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Garcia E, Mandaleson A, Stannage K, Williams N. Occupational hazards and pregnancy in orthopaedics: female surgeons are at increased risk of infertility and pregnancy complications. ANZ J Surg 2024; 94:1910-1918. [PMID: 38590139 DOI: 10.1111/ans.18992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Female surgeons have increased rates of infertility and pregnancy complications compared to the general population. Reported infertility rates in surgeons are 32% compared to 10.9% in the general population. Reported pregnancy complication rates in surgeons range from 25% to 35%. In the orthopaedic operating theatre occupational hazards that have an effect on pregnancy outcomes include radiation, exposure to methyl methacrylate in bone cement, surgical smoke, sharps injuries, exposure to anaesthetic waste gases and the effects of the physical demands of surgery including prolonged work hours and night shift work. Outside the operating theatre exposure to nitrous oxide, formaldehyde, surgical scrub also have evidence of negative pregnancy outcomes. This review summarizes the available evidence as it relates to specific occupational hazards that face health workers in an orthopaedic operating theatre. This information, while targeted at orthopaedic health workers, is also relevant to anaesthetists, radiographers, nursing staff, medical device company representatives and female surgeons in other specialties.
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Affiliation(s)
- Elizabeth Garcia
- Australian Orthopaedic Association, Sydney, New South Wales, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Avanthi Mandaleson
- Australian Orthopaedic Association, Sydney, New South Wales, Australia
- Dandenong Hospital, Dandenong, Victoria, Australia
| | - Katherine Stannage
- Australian Orthopaedic Association, Sydney, New South Wales, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Nicole Williams
- Australian Orthopaedic Association, Sydney, New South Wales, Australia
- Adelaide Women's and Children's Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
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Bw H, Mh C, Me V, K PN, Eh C, Nr F. Aerosol mitigation in upper airway surgery. Int J Pediatr Otorhinolaryngol 2024; 186:112153. [PMID: 39489003 DOI: 10.1016/j.ijporl.2024.112153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/24/2024] [Accepted: 10/29/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Aerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room. METHODS Utilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5-10 μm in diameter were measured. Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations. RESULTS SES was effective compared to controls, but inferior to intraoral mitigation strategies (p < 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p < 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles. CONCLUSIONS Intraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.
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Affiliation(s)
- Herrmann Bw
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
| | - Choi Mh
- Department of Computer Science and Engineering, University of Colorado Denver, Denver, CO, USA
| | - Vance Me
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Pickett-Nairne K
- Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, USA
| | - Cooper Eh
- Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, USA
| | - Friedman Nr
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA
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Zheng Y, Gong R, Du Z, Yu C, Lian A. Analysis and visualization of the research progress on surgical smoke. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 281:116671. [PMID: 38959788 DOI: 10.1016/j.ecoenv.2024.116671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/16/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND With the advancement of medical technology, tools such as electrosurgical equipment, laser knives, and ultrasonic scalpels have made modern medical procedures more convenient and effective. However, the generation of surgical smoke during these procedures poses significant health risks to medical personnel. Despite this, only a few studies have examined the literature systematically in this area. By analyzing bibliometric data on surgical smoke, we can gain insights into current research hotspots and forecast future trends. METHODS This study included literature related to surgical smoke from the Web of Science and China National Knowledge Infrastructure (CNKI) databases, covering the period from 2000 to 2024. We used VOSviewer, CiteSpace, and BioBERT to visualize research trends and hotspots. RESULTS In the early stages of research, the focus was mainly on the composition, generation mechanisms, and susceptible populations related to surgical smoke. In recent years, with the development of laparoscopic surgery and the global COVID-19 pandemic, research interests have shifted towards occupational protection of healthcare workers and public health. Currently, the research in this field primarily explores the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as occupational protection and health education for healthcare workers. Disease research focuses heavily on Smoke Inhalation Injury, Infections, Neoplasms, Postoperative Complications, and Inflammation. CONCLUSION We explored future research directions in the field of surgical smoke using VOSviewer, CiteSpace, and BioBERT. Our findings indicate that current research focuses on investigating the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as on occupational protection and health education for healthcare workers. We summarized existing preventive measures, aiming to facilitate further research advancements and the translation of research outcomes into clinical results. These efforts provide new insights for advancing research in occupational protection of healthcare workers.
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Affiliation(s)
- Yi Zheng
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ruitao Gong
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiwei Du
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cuiping Yu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ailing Lian
- Department of Operating Room, First Affliated Hospital of Harbin Medical University, Harbin, China.
