Endoscopic skull base and transoral surgery during <scp>COVID</scp>‐19 pandemic: Minimizing droplet spread with <scp>negative‐pressure</scp> otolaryngology viral isolation drape

David, Abel P.; Jiam, Nicole T.; Reither, Joshua M.; Gurrola, José; Aghi, Manish K.; El‐Sayed, Ivan H.

doi:10.1002/hed.26239

Cited by 49 publications

(73 citation statements)

References 11 publications

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“…Additionally, asymptomatic and pre-symptomatic SARS-CoV-2 transmission mandate precautionary measures like that to reduce viral spread [ 7 ]. Similar barrier techniques were already proposed and successfully used in other airway procedures during the COVID era, highlighting the fact that ENT surgeons have appreciated the importance of aerosol mitigation during ENT procedures [ 8 – 10 ]. Our method allowed for unrestricted hand movements and there was not any interference in the visualisation of the surgical field e.g., glaring from the plastic transparent cover previously described [ 8 ].…”

Section: Discussionmentioning

confidence: 93%

“…Our method allowed for unrestricted hand movements and there was not any interference in the visualisation of the surgical field e.g., glaring from the plastic transparent cover previously described [ 8 ]. Contrary to the covers with open slits or ports, our tight-seal arrangement around the cables and incorporating the surgeon’s arms within the drape ensures minimal aerosol escape [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

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The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

Tsagkovits

Ioannidis

Rokade

2020

Eur Arch Otorhinolaryngol

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Background Otolaryngologists are faced with concerning challenges since the onset of the coronavirus disease (COVID-19) pandemic due to significant risk of occupational infection. Transmission can happen during intraoperative exposure to viral particles carried by droplets or aerosols. Endoscopic sinus and skull base surgery are notable for causing aerosolisation, putting healthcare staff at substantial risk. Method We describe the creation of a tight-seal tent from a microscope drape covering the operative field and the operator’s hands with the aim to contain aerosols during transnasal endoscopic surgery. Conclusion The microscope drape technique is a simple barrier measure that could potentially improve safety during endoscopic procedures.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

Tsagkovits

Ioannidis

Rokade

2020

Eur Arch Otorhinolaryngol

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“…If SARS-CoV2-infection is detected, these intervention techniques should be avoided. In addition, protective measures should be used if applicable [24]. Emergency treatment in cases of uncertain infectious status represents a particular challenge.…”

Section: Conclusion For Clinical Applicationmentioning

confidence: 99%

In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling

Guderian

Loth

Weiß

et al. 2020

Eur Arch Otorhinolaryngol

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Introduction Based on current knowledge, the SARS-CoV-2 is transmitted via droplet, aerosols and smear infection. Due to a confirmed high virus load in the upper respiratory tract of COVID-19 patients, there is a potential risk of infection for health care professionals when performing surgical procedures in this area. The aim of this study was the semi-quantitative comparison of ENT-typical interventions in the head and neck area with regard to particle and aerosol generation. These data can potentially contribute to a better risk assessment of aerogenic SARS-CoV-2-transmission caused by medical procedures. Materials and methods As a model, a test chamber was created to examine various typical surgical interventions on porcine soft and hard tissues. Simultaneously, particle and aerosol release were recorded and semi-quantitatively evaluated timedependently. Five typical surgical intervention techniques (mechanical stress with a passive instrument with and without suction, CO 2 laser treatment, drilling and bipolar electrocoagulation) were examined and compared regarding resulting particle release. Results Neither aerosols nor particles could be detected during mechanical manipulation with and without suction. The use of laser technique showed considerable formation of aerosol. During drilling, mainly solid tissue particles were scattered into the environment (18.2 ± 15.7 particles/cm 2 /min). The strongest particle release was determined during electrocoagulation (77.2 ± 30.4 particles/cm 2 /min). The difference in particle release between electrocoagulation and drilling was significant (p < 0.05), while particle diameter was comparable. In addition, relevant amounts of aerosol were released during electrocoagulation (79.6% of the maximum flue gas emission during laser treatment). Discussion Our results demonstrated clear differences comparing surgical model interventions. In contrast to sole mechanical stress with passive instruments, all active instruments (laser, drilling and electrocoagulation) released particles and aerosols. Assuming that particle and aerosol exposure is clinically correlated to the risk of SARS-CoV-2-transmission from the patient to the physician, a potential risk for health care professionals for infection cannot be excluded. Especially electrocautery is frequently used for emergency treatment, e.g., nose bleeding. The use of this technique may, therefore, be considered particularly critical in potentially infectious patients. Alternative methods may be given preference and personal protective equipment should be used consequently.

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“…Finally, smoke evacuation system is set up inside the tent to evacuate any smoke produced during the surgery. 24 Alternative surgical approach like external paracanthal, paralateronasal, sublabial approach is preferred instead of endonasal approach. This will reduce the use of drill and microdebrider while doing surgery, thus minimizing the risk of aerosolization from tissue micro-fragments contaminated by the virus.…”

Section: Staff Preparationmentioning

confidence: 99%

Guidelines for rhinology surgery in COVID-19 pandemic

Juvekar

Sarkar²

2020

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">COVID-19 disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province. Amid the ongoing COVID-19 pandemic, India has witnessed a massive surge of coronavirus cases. This study reviews the measures to take by the clinicians involved in rhinology surgery in light of the recent COVID-19 pandemic. The current finding about COVID-19 infection and its relation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) virus is evaluated and possible safety measure guidelines to be taken while doing rhinology procedures is reviewed. The risk of coronavirus 2019 can be largely reduced by wearing personal protective equipment (PPE) kit with powered air purifying respirator, double gloves, eye protection, face shield, gown, shoe covers, limiting attendance to operation theatre, negative pressure room, using negative-pressure otolaryngology viral isolation drape (NOVID) system to cover the patient and proper removal of patient drape after operation. Additionally, low oscillation speeds of microdebrider with continuous suction is associated with low risk of aerosol transmission into the environment. Rhinology and endonasal surgeries are high risk procedures and should adhere to general guidelines set for high-risk procedures. If the proposed protocols are strictly maintained then the risk of getting infected by coronavirus is markedly reduced. In this current scenario is it mandatory to attain the emergent surgical cases with all possible precautions as mentioned and defer the rest of the cases till the pandemic gets over.</p>

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Endoscopic skull base and transoral surgery during COVID‐19 pandemic: Minimizing droplet spread with negative‐pressure otolaryngology viral isolation drape

Cited by 49 publications

References 11 publications

The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling

Guidelines for rhinology surgery in COVID-19 pandemic

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