Neither “hot” nor “cold” –Establishing the role of the micro-debrider in central airway tumours
S. Krishnan*a (Dr), A. Satpatia (Dr), B. Biswasa (Dr), S. Bhattacharyyaa (Dr), A. Bhattacharyyaa (Dr), R. Dhara (Dr)
a Calcutta Medical Research Institute & Hospital, Kolkata, INDIA
The microdebrider, first introduced over 15 years ago, has been sparsely used by interventional pulmonologists in debulking central airway tumors. Its utilization has been mainly by Otolaryngologists in resecting glottic and subglottic lesions. We did this study to establish the safety and efficacy of the microdebrider in debulking central airway tumors more effectively compared to existing modalities.
6 consecutive patients with central airway tumours, from March 2021 to April 2022, underwent resection using the microdebrider under general anaesthesia. A 12 mm Rigid Bronchoscope was used for bronchial tumours while a 14 mm Rigid Tracheoscope was used for the tracheal tumours. The 45cm long Bronchial blade microdebrider was used for debulking. Our protocol involved taking a conventional biopsy pre-debridement.
Of the 6 patients, 3 had left main bronchial tumours, 2 had right main bronchial tumours, and 1 tracheal tumour. Of these, 2 bronchial tumours were diagnosed as squamous cell cancer, 2 neuroendocrine tumours, 1 small cell cancer and 1 tracheal amyloidosis. Obstructing lesions were rapidly removed in all patients with the microdebrider and the interventions lasted between 4 and 15 minutes. 3 of the bronchial tumours were very vascular but the bleed was controlled in a short time with fogarty balloon tamponade. There were no other procedure-related complications. As 3 patients with bronchial tumours had malacic airways post debulking, covered metallic bronchial stents were placed. There was no mortality and no patients required a repeat procedure for airway obstruction in the 6 month follow up period.
The advantage of the microdebrider includes rapid, precise tumour debulking (especially broad based tumours) with simultaneous suctioning of the bleed thereby maintaining vision. It avoids airway fires, as might happen with hot techniques. We need to be cautious of airway wall damage in this procedure.
Disclosure of funding source(s): none