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Nose Y, Kato M, Aoyagi S, Akeo K, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Takahashi T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Use of current automatic smoke evacuation system in flexible gastrointestinal endoscopy: Its feasibility and potential usefulness. DEN OPEN 2024; 4:e367. [PMID: 38605997 PMCID: PMC11007223 DOI: 10.1002/deo2.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
Objectives Flexible endoscopy does not have a system that can automatically evacuate surgical smoke generated in the gastrointestinal lumen. We aimed to investigate the feasibility and potential usefulness of automatic smoke evacuation systems in flexible endoscopy. Methods [Bench] After surgical smoke generated in the stomach was evacuated by the evacuator, the degree of residual smoke and gastric luminal collapse were evaluated to optimize the evacuator settings. [Animal] Insufflation, suction, and total operation time to complete the protocol of 10 cauterizations of the gastric mucosa were measured in three groups: "manual suction only," "manual suction with automatic evacuation (50% force)," and "manual suction with automatic evacuation (70% force)." The stability of endoscopic visualization and operability was evaluated by 10 endoscopists blinded to those suction settings, and the number of manual suctions, insufflations, and total operation time were measured. Results [Bench] The degree of residual smoke and gastric luminal collapse were inversely correlated. [Animal] When the automatic evacuator was partially used, there was no difference in the insufflation time, but the suction time (vs 50%; p = 0.011, vs. 70%; p = 0.011) and total operation time (vs. 50%; p = 0.012, vs. 70%; p = 0.036) were significantly reduced compared to manual operation only. Furthermore, manual suction with automatic evacuation (50% force) significantly improved the stability of endoscopic visualization and operability compared to manual operation only (p = 0.041, p = 0.0085). Conclusions The automatic smoke evacuation in flexible gastrointestinal endoscopy was potentially feasible and useful by improving the device setting.
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Affiliation(s)
- Yohei Nose
- Department of Next Generation Endoscopic Intervention (Project ENGINE)Graduate School of Medicine, Osaka UniversityOsakaJapan
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | | | | | - Kotaro Yamashita
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Takuro Saito
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Koji Tanaka
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Tomoki Makino
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE)Graduate School of Medicine, Osaka UniversityOsakaJapan
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
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Li H, Huang C, Li C, Zhang M. High-frequency electric knife smoke particles: An experimental study on factors influencing emission characteristics. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 273:116096. [PMID: 38367609 DOI: 10.1016/j.ecoenv.2024.116096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
During surgery, the use of a high-frequency electric knife produces smoke, which can be harmful to the health of indoor medical staff and patients. The quantity and particle size distribution of smoke particles produced by different tissues may vary. Understanding the release characteristics of these smoke particles is necessary to clarify their impact on the surgical environment and to seek effective smoke control methods. A previous comparative analysis of human and pig tissues revealed that they share similar water and fat compositions in certain anatomical regions. In this study, we investigated the emission characteristics of smoke particles from various tissues of pigs (skeletal muscle, liver, kidney, skin, and subcutaneous fat) under different operating powers of an electric knife. We measured the indoor particle number concentration (particle concentration), and estimated the PM2.5 mass concentration (PM2.5 concentration), particle size distribution, and emission rate of the smoke particles. The study obtained the particle emission rates of different tissues under different electric knife operating powers, results of which showed that (1) during the operation of the electric knife, mainly small particles below 1 μm are produced. Among them, particles of 0.3 μm were the most abundant, with a particle concentration level of up to 109 particles/m3, accounting for 85.17-97.64% of the total particle number, and as the particle size increased, the particle concentration and percentage decreased significantly. (2) The water and fat compositions of different tissues influenced the indoor particle concentration and emission rate of the smoke emitted by the electric knife. Among different tissues, subcutaneous fat tissue had the lowest particle concentration and emission rate. (3) The electric knife operating power mainly affected particles below 1 μm, and except for kidney tissue, the indoor concentration and emission rate of these particle sizes were positively correlated with the power. The experimental results can provide data reference for the use of high-frequency electric knives in surgeries involving different human tissues in the operating room.
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Affiliation(s)
- Hao Li
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China.
