Microshaver Sinus Surgery

This article was first published at SinusDoctor by Dr.G V K Chaitanya Rao, a member of American Rhinologic Society (ARS) and European Rhinologic Society (ERS), and has 10+ years of experience in the field of ENT.

Importance of keeping the mucosa healthy

Sinus cavity self-cleaning system

An important layer called mucosa lines the entire Sinus cavity. The complex structure of this layer acts as a self-cleaning system, enabling sinuses to remove foreign particles and pathogens from the Sinus cavity. Two main components of this system are responsible for normal Sinus drainage.

Mucosa contains cells that produce mucus that acts as a barrier in which the particles (including allergens) and infective microorganisms remain trapped. Sticky mucus is also beneficial as it moistens and warms the air within the sinus cavities, keeping the mucosal cells lubricated and fully functional. Tiny hairs called cilia, located on the surface of some mucosal cells, are constantly working to eliminate the mucus with entrapped particles from the sinus cavity — keeping the sinuses clean and healthy.

Immune response

Relatively recent scientific evidence implies that there is much more going on within the mucosal layer of the sinus cavities rather than just the production and elimination of mucus. It has been recognized by the scientific expert community that mucosa plays an important role in the local immune response of sinuses.

Local defensive mechanisms of the sinus mucosa include the production of specific proteins called antigen-binding proteins that represent an additional protective component of a complex immune response. Production of cytokines by mucosal layer boosts the inflammatory response, directly facilitating the elimination of infective microorganisms.

Preventing harm to the mucosal layer

Due to all of the above-mentioned protective factors, it is clear that sinus mucosa plays a very important role in keeping the sinus environment healthy. Therefore, the main goal of each surgical approach on sinuses should be to leave the sinus mucosa intact, prevent scar formation or bleeding within the mucosal layer that could damage its’ normal function. Contemporary surgical techniques allow precise and delicate removal of the diseased tissue while preserving the healthy sinus mucosa and safeguarding the mucosa’s own protective mechanisms.

Fundamentals of Microshaver Sinus Surgery

Recurring purulent nasal discharge, headaches, congestion, cough, even asthma, are some of the indicators of chronic sinusitis that may significantly impact the quality of life of individuals suffering from this condition. It can be roughly estimated that every tenth person in India may suffer from signs and symptoms associated with chronic sinusitis. Smokers are at a significantly higher risk of developing chronic sinusitis.

Once all the medicines and other conservative therapeutic options have shown to be ineffective against this condition, surgical treatment of sinus cavities should be the preferred management option.

Conventional Sinus surgery has a reputation of being a slightly aggressive treatment approach, leaving patients with pain and bruising lasting for weeks following the procedure. So-called cold instruments, including forceps, trocar, Kerrison punch can inflict damage to the surrounding tissue, which is directly associated with prolonged recovery time.

Use of the Microshaver sinus surgery ushered in a more precise, delicate, and sophisticated way of eliminating the diseased tissue while inducing minimal trauma and preserving the healthy mucosal layer. Microshaver Sinus Surgery was introduced in 1968 with the intention to treat a specific tumor (acoustic neuroma) located in the inner ear. Orthopedic surgeons later adopted this technology to operate on some joint conditions, while plastic surgeons use this approach during liposuction. ENT surgeons found this technique to be effective for managing Sinus pathology in the 1990s.

The Equipment

Microshaver is a device that has three main components:

Console: which controls the speed and direction of the rotating blade

Handpiece: which controls the blade and allows for the suction of the removed tissue debris via the suction tubes connected to it

Blade: represents a metal tube with a port for suction; blades come in various sizes and angles allowing the most appropriate tissue removal

The overall design enables simultaneous cutting and removal of dissected tissue.

Microshaver sinus surgery employs constant suction in order to pull the tissue towards the blade, resulting in easier cutting and dissection of the selected tissue segment. The continuous suction process allows for the immediate elimination of the debris from the surgical site, which in turn ensures proper visibility of the operating field.

Rotating movements of the blade allow cutting of tissue in all directions which ensures easier and more complete removal of the target. The ergonomic design of the device makes it more safe and user-friendly. Microshaver sinus surgery can be operated easily using only one hand enabling surgeons to have greater freedom of movement. Your surgeon will thus be able to — more easily, delicately and in a shorter time period — eliminate the afflicted sinus tissue.

