A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era

Abstract

Purpose To provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era. Methods We have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model. Results The pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization. Conclusions The mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke. Electronic supplementary material The online version of this article (10.1007/s00405-020-06462-1) contains supplementary material, which is available to authorized users.

One year into the COVID‐19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

“…Nineteen studies considered techniques to mitigate this risk and they will be considered in terms of those which employ ‘standard’ precautions, those which investigate the role of suction on aerosolisation and those which report novel adjunctive techniques. 12 , 14 , 15 , 16 , 18 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 …”

“…Three studies tested the fitment of a specific mask on the patient. 16 , 18 , 28 All such work was performed in simulated settings and considered droplet spread in terms of splatter evaluated through fluorescent tracing with fluorescein. Viera‐Artiles et al 28 and Helman et al 18 used 3‐D printed mask designs and evaluated droplet dispersal following endonasal high‐speed drill use.…”

One year into the COVID-19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

“…Three studies tested the fitment of a specific mask on the patient. 16,18,28 16 added suction beneath their patient mask to create a negative pressure environment finding that droplet spread was eliminated during cadaveric sinus surgery simulations using both the microdebrider and high-speed drill. Though encouraging, this work does not consider aerosolisation of smaller particles.…”

Strategies for the Practice of Otolaryngology and Head and Neck Surgery during COVID-19 Pandemic

“…Endoscopic sinonasal surgery [67,68] • Avoid the use of microdebriders, high resolution motors, or surgical drills whenever possible.…”