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chao Li
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Minwei Zhang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
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Kahramansoy N. Surgical smoke: a matter of hygiene, toxicology, and occupational health. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc14. [PMID: 38655124 PMCID: PMC11035985 DOI: 10.3205/dgkh000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The use of devices for tissue dissection and hemostasis during surgery is almost unavoidable. Electrically powered devices such as electrocautery, ultrasonic and laser units produce surgical smoke containing more than a thousand different products of combustion. These include large amounts of carcinogenic, mutagenic and potentially teratogenic noxae. The smoke contains particles that range widely in size, even as small as 0.007 µm. Most of the particles (90%) in electrocautery smoke are ≤6.27 µm in size, but surgical masks cannot filter particles smaller than 5 µm. In this situation, 95% of the smoke particles which pass through the mask reach deep into the respiratory tract and frequently cause various symptoms, such as headache, dizziness, nausea, eye and respiratory tract irritation, weakness, and abdominal pain in the acute period. The smoke can transport bacteria and viruses that are mostly between 0.02 µm and 3 µm in size and there is a risk of contamination. Among these viruses, SARS-CoV-2, influenza virus, HIV, HPV, HBV must be considered. The smoke may also carry malignant cells. The long-term effects of the surgical smoke are always ignored, because causality can hardly be clarified in individual cases. The quantity of the smoke changes with the technique of the surgeon, the room ventilation system, the characteristics of the power device used, the energy level at which it is set, and the characteristics of the tissue processed. The surgical team is highly exposed to the smoke, with the surgeon experiencing the highest exposure. However, the severity of exposure differs according to certain factors, e.g., ventilation by laminar or turbulent mixed airflow or smoke evacuation system. In any case, the surgical smoke must be removed from the operation area. The most effective method is to collect the smoke from the source through an aspiration system and to evacuate it outside. Awareness and legal regulations in terms of hygiene, toxicology, as well as occupational health and safety should increase.
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Affiliation(s)
- Nurettin Kahramansoy
- Department of Surgery, İzmir Bozyaka Education and Research Hospital, İzmir, Turkiye
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Li C, Geng M, Li S, Li X, Li H, Yuan H, Liu F. Knowledge mapping of surgical smoke from 2003 to 2022: a bibliometric analysis. Surg Endosc 2024; 38:1465-1483. [PMID: 38228836 PMCID: PMC10881617 DOI: 10.1007/s00464-023-10641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE The purpose of this study is to identify and characterize the literature on surgical smoke, visualize the data and sketch a certain trending outline. METHODS In the Web of Science Core Collection (WoSCC), all the data were acquired from January 1st 2003 to December 31st 2022. VOSviewer and CiteSpace were employed to visualize data, based on publications, bibliographic coupling, co-citation, or co-authorship relations. Microsoft Excel 2019 was used to comb and categorize all the statistics. RESULT A total 363 of journal papers were retrieved. The publication number was in a slow but steady growth between 2003 and 2019, followed by a sharp surge in 2020, and then the publication kept in a productive way. Surgical endoscopy and other interventional techniques was the most active journal on surgical smoke. USA played an important role among all the countries/regions. There were 1847 authors for these 363 papers, among whom 44 authors published more than three articles on surgical smoke. "Surgical smoke", "covid-19" and "surgery" were the top 3 appeared keywords, while the latest hot-spot keywords were "COVID-19", "virus", "transmission", "exposure" and "risk". There were 1105 co-cited references and 3786 links appeared in all 363 articles. Among them, 38 references are cited more than 10 times. The most co-cited article was "Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery." Based on the titles of references and calculated by CiteSpace, the top 3 cluster trend network are "laparoscopic surgery", "COVID-19 pandemic" and "surgical smoke". CONCLUSION According to bibliometric analysis, the research on surgical smoke has been drawing attention of more scholars in the world. Increasing number of countries or regions added in this field, and among them, USA, Italy, and China has been playing important roles, however, more wide and intense cooperation is still in expectation.
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Affiliation(s)
- Chuang Li
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng Geng
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shujun Li
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xianglan Li
- Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Huiqin Li
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hufang Yuan
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fengxia Liu
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
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Steel BJ, Horridge C, Awni S, Adams JR. Chemical constituents, viable micro-organism and malignant cell content in ultrasonic scalpel plume: A literature review. J Perioper Pract 2024; 34:47-56. [PMID: 36635896 DOI: 10.1177/17504589221140990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To identify all published data on the chemical, micro-organism and malignant cell contents of ultrasonic scalpel plume, if any, and on any clinical implications of the contents on patients and operating staff. METHODS Searches were conducted aiming to identify all published evidence on the chemical constituents, presence/absence of viable micro-organisms and malignant cells in ultrasonic scalpel plume. Attempts were made to source unpublished industry data. RESULTS There is evidence from human and in vitro studies of the presence of a range of harmful, and some human carcinogenic, chemicals within ultrasonic plume, mostly at very low concentrations. Any clinical relevance of this has not been studied. There is evidence from experimental studies of the presence of hepatitis virus, human coronavirus and human papillomavirus material within ultrasonic plume. Any clinical effect of this has not been studied. There is conflicting evidence from combined in vitro and mouse model studies of the presence of viable malignant cells within ultrasonic plume. Any clinical relevance of this has also not been studied. CONCLUSION Overall, relatively little research into the plume has been published, and further study is required to more clearly delineate any potential risk to patients, surgeons and other theatre staff. Current safety recommendations are discussed.
