critical to ensure the safety and comfort of both adult and pediatric patients. This can be achieved using the Diego Elite RF blades, while the submucosal bipolar microdebrider blade for turbinoplasty (SMR) offers a safe and effective treatment for turbinate hypertrophy. In fact, Dr. Mirza 3 from Sheffield Teaching Hospital states that “the 2mm DIEGO ELITE microdebrider is a valuable tool for performing effective submucosal turbinate reductions with minimal bleeding, rapid healing, and can be performed under local anesthetic.”

Safety for All: Minimizing the Risk of Cross Contamination

Another important point to consider while using a microdebrider is the potential risk of cross contamination due to the inaccessible tube-like design of standard handpieces.

RF blades’ tip. RF Action

The open ring design of the DIEGO ELITE handpiece helps to minimize the risk of cross infection risk.

At the same time, the simplified setup and dismantling system for the blade and suction tube reduces the risk of biomaterials contaminating the surgical field during a procedure.

Summary

Microdebriders are commonplace in the ENT environment but advances in design are few and far between. Traditional microdebriders are notoriously time-consuming, with lots of room for human error due to the need for manual speed setup and inefficient declogging protocols. By combining innovative features such as monopolar and bipolar radio frequency blades, automatic blade recognition and an advanced declogging feature, the DIEGO ELITE is an efficient and safe solution that helps to improve OR efficiency. As a result, patient safety is improved, enabling the transition from OR to office, for greater cost-savings and efficiencies.

References

  1. 1.Microdebriders Offer New Surgical Options Polley, S. J. (2007) ENTtoday
  2. 2.Bipolar Microdebrider May Reduce Intraoperative Blood Loss and Operating Time during Nasal Polyp Surgery. Kumar, N., Sindwani, R. (2012) Ear, Nose & Throat Journal
  3. 3.Bipolar Microdebrider Turbinoplasty. ENT & Audiology News SEPTEMBER/OCTOBER 2019, VOL. 28, NO. 4
  4. 4.Declog Bulb Feature on Time Spent Declogging Microdebrider Blades: A Comparative In Vitro Assessment. Tang, D. M., Roxbury, C. R., Sindwani, R. Section of Rhinology, Sinus & Skull Base Surgery, Head & Neck Institute, Cleveland Clinic, Cleveland, OH.
  5. 5.The Use of Bipolar-Energy Shaver Blades in FESS for Patients with CRS — Case Series Report by Dr. Filippo Montevecchi Dr. Filippo Montevecchi MD ENT Department AUSL della Romagna — Forlì Hospital Morgagni-Pierantoni