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He subsequently received chemo- and radiotherapy&#46; In March 2014&#44; the patient had to undergo bronchoscopic interventionism to resect granulomas in the distal end of the prosthesis which were occluding over 75&#37; of the lumen&#46; We mechanically resected these granulomas using the Straightshot<span class="elsevierStyleSup">&#174;</span> M4 Microdebrider &#40;37<span class="elsevierStyleHsp" style=""></span>cm in length and 4<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; with a 15&#176; angulated tip&#41;&#44; via a rigid tracheoscope &#40;Efer-Dumon<span class="elsevierStyleSup">&#174;</span>&#41; 13&#46;20<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; The intervention lasted 35<span class="elsevierStyleHsp" style=""></span>min&#44; and the post-operative period was incident-free&#46; To date&#44; August 2015&#44; the patient continues in follow-up with no relapse &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">This instrument&#44; which is very familiar in eye&#44; nose and throat surgery and in interventions of the base of the skull&#44; has rarely been used in lower airway procedures&#46; It consists basically of a revolving tip connected to a control panel&#46; Its advantages include very rapid tissue dissection&#59; it aspirates as it cuts&#44; keeping the surgical field clear most of the time&#44; so the anesthetist can provide the fraction of inspiratory oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; required by the patient&#46; Several different attachments are marketed allow larger or smaller resections depending on the size of the lesion&#44; the required precision&#44; and Skimmer<span class="elsevierStyleSup">&#174;</span> Blade cutting mode&#46; The device also includes a serrated&#44; 2&#46;9<span class="elsevierStyleHsp" style=""></span>mm or 4<span class="elsevierStyleHsp" style=""></span>mm diameter TriCut<span class="elsevierStyleSup">&#174;</span> Blade rotating tip&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Rotation speed is controlled manually or by a pedal &#40;1500&#8211;5000<span class="elsevierStyleHsp" style=""></span>rpm&#41;&#46; Drawbacks include its length&#44; which at 37<span class="elsevierStyleHsp" style=""></span>cm limits its field of action to the tracheal and main bronchi&#46; As this is a rigid instrument&#44; it cannot be used with flexible bronchoscopy&#46; It has been used in both malignant and benign lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2&#44;3</span></a> The literature on this device has all been generated outside Spain&#44; and there is no record of it having been used in the lower airway in this country&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main reason for choosing the microdebrider was that the patient presented an abnormal spirometry with a severe mixed pattern&#44; and needed oxygen therapy at higher levels to maintain safe oxygen saturation&#46; Thermo ablative endoscopic procedures &#40;lasers&#44; electrocautery&#44; argon plasma&#41; are known to require low FiO<span class="elsevierStyleInf">2</span> due to the risk of ignition&#46; Moreover&#44; the speed with which mechanical resection can be performed greatly reduces anesthesia time&#44; which is an important factor in patients with low cardiorespiratory reserves&#46; Our patient had a permanent pacemaker&#44; preventing the use of bronchial electrocautery&#46; Another alternative would have been cryotherapy&#44; but this is not available in our hospital&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; we believe that mechanical debridement with this device offers new possibilities&#44; and can be used when conventional thermoablation is either unavailable or unsafe&#46;</p></span>"
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                            1 => "R&#46; Garland"
                            2 => "S&#46; Ashiku"
                            3 => "R&#46;L&#46; Thurer"
                            4 => "D&#46; Feller-Kopman"
                            5 => "A&#46; Enrnst"
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