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Affiliation(s)
- Ben J Steel
- Department of Oral and Maxillofacial Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Catherine Horridge
- Department of Oral and Maxillofacial Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Sarah Awni
- Department of Oral and Maxillofacial Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - James R Adams
- Department of Oral and Maxillofacial Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Ruan J, Dai B, Zhao JG, Tao L, He F. The usefulness and utilization of Gold-finger retractor for endoscopic thyroid surgery. Front Endocrinol (Lausanne) 2023; 14:1228657. [PMID: 37795372 PMCID: PMC10546332 DOI: 10.3389/fendo.2023.1228657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Aims In endoscopic surgery, the visual field is frequently obstructed by muscles, blood, and even smoke. To overcome this problem, we have developed a new detachable Gold-finger retractor for narrow-space surgery. Methods Gold-finger retractor was used in 30 patients to facilitate surgical field exposure and smoke discharge, while in 27 patients, percutaneous silk thread suspension was employed for the same purpose. Both groups underwent endoscopic unilateral thyroidectomy and unilateral central lymph node dissection via oral vestibular microincision combined with the axillary-assisted approach. A comparative analysis was conducted to evaluate the efficacy of the Gold-finger retractor and silk thread suspension in relation to intraoperative exposure effect, surgical fluency, surgeon's comfort, operation time, postoperative complications, and length of hospital stay. This analysis was based on surgical video recordings and postoperative indicators. Results With Gold-finger retractor support, surgeons were able to perform meticulous operations. Complication rates were similar between the two groups, and no serious complications occurred. The number of lymph nodes dissected in the Gold-finger group was significantly greater than that in the routine group (12.43 ± 6.18 and 5.7 ± 2.95, respectively). Further analysis of surgeons' comfort (visibility and convenience in peeling) revealed that the Gold-finger group was significantly better. Electrosurgery smoke was removed effectively with Gold-finger, and the operation time was significantly reduced. Conclusion In thyroid surgery, Gold-fingers enhance visual field resolution, avoid muscle cutting, save time, and improve the surgical experience.
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Affiliation(s)
- Jian Ruan
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Bin Dai
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Jian Guo Zhao
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Long Tao
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
| | - Fan He
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital, Wuhan, China
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Kuo TC, Chen KY, Lai CW, Wang YC, Lin MT, Chang CH, Wu MH. Synergic evacuation device helps smoke control during endoscopic thyroid surgery. Surgery 2023:S0039-6060(23)00187-3. [PMID: 37202307 DOI: 10.1016/j.surg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Surgical plumes in small cavities, such as transoral endoscopic thyroid surgery, have never been satisfactorily resolved. We aimed to study the use of a smoke evacuation system and evaluate its efficacy, including the field of view and operating time. STUDY DESIGN We retrospectively reviewed 327 consecutive patients who underwent endoscopic thyroidectomy. They were separated into 2 groups based on whether the smoke evacuation system was used. To reduce the possible experience bias, only patients 4 months before and after implementing the evacuation system were included. Recorded endoscopic videos were evaluated, including the field of view, the incidence of scope clearance, and time spent during air-pocket creation. RESULTS Overall, there were 64 patients with a median age of 43.59 years and a median body mass index of 22.87 kg/m2, including 54 women, 21 thyroid cancers, and 61 hemithyroidectomies. The operative duration was comparable between the groups. The group where the evacuation system was used scored more as good in terms of endoscopic views (8/32, 25% vs 1/32, 3.13%, P = .01), fewer incidences of endoscope lens pull out for clearance (3.5 vs 6.0 times, P < .01), less time for clear view after energy device activation (2.67 vs 5.00 seconds, P < .01), and less time spent (8.67 vs 12.38 minutes, P < .01) during air-pocket creation. CONCLUSION In conjunction with the synergy function of energy devices, evacuators enhance the field of view and optimize the time spent in the real clinical setting of low-pressure and small-space endoscopic thyroid procedures, in addition to the benefit of reducing smoke harm.
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Affiliation(s)
- Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. https://twitter.com/tinakuo1204
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Wen Lai
- Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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11
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Lathers S, Krishnamoorthy M, Vasdev N, Tegan G. Distribution of surgical smoke particles within a simulated laparoscopic cavity utilizing an AirSeal ® system. J Med Eng Technol 2023; 47:12-28. [PMID: 35801978 DOI: 10.1080/03091902.2022.2096134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
An exploratory study was performed to determine the distribution of surgical smoke particulate matter (SSPM) and evacuation times within an AirSeal® System and a traditional insufflation access system in various simulated surgical scenarios. Identified trends showed statistical significance when setting the AirSeal® System to Low smoke evacuation that it reduces the percentage of particulate matter at the Access Port opening. Additionally, it was observed that when utilising a laparoscopic tool a similar trend in particle distributions were seen between either insufflation and access system at the opening of the Access Port and trocar. Evacuation times for SSPM removal within the AirSeal® System showed an overall average to ≥95% reduction of 5.64 min within the surgical cavity, 3.69 min at the Access Port opening, and 3.61 min within the smoke evacuation line. The overall average for the traditional insufflation and access system was 9.38 min within the surgical cavity and 6.06 min at the trocar opening. Results showed that when using the traditional system compared to the AirSeal® System, it resulted in a percent change increase in evacuation times of 66.31% within the surgical cavity and 64.23% at the trocar opening.
