Exoscope and Personal Protective Equipment Use for Otologic Surgery in the Era of COVID‐19

Gordon, Steven A.; Deep, Nicholas L.; Jethanamest, Daniel

doi:10.1177/0194599820928975

Cited by 17 publications

(28 citation statements)

References 11 publications

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“…The characteristics of included trials were presented in Table 1 . A total of 269 patients from 47 studies [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 [95% CI, 42.49; 59.34], and 49% [95% CI, 0.33, 0.65] patients were female.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 47 studies included in the analysis, only 20 studies [ 16 , [18] , [19] , [20] , 24 , 25 , 29 , 32 , 39 , 42 , 45 , 46 , 50 , 53 , [55] , [56] , [57] , [58] , [59] , 61 ] reported the information of medical staff infection which identified that a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment during the perioperative period did not get infected.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Wang¹,

Wu²,

Xu³

et al. 2020

EClinicalMedicine

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Background The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking. Methods We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms “COVID-19″ or “SARS-CoV-2″ and “Surgery” or “Operation” for all published articles on COVID-19 from December 1, 2019 to October 5, 2020. Findings A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality ( r = 0.891, p < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality ( r = 0.675, p = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected. Interpretation COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE). Funding Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Wang¹,

Wu²,

Xu³

et al. 2020

EClinicalMedicine

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“…This study demonstrates that mastoid drilling generates large quantities of 1- to 10-µm aerosolized particles, complementing existing research of larger particles generated during mastoidectomy. 6,10 Concerns that COVID-19 may be spread through otologic and neurotologic surgery have arisen, 14 as the fluid and mucosa of the middle ear and mastoid are contiguous with that of the upper respiratory tract, where the viral load is high. 2 Other respiratory viruses—such as human coronavirus, rhinovirus, respiratory syncytial virus, influenza, parainfluenza, enterovirus, and adenovirus—have been identified in middle ear fluid samples from children with upper respiratory illnesses.…”

Section: Discussionmentioning

confidence: 99%

Aerosol Dispersion During Mastoidectomy and Custom Mitigation Strategies for Otologic Surgery in the COVID‐19 Era

Chari¹,

Workman²,

Chen³

et al. 2020

Otolaryngol.--head neck surg.

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Objective To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies. Study Design Cadaveric simulation. Setting Surgical simulation laboratory. Methods An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports. Results Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels ( P < .001, U = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling ( P < .001, U = 0, n = 10, 12; P < .001, U = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed. Conclusions Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.

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“…They found that the 3D image was obscured when looking through 3D glasses under a face shield, but that the image was restored when the glasses placed on the outside. 52 They reported a minimal learning curve, improved ergonomics, and similar surgical time, and recommend the use of transmastoid exoscopic and transcanal endoscopic approaches to safely perform surgery while wearing the necessary PPE.…”

Section: Discussionmentioning

confidence: 97%

Heads-up Surgery

Ridge

Shetty

Lee

2021

Otolaryngologic Clinics of North America

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Synopsis A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope are now shared with rigid endoscopes and exoscopes. These two modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared to binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.

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Exoscope and Personal Protective Equipment Use for Otologic Surgery in the Era of COVID‐19

Cited by 17 publications

References 11 publications

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Aerosol Dispersion During Mastoidectomy and Custom Mitigation Strategies for Otologic Surgery in the COVID‐19 Era

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