The benefits of the Microshaver device are numerous. The minimally invasive nature of the procedure it enables guarantees a shorter recovery period and a lower rate of complications. A rapid removal of the diseased tissue directly reduces the duration of the procedure. Simultaneous cutting and removal of the diseased tissue enable a more clean procedure, while the ability to stop the rotation of the blade prevents an excessive injury to the healthy part of the sinuses.

Advantages of Microshaver Sinus surgery over conventional surgical treatment

Diverse blade size and design — Various sizes and shapes of the blades allow customization of the procedure depending on the specific sinus pathology and sinus anatomy in each patient. This guarantees more precision and less damage to the mucosa. Adjusting the size and shape of the blade enables the surgeon to more easily access and remove targeted structures, which contributes to the overall safety of the procedure.

360-degree rotation: The system is constructed to allow the full rotation of the blade in pre-selected directions. This mechanism is essential for precise and complete dissection. The speed of the rotation can also be adjusted, which empowers the surgeon to not only cut the soft tissue but also to cut through the bone.

Start-Stop function: The rotation of the blade may be stopped. This is essential for patient safety. Stopping rotation allows the surgeon to preserve the healthy mucosal layer of the sinus. When one of the lesions is completely removed, the rotation of the blades may be interrupted and the precise position of the device for the next lesson can be safely established without any harm to the surrounding structures.

Continuous suction: The suction process pulls into the blade the selected tissue to facilitate the dissection process. Continuous suction allows the successful elimination of blood and debris, which directly ensures excellent visualization of the surgical site.

Accelerated healing time: Compared to conventional sinus surgery, there is a substantially faster healing time associated with Microshaver surgery. Minimal or no damage to the healthy structures facilitates the healing process and provides less painful and a more comfortable recovery for each patient.

Less bleeding: Limited blood loss is one of the key advantages of Microshaver surgery compared to the conventional method that includes the use of instruments afflicting more damage to the sinuses and surrounding structures. Some Microshaver device manufacturers have added a cauterization device to the standard equipment, which allows for even better bleeding control. Bleeding, which was the archenemy for each surgeon, is now managed without difficulty, enabling the operator to easily access each area of interest within the sinus.

No scarring/bruising: Conventional surgical treatment involves a more invasive manipulation of tissues which results in plenty of tissue bruising and scarring. During the traditional surgical intervention, it was quite challenging to preserve the healthy mucosal barrier. The development of the minimally invasive Microshaver surgical technique allows preservation and minimal damage to healthy structures, which directly prevents scarring and/or bruising.

Shorter pre-operative and post-operative period: Conventional Sinus surgery is linked with a more extensive pre-operative preparation when compared with Microshaver surgery. A somewhat prolonged and complicated post-operative period is anticipated in patients undergoing traditional surgical management. Minimally invasive Microshaver surgery substantially decreases the pre-operative period and recovery time after the surgery, having a positive effect on the quality of life.

Fewer complications: Common risks that occur following the traditional surgical approach include severe nose bleeding, excessive scarring and bruising, inflammation of the brain membrane, leakage of the cerebrospinal fluid, partial or complete loss of vision, and infection. Most of these risks are severe in nature and each requires substantial therapeutic management. Microshaver surgery is associated with a fairly uneventful post-operative period.

Summary

Studies have demonstrated that Microshaver Sinus surgery represents an effective therapeutic method for a diverse range of Sinus pathologies. Researchers and experts have deemed it a convenient and efficient surgical option with the main advantages including precision, a very low rate of complications, a speedy recovery after the procedure, and most importantly, the high possibility of preserving the healthy sinus mucosa.

This surgical approach is substantially less traumatic and aggressive when compared to the traditional surgical technique. Limited blood loss and reduced scarring contribute to the delicacy of the procedure, allowing lesser bruising and accelerated healing following the procedure. To conclude, Microshaver sinus surgery represents an effective and more comfortable treatment option for individuals suffering from conditions affecting the Sinuses.

If you are looking for Microshaver Sinus Surgery in India, You can reach me out at Sinus Doctor.