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Affiliation(s)
- Steven Lathers
- Research and Development, CONMED Corporation, Largo, Florida, USA
| | | | - Nikhil Vasdev
- Department of Urology, Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Gary Tegan
- Research and Development, CONMED Corporation, Largo, Florida, USA
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12
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Suzuki T, Matsumoto A, Akao T, Kobayashi S, Matsumoto H. Laparoscopic appendectomy for acute appendicitis in patients with COVID-19 confirmation: A case report. Int J Surg Case Rep 2022; 100:107740. [PMID: 36245748 PMCID: PMC9551111 DOI: 10.1016/j.ijscr.2022.107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 10/28/2022] Open
Abstract
Introduction Strategies to postpone elective surgeries were proposed to maintain the hospital capacity to cater for coronavirus disease 2019 (COVID-19) and emergency non-COVID cases. Non-operative management (NOM) was recommended when possible during the COVID-19 era. However, the optimal approach to acute appendicitis (AA) in patients with COVID-19 remains controversial. Presentation of case A 25-year-old man who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) was referred to our institution with a diagnosis of AA with appendicolith. Chest computed tomography did not detect evidence of pneumonia. Laparoscopic appendectomy was performed after strict infection prevention measures were taken. The postoperative course was uneventful. No respiratory symptoms such as cough or sputum production occurred postoperatively. No signs of infection in medical staff or spread in the operating room and infectious disease ward were observed. Discussion The treatment policy should fully consider the risk of COVID-19 infection to medical staff and the risk of aggravation in patients who tested positive for SARS-Cov-2. Surgery was chosen over NOM for AA with appendicolith because the presence of appendicolith was thought to indicate a high probability of treatment failure in NOM and possible perforation; thus, case more difficult measures were required for SARS-Cov-2-positive cases. Conclusion Careful assessment of the patient's condition and consideration of the treatment method is important, rather than choosing NOM over operative management based solely on SARS-Cov-2-positive status. Laparoscopic appendectomy with adequate infection control measures can be safely performed in SARS-Cov-2-positive cases.
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13
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Riopelle AM, Potter CT, Jeong D, Schanbacher CF. Plume Generated by Different Electrosurgical Techniques: An In Vitro Experiment on Human Skin. Dermatol Surg 2022; 48:949-953. [PMID: 36054048 DOI: 10.1097/dss.0000000000003518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Plume generated by electrosurgical techniques is a health hazard to patients and dermatologists. OBJECTIVE To compare the particle concentration generated by various energy devices used in dermatologic surgery. MATERIALS AND METHODS Five surgical techniques were tested on human tissue samples in a closed chamber. A particle counter, positioned at a fixed point 20 cm away from the sample, recorded the concentrations of aerosolized particles generated over 7 particle sizes (0.3, 0.5, 0.7, 1, 2.5, 5, and 10 μm). RESULTS Monopolar electrocoagulation created the greatest concentration of particles followed by electrocautery, electrodesiccation, electrofulguration, and bipolar electrocoagulation. Bipolar electrocoagulation created 80 times fewer 0.3 μm particles and 98 times fewer 0.5 μm particles than monopolar electrocoagulation. Across all electrosurgical techniques, the greatest concentrations of particles generated were of the 0.3 and 0.5 μm particle size. CONCLUSION Bipolar electrocoagulation created the lowest concentration of particulate matter. Given the noxious and hazardous nature of surgical plume, the bipolar forceps offer surgeons a safer method of performing electrical surgery for both the surgical staff and the patient.
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Affiliation(s)
| | | | | | - Carl F Schanbacher
- Kuchnir Dermatology, Milford, Massachusetts
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts
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14
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Dröge J, Moussaoui IE, Klingelhöfer D, Held H, Groneberg DA, Verhoff MA, Plenzig S. Particulate matter emissions during autopsies: a method to reduce exposure. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:60519-60530. [PMID: 35420344 PMCID: PMC9008663 DOI: 10.1007/s11356-022-20021-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Particulate matter emitted during autopsies can serve as a vector for numerous viruses or bacteria and can lead to infections. Reducing the exposure of those particles in indoor working environments is, therefore, an important issue. To assess the health risk for employees in forensic medicine, we measure particulate matter in the ambient air during autopsies by using an aerosol spectrometer. The autopsies were performed with either an ordinary oscillating saw or an adapted saw with a suction unit. The particle emissions from both saws were compared to each other in order to evaluate whether a technical adaption leads to a particle reduction. Furthermore, the particle exposure reduction by wearing a face mask and variations in the background concentration in the room were analyzed. High particle concentrations were measured while using the ordinary saw. By using the adapted saw or wearing a face mask, the particle exposure could mostly be avoided. On the majority of the working days, an increase in the background concentration could be observed. Based on this knowledge, the use of a proper suction unit and wearing a face mask during autopsies is necessary. Besides, it is important to have sufficient ventilation in the room so that long-lasting high background concentrations can be prevented.
