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News -> July, 1999 News
While working on a home remodeling project this weekend, I tried to
put a wood screw in without a pilot hole but I could not. Upon failure,
I removed the screw and took out the drill to place the pilot hole.
Next, I had to search the house for an extension cord. The thought
occurred to me, "If only I had a powered screwdriver and drill with
a portable power source. I could have finished the job quicker,
more easily and more efficiently."
That same thought process also occurred to me when I recently walked
the exhibition halls at COSM and was greeted by so many choices for
both manual and powered sinus surgery instruments. Powered instruments
inherently seem quicker, easier and more efficient than manual
instruments. Working with residents, I am constantly asked about
manual verses powered sinus instrumentation. I can only offer a
few observations from my own experiences with both types of instruments.
The advantages of manual instrumentation for sinus surgery are
general availability, lower costs, better tactile sense, and ease
of surgical setup. The difference between the thin eggshell
partitions of the ethmoid cavity and the thicker bone of the
fovea ethmoidalis is much more obvious with manual instruments.
The gauging of the strength needed to execute a maneuver, especially
in grasping and removing bone, is also much easier with manual
instruments. Yet, the powered instrumentation seems to cause less
bleeding on severe polyp cases, and can contour the excision better.
In addition, normal mucosa is more easily left intact with the power
instrumentation. Plus, the microdebriders are fun to use! There is
no question watching a polyp get "slurped up" is entertaining and
exciting.
But when residents go to work with the microdebriders, I have noticed
they tend to "contour" a cavity in the polyps rather than dissect
to the extremes of the ethmoid cavity. Thus, they leave more diseased
tissue in the cavity with the powered instruments compared to the
manual sinus instruments. They also tend to go slower with the
power tools.
I exclusively use manual instrumentation so that I can send both
the mucin and the polypoid tissue to the pathologist. Merely taking
a sample biopsy of a nasal polyp is inadequate as in many cases
allergic mucin is deep in the sinus cavities or may be localized
in one area. The use of the suction and the microdebrider leads
to loss of this important pathologic information. In addition,
I can operate much more quickly with manual instruments. Some
places the powered instruments are excellent are for the endoscopic
treatment of choanal atresia, and for the removal of ethmoid
osteomas. The sheathed drill bits are safer and easier to use
intranasally then otologic or neurologic drills.
"To use powered sinus instruments or not"--that is the question.
There is no right answer. Each surgeon needs to come to his or
her own conclusions. Do not assume one is more efficient or easier
to use than the other without an adequate trial of each.
David A. Sherris, M.D.
Mayo Clinic
Department of Otolaryngology
Division of Rhinology
Rochester, Minnesota
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