Impact of Laparoscopic Lens Contamination in Operating Theaters: A Study on the Frequency and Duration of Lens Contamination and Commonly Utilized Techniques to Maintain Clear Vision

Yong, Nathanael; Grange, Philippe; Eldred‐Evans, David

doi:10.1097/sle.0000000000000289

Cited by 27 publications

(25 citation statements)

References 15 publications

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“…For a typical laparoscopic operation with four ports, this translates to the same volume as 4 two-liter bottles of soda, potentially containing aerosolized contaminants, being released into the OR environment from the patient’s surgical cavity. Instrument insertion and removal events (conservatively estimated at 6 events/h in the OR) appear to release additional potentially harmful gas volumes equal to 1–2 cans of twelve ounce sodas [ 43 ]. Using an average of 6 instrument removals per hour, results from this study might then suggest a range of 324–684 mL of potentially contaminated gases released during 1 h of surgery (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…The Instrument Full Insertion/Removal scenario was used to simulate an instrument exchange or other such removal and/or insertion event, which is commonly experienced during laparoscopy for each and every case. For example, scope removals are often performed to clean the lens, and instruments are commonly removed to achieve access through a different port or to exchange them out for a new instrument [36,37,[40][41][42][43]. Each instrument-port configuration also helped to represent a few different levels of such combinations seen in today's OR.…”

Section: Test Procedures For Each Use Case Scenariomentioning

confidence: 99%

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Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Uecker

Fagerberg²,

Ahmad³

et al. 2020

Surg Endosc

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Background Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. Methods A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure. Results For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. Conclusions Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Test Procedures For Each Use Case Scenariomentioning

confidence: 99%

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Uecker

Fagerberg²,

Ahmad³

et al. 2020

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…Indeed, much of the evidence focussed upon primary outcome measures related to laparoscopic lens fouling or fogging events and thus, failed to consider patient and operative outcomes. Wider research has shown that laparoscopic lens fogging and removal of laparoscopes during surgery can be associated with significant increases in operative time and blood loss, although the effect sizes reported were small and thus, it is not clear whether reductions in lens fogging or fouling would lead to meaningful improvements in operative time and blood loss in routine practice [ 27 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review

2021

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Objective To review the recently available interventions to achieve optimal visual clarity in laparoscopic abdominopelvic surgery compared to conventional cleaning alternatives. Summary background data Currently, there is no consensus on the most effective method for the cleaning of endoscopic lenses used in minimally invasive abdominopelvic surgery. Methods Literature searching for articles relevant to answering a predefined research question was performed in December 2019 and involved searching of the electronic databases of MEDLINE, the Cochrane Registry, and EMBASE. Basic search terms were derived using the PICO (population, intervention, comparator and outcomes) framework and through a scoping search of literature via MEDLINE. A manual search of Google Scholar and citation screening of eligible studies was also performed to ensure the identification and inclusion of all pertinent studies to address the research question. Results Among conventional and readily available methods, the most effective approaches involved heated sterile water, heating of laparoscope lenses, and surfactant solutions, including FRED and Ultra-Stop, while evaluations of all novel devices and methods were more effective than controls, which included lens wiping systems and air and carbon dioxide flow systems. While the former surgical techniques were consistently associated with superior lens cleaning ability and/or defogging capability and subsequent optical clarity of images within the surgical field, no methods conferred any meaningful effects upon other clinically important outcomes, such as operative time, costs, complication rates and length of stay, suggesting that decision making concerning the selection of lens cleaning method/device should suit the preferences of the instrument operator and/or the responsible surgeon. Conclusions We demonstrated that a range of endoscopic lens cleaning methods and devices can be used to achieve sufficient optical clarity of the laparoscopic surgical field through either preventing lenses from fogging and/or facilitating the inter-operative cleaning of fouled lenses. Despite the various methods evaluated in this review, there were no significant differences in complication rates between the intervention and control groups.

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“…Although repeated cleaning of the lens is required during procedures, which is time consuming and distracting, there have been few improvements in lens cleaning methods. Yong et al reported that 37% of operative time was spent under impaired endoscopic views and 7% was used for lens cleaning during endoscopic operations by surgeons [ 1 ]. Moreover, most surgeons are reluctant to clean the lens and sometimes continue the operation with contaminated lens, which is unfavorable from a safety viewpoint.…”

Section: Introductionmentioning

confidence: 99%

“…Some commercial devices can provide or maintain a clear endoscopic view [ 3 , 4 ]. In actual practice, however, most of these devices are not commonly used [ 1 ]. Considering this situation, it would be useful to have an alternative method of cleaning the endoscopic lens completely in one short action of a novel device.…”

Section: Introductionmentioning

confidence: 99%

A novel one-step lens cleaning device using air and water flow for endoscopic surgery

et al. 2018

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In a surgical operation requiring endoscopy, it is essential to obtain a clear endoscopic view. However, it is often disturbed by the contamination on the lens during the surgery. No device can clean the lens surface simply and completely. Many surgeons are hampered by the impaired view and the distraction by the repeated cleaning of the lens. Therefore, we developed a novel endoscope cleaning device to address this problem. The device was made of 3D-printed rubber-like plastic. It contains a syringe filled with saline and an aspiration system. It would be used intraoperatively to wash the lens surface in a few seconds with rapid flow of water and air. The cleaning ability of the device was evaluated using mayonnaise with adenosine triphosphate (ATP) as a model contaminant. The gauze-wiping maneuver was selected as control. After each maneuver, the clarity of the endoscopic view was evaluated, and residual contaminants were assessed quantitatively with ATP assay. The cleaning device obtained a crisp and clear view and eliminated the contaminant on the lens every time after a single cleaning maneuver. The gauze-wiping maneuver required for the lens to be wiped at least three times to obtain a clear view, and even then, some contaminants remained. Repeated contamination and cleaning using gauze led to accumulation of contaminants on the lens, which resulted in difficulty in cleaning the lens as the operation proceeded. The cleaning device did not show such accumulation. Our novel cleaning device with air and water flow has been shown to wash out the lens contaminants completely and immediately in a simple manner. It is expected to improve the safety and cost-effectiveness of endoscopic surgery.

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Impact of Laparoscopic Lens Contamination in Operating Theaters: A Study on the Frequency and Duration of Lens Contamination and Commonly Utilized Techniques to Maintain Clear Vision

Cited by 27 publications

References 15 publications

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review

A novel one-step lens cleaning device using air and water flow for endoscopic surgery

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