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Affiliation(s)
- Janis Dröge
- Institute of Occupational, Social, and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Ibrahim El Moussaoui
- Institute of Occupational, Social, and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Doris Klingelhöfer
- Institute of Occupational, Social, and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Hannelore Held
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational, Social, and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - Stefanie Plenzig
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
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15
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Heroor AA, Asaf BB, Deo SSV, Lau EHL, Mok CW, DiPasco PJ, Jain P, Anand U. Occupational Hazards of Surgical Smoke and Achieving a Smoke Free Operating Room Environment: Asia-Pacific Consensus Statement on Practice Recommendations. Front Public Health 2022; 10:899171. [PMID: 35692344 PMCID: PMC9178078 DOI: 10.3389/fpubh.2022.899171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgical smoke generated through energy devices may present detrimental effects on individuals present in the operating room (OR). Despite the concerns possibly associated with surgical smoke, there may be no mandatory policies that suggest protective measures and limited firm standards are committed yet to address the same. Aim The aim of this paper is to present recommendations for surgeons and OR personnel by taking a consensus approach based on available literature and its interpretation by a multi-national panel of experts. Methods The Asia-Pacific (APAC) group was established with the aims of reviewing literature evidence, discussing key issues regarding surgical smoke and its hazards, and offering a summary of statements in achieving a smoke-free OR environment. Eleven expert surgeons from the international APAC region were gathered with the purpose of coming to a consensus on engineering, best work-practices, and administrative controls in minimizing surgical smoke exposure. A two-phase consensus method was used to obtain opinions from the expert panel of specialists. Statements with an agreement of more than 80% were accepted. Findings For twenty-one statements, the panel achieved consensus on 17 statements; another 5 were dropped due to lack of consensus. The consensus was obtained on statements that address the need for the implementation of administrative policies, training and awareness, standard procedure for the continued use of engineering controls, stringent work practice controls and preventive controls. Conclusion The statements presented may guide surgeons and OR personnel in the practical management of surgical smoke safety, mitigating the risks associated with it. The consensus statement also provides a series of recommendations that can be used with other stakeholders, such as policymakers, hospital administrators and professional societies, to highlight and motivate the implementation of meaningful policies.
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Affiliation(s)
| | - Belal Bin Asaf
- Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, India
| | | | - Eric Hui-Lun Lau
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore
- Singhealth Duke-NUS Breast Centre, Singapore, Singapore
| | | | - Pradeep Jain
- Gastro-Intestinal Oncosurgery, Fortis Hospitals, New Delhi, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
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Hirota M, Takahashi H, Takahashi T, Kurokawa Y, Yamasaki M, Eguchi H, Doki Y, Nakajima K. A Smoke Evacuator Equipped With a Filter Contributes Enough to Safe Gas Exhaustion From the Abdominal Cavity. Asian J Endosc Surg 2022; 15:427-431. [PMID: 34532969 DOI: 10.1111/ases.12988] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
Surgical plume (SP) carries biological risks such as virus transmission. An evacuation system can remove SP from the surgical field, but is it safe to release evacuated gas into the operating room (OR) atmosphere? We examined this using a commercially available evacuator equipped with a filter under a laparoscopic porcine surgery model. SP was generated by activating an electrocautery or ultrasonic scalpel on the surface of the liver, and we evaluated whether DNA fragments derived from porcine tissue were present in the exhausted gas from the evacuation system into the atmosphere. DNA fragments were detected in the inlet gas of the evacuation system, while it was not detected in the outlet gas. As far as pathogen transmission via SP in the abdominal cavity is concerned, if the smoke evacuator ensures filter adsorption, it seems that there is little risk in releasing the suction gas into the atmosphere in the OR.
