Heat generation and thermal safety of powered instrumentation in endoscopic sinus surgery.

PURPOSE OF REVIEW: This narrative review aims to summarize current evidence on thermal energy generation during endoscopic sinus surgery (ESS), with particular emphasis on the powered devices, their safe application, and an understanding of device-specific thermal characteristics.

RECENT FINDINGS: Powered instrumentation has become integral to ESS, contributing to improved precision, efficiency, and visualization. However, different powered devices generate heat through distinct mechanisms related to their design, operating principles, and patterns of tissue interaction. Heat-related effects may occur during the use of microdebriders, coblation, radiofrequency, high-speed drills, and laser systems. The risk of thermal injury to sinonasal mucosa, bone, and adjacent critical structures is influenced by both device characteristics and operator-dependent factors, including activation time, contact time, and cooling techniques. Tissue injury depends not only on peak temperatures achieved but also on the duration and cumulative burden of heat exposure.

SUMMARY: Appropriate selection and informed use of powered instruments are central to minimizing thermal risk in ESS. A thorough understanding of how different devices generate and dissipate heat, together with attention to modifiable operative factors, can enhance surgical safety and reduce the likelihood of thermal injury.