Standard Instruments Versus Microdebrider in Endoscopic Sinus Surgery-An Outcome Based Comparative Study: ATertiary Care Hospital Experience

Background :In endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis, the standard instruments have been in use to remove diseased mucosa and polyps since decades. The powered instrument like microdebrider is a current innovation to replace the conventional instruments during ESS. Objective :  To compare the outcome after using standard instruments versus microdebrider in endoscopic sinus surgery for restoring sinus drainage. Methods: This Randomized Controlled Trial (IRCT Id:78723) was conducted at Department of Otorhinolaryngology, Bahawal Victoria Hospital Bahawalpur from 1st April 2022 to 31st  December 2022. About 130 patients of chronic rhinosinusitis with nasal polyposis from 15-65 years of age were included after informed written consent. Patients were equally divided in two groups. In Group A, patients underwent endoscopic polypectomy and clearance of the sinuses with widening of ostia using microdebrider while in group B, standard conventional instruments were used. All patients were followed for 8 weeks and outcome (duration of procedure, per-operative bleeding, post-operative pain, synechiae formation and recurrence) was noted. The data was analyzed by using the SPSS version 25. Results: Out of 130 patients 49 were females and 81 were males. Mean duration of surgery was 53.58 ± 6.97 minutes in microdebrider group and 76.18 ± 6.80 minutes in standard instruments group. Mean intraoperative blood loss was 81.57 ± 9.28 ml in microdebrider group and 104.80 ± 10.44 ml in standard instruments group. Mean post-operative pain (by Visual Analogue Scale) was 1.25 ± 1.00 in microdebrider group and 3.83 ± 1.26 in standard instruments group. Synechiae formation and recurrence were seen in 4.62% and 3.08% respectively after ESS with microdebrider (group A) while in 13.85% and 16.92% respectively after ESS with standard instruments (group B). Conclusion : There is significantly less post-operative pain, duration of surgery and per-operative blood loss in patients having endoscopic sinus surgery with microdebrider as compared to standard instruments.