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Affiliation(s)
- Masashi Hirota
- Department of Next Generation Endoscopic Intervention, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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17
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Yan L, Liu Y, Zhang J, Chen X, Li J, Zhu X. In vivo and in vitro study of the potential hazards of surgical smoke during cervical cancer treatment with an ultrasonic scalpel. Gynecol Oncol 2022; 164:587-595. [PMID: 35033382 DOI: 10.1016/j.ygyno.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the composition and potential hazards of cervical cancer surgical smoke generated by ultrasonic scalpels. METHODS Surgical smoke was collected during the cutting and coagulation of cervical cancer xenograft tumors using an ultrasonic scalpel. Surgical smoke-filtered cells were cultured and subcutaneously injected into nude mice. Cell morphology and viability were assessed by HE, Pap and trypan blue staining. HPV DNA in surgical smoke samples was identified by PCR. HPV transmission was determined by culturing HPV-negative C33A cells in HPV-positive surgical smoke-filtered medium. The cytotoxicity of surgical smoke to small airway epithelial cells (SAECs) and THP-1 cells was determined by CCK-8, MTS and LDH release assays. Volatile organic compounds (VOCs), which are present in cervical cancer surgical smoke samples obtained by laparoscopic hysterectomy, were analyzed by gas chromatography-mass spectrometry (GC-MS). RESULTS Cellular debris and epithelioid cells were found in surgical smoke, but no malignant cells were observed. HPV DNA was identified in all smoke samples, and HPV genotypes were matched to those in cervical cancer cells. Coculture with HPV-positive surgical smoke-filtered medium induced an 83% (15 of 18) HPV positivity rate in C33A cells. Subculture in normal medium decreased this rate to 50% (9 of 18). The proliferation of SAECs and THP-1 cells was inhibited by smoke-filtered medium in a time-dependent manner. The concentration of total VOCs, especially benzene, toluene and xylene, in surgical smoke exceeded the standard for good indoor air quality. CONCLUSION Cervical cancer surgical smoke contains HPV and VOCs and exhibits cytotoxicity and infectivity in vitro. Surgical smoke is an occupational hazard to health care workers.
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Affiliation(s)
- Linzhi Yan
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yi Liu
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jianan Zhang
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xin Chen
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jingwei Li
- Department of Obstetrics and Gynecology, Taizhou Women and Children's Hospital of Wenzhou Medical University, Taizhou 317599, Zhejiang, China
| | - Xueqiong Zhu
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China; Department of Obstetrics and Gynecology, Taizhou Women and Children's Hospital of Wenzhou Medical University, Taizhou 317599, Zhejiang, China.
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18
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Geier CM, Barnes KH, Simon BT, Thieman Mankin KM. The effect of a smoke‐evacuation unit on ultrafine particle concentrations in the operating room during approach to the proximal tibia for tibial plateau‐leveling osteotomy surgery in dogs. Vet Surg 2022; 51:809-815. [DOI: 10.1111/vsu.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/10/2021] [Accepted: 02/06/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Cindy M. Geier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas USA
| | - Katherine H. Barnes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas USA
| | - Bradley T. Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas USA
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station Texas USA
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19
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Morimoto G, Kawahira H, Takayama S, Lefor AK. Chemical Components of Smoke Produced From Versatile Training Tissue Models Using Electrocautery. Simul Healthc 2022; 17:29-34. [PMID: 34009917 PMCID: PMC8812419 DOI: 10.1097/sih.0000000000000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION While exposure of surgeons and other staff to surgical smoke is an increasing health risk concern, there is a similar risk for users in surgical simulation and training. This study was undertaken to determine the chemical composition of smoke produced from a novel training model, Versatile Training Tissue (VTT), which is used for surgical simulation and training, and to compare this with smoke from a chemosynthetic model and porcine muscle and liver. METHODS A variety of models (VTT, polyvinyl alcohol, porcine muscle and liver) were prepared and cauterized. Identification of chemical substances in smoke was performed using gas chromatography-mass spectrometry. Quantitative instrumental analysis was implemented with gas chromatography-mass spectrometry and high-performance liquid chromatography. A convenient analysis was performed with a general smoke tube kit. RESULTS The main chemical components of smoke produced from VTT models include water and carbon dioxide. A small number of organic compounds were detected. Versatile Training Tissue models produced smoke with fewer compounds than smoke from a chemosynthetic model or porcine muscle. CONCLUSIONS The concentration of organic compounds from VTT models is considered to be below relevant health risk limits and lower than from polyvinyl alcohol and porcine muscle models. Although porcine liver smoke contains less of the main organic compounds of concern than a KM, it contains potentially hazardous nitrile compounds that are absent in KM smoke. Therefore, surgical simulation and training with VTT models should be considered relatively safe for trainees.
