Neither “hot” nor “cold” – Re-establishing the role of the micro-debrider in central airway obstruction.

<bold>Introduction:</bold> 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. <bold>Aims:</bold> We did this study to establish the safety and efficacy of the microdebrider in debulking central airway tumors. <bold>Methods:</bold> A total of 21 patients with central airway tumors from April 2021 to December 2023 underwent resection using the microdebrider. All procedures were done under general anesthesia. A 12 mm Rigid Bronchoscope was used for bronchial tumors while a 14 mm Rigid Tracheoscope was used for the tracheal tumors. The 45cm long Bronchial blade microdebrider was used for debulking. <bold>Results:</bold> In our study involving 21 cases of Central Airway Obstruction (CAO), 71% (15/21) were malignant, predominantly non-small-cell lung cancer (52.4%, n=11/21). The mean airway obstruction reduced from 86% pre-treatment to 10% post-treatment with the debrider, indicating significant improvement. The debulking time ranged from 4 to 18 min (average 11min). The average procedure time was notably shorter at 28.4 minutes compared to 51.2 minutes with conventional methods in historical controls, showcasing the debrider's efficiency, with no reported adverse events or mortality. <bold>Conclusion:</bold> The debrider represents a valuable tool in the armamentarium of interventional pulmonologists, offering quick and precise tumor removal without needing to be withdrawn, while also suctioning blood to maintain visibility and avoid complications like airway fires from thermal methods. Inadvertent damage to the airway wall is a complication to be aware of.