Aerosol Production with Surgical Instrumentation: Implications for Head and Neck Surgery in the COVID-19 Era

Abstract

Evaluating the aerosolization of droplets from surgical instruments to assess the implications of surgery in SARS-CoV-2 transmission for both patients and providers. Cadaver study. Outpatient surgery center. Aerosolized particles between 0.3 and 25 microns were measured. Instruments tested included monopolar cautery with and without suction, bipolar cautery, a bipolar vessel sealing device, and tissue scissors. Each trial was compared to a background reading. Monopolar cautery without suction, Ligasure used continuously and Bipolar cautery produced the most aerosols. Monopolar cautery with simultaneous suction produced no detectable aerosols. Ligasure used for a single cycle produced notably fewer aerosols than during continuous use. Most aerosols produced were < 5 microns. These data support n95 use during surgical management of the upper aerodigestive tract, as well as the use of suction in the surgical field.

The effect of activity and face masks on exhaled particles in children

“…Third, unlike some prior laboratory-based studies, 76-78 our measurements were not conducted in a clean chamber with zero ambient particles. Similar to other studies measuring the effect of particular activities on the relative production of particles, 51,[79][80][81][82][83] our study design allows relative comparisons (e.g., breathing vs. sneezing, surgical vs. no mask), but limits our ability to compare absolute particle concentrations to the findings of other studies. Finally, our study was limited to volunteer participants in a clinical research study, who may be more adherent to appropriate mask-wearing than other children in real-world settings.…”

“…Third, unlike some prior laboratory‐based studies, 76 , 77 , 78 our measurements were not conducted in a clean chamber with zero ambient particles. Similar to other studies measuring the effect of particular activities on the relative production of particles, 51 , 79 , 80 , 81 , 82 , 83 our study design allows relative comparisons (e.g., breathing vs . sneezing, surgical vs .…”

Comparing Aerosol Generation in Human and Animal Tissues During Common Otolaryngology Procedures

“…In these cases, N95 or N99 may provide increased protection against submicrometer particles, with N99 providing greater protection against small particles 24 . In addition to worn protection, irrigation of tissue and smoke evacuators have been demonstrated to significantly decrease the number of aerosolized particles in the 0.5‐ to 1‐micrometer size range, and combining these strategies with masking may further reduce exposure 25,26 . Operating suites are also equipped with filtration and air conditioning systems that significantly decrease the half‐life of aerosolized particles and prevent their spread outside of the operating room 27,28 .…”

“…24 In addition to worn protection, irrigation of tissue and smoke evacuators have been demonstrated to significantly decrease the number of aerosolized particles in the 0.5-to 1-micrometer size range, and combining these strategies with masking may further reduce exposure. 25,26 Operating suites are also equipped with filtration and air conditioning systems that significantly decrease the half-life of aerosolized particles and prevent their spread outside of the operating room. 27,28 Decreasing the movement of staff in and out of the operating suite can also reduce exposure and spread of aerosolized particles.…”