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20
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Mizukami Y, Maki R, Adachi H. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6541664. [PMID: 35238383 PMCID: PMC9373938 DOI: 10.1093/icvts/ivac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 11/12/2022] Open
Abstract
Fogging of the thoracoscopic lens affects a surgeon’s ability to maintain a clear operating field. In uniportal video-assisted thoracoscopic surgery, the thoracoscopic lens tends to fog when the surgeon does not hold a suction instrument. Thus, a suction instrument needs to be held by the surgeon’s nondominant hand to remove surgical smoke, mist, and moisture. Here, we describe a simple, easy and cost-effective surgical smoke ventilation technique for uniportal video-assisted thoracoscopic surgery using a suction catheter to solve the problem. We present this technique and comment on its advantages, including decreased cost and improved surgical visualization.
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Affiliation(s)
- Yasushi Mizukami
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
- Corresponding author. Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, 2-3-54 Kikusui 4-jo, Shiroishi-ku, Sapporo-shi, Hokkaido 003-0804, Japan. Tel: +81-11-811-9111; fax: +81-11-832-0652; e-mail: (Y. Mizukami)
| | - Ryunosuke Maki
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
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21
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Cinar F, Sanlier NB. Investigation of Surgical Smoke Exposure and Well-Being Levels of Operating Room Workers in the COVID-19 Pandemic. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/tq3vuocmzd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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22
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Gioutsos K, Nguyen TL, Biber U, Enderle MD, Koss A, Kocher GJ. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:775-782. [PMID: 35137083 PMCID: PMC9070503 DOI: 10.1093/icvts/ivac024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Konstantinos Gioutsos
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh-Long Nguyen
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Gregor J Kocher
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Corresponding author. Division of General Thoracic Surgery, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland. Tel: +41-31-6322330; fax: +41-31-6322327; e-mail address: (G.J. Kocher)
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23
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Balakrishna P, Singh HK, Kumar NP, Jamir L. Minimally invasive surgery in India during the COVID-19 pandemic: A survey. J Minim Access Surg 2022; 18:58-64. [PMID: 35017394 PMCID: PMC8830557 DOI: 10.4103/jmas.jmas_244_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to the healthcare systems worldwide. This uncharted territory has changed the practices in modern healthcare delivery; this is particularly true in the case of minimally invasive surgery (MIS) where various changes are being adopted. This survey was conducted to determine the impact of the pandemic and the changes being adopted in the field of MIS, from a resource-limited developing country, India. MATERIALS AND METHODS The survey was carried out from 27 July to 22 August 2020, amongst MIS surgeons in India using an online questionnaire generated on Google Forms. RESULTS The survey was completed by 251 MIS surgeons nationwide. There was a proportional reduction of overall elective surgeries and MIS. Approximately 30% of the surgeons continued to use MIS, as during the pre-pandemic era. Pre-operative tests for COVID-19 (96.1%) and personal protective equipment (PPE, 66%-86%), including respirators (95.2%), are used uniformly across the nation. Almost half (43.1%) of the MIS surgeons are using ≥6 recommended intraoperative modifications in MIS to mitigate the COVID-19 transmission. CONCLUSION MIS surgeons in India have adapted within a short time to the challenge of the pandemic by embracing pre-operative testing, PPE and new techniques/technologies to continue patient care. Innovations and low-cost indigenous customisations are the need of the hour for a developing country like India. Further studies are required to establish the true risk of viral transmission involved in MIS and the efficacies of the techniques/devices to reduce the spread of the virus.
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Affiliation(s)
- Pavithra Balakrishna
- Department of General Surgery, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Hemant Kumar Singh
- Department of General Surgery, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Naresh P. Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Limalemla Jamir
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
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24
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Zhu Z, Liu N, Xia W, Liu H, Wood KB, Wang K. Bacteria in Surgical Smoke: A Self-controlled Laboratory Study Using Porcine Spinal Tissues. Spine (Phila Pa 1976) 2021; 46:E1230-E1237. [PMID: 33907080 DOI: 10.1097/brs.0000000000004079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A laboratory study performed in a self-controlled fashion. OBJECTIVE The aim of this study was to examine whether "surgical smoke" generated by using the electrocautery on porcine spinal tissues could contain viable bacteria. SUMMARY OF BACKGROUND DATA The year 2020 has seen a surge in legislation regarding surgical smoke evacuation in the operating room across the United States. Surgical smoke contains numerous toxic and carcinogenic substances, which spine surgeons and operating room staff are regularly exposed to. Although the smoke's chemical toxicity has been extensively studied, little is known about its biohazard level. METHODS The electrocautery was used to "operate on" 20 segments of porcine spinal tissues on a clean bench. In each operation, the generated smoke was captured with a swab, which was positioned above the surgical site and within the smoke, to obtain bacteria cultures. Two other swabs-a tissue swab (swabbing the porcine tissue itself) and a blank swab (swabbing an empty sterile bowl)-were collected as controls. The culture results were compared among the three groups. An additional experiment was conducted to see whether using a mask can reduce the "infection rate" of the swab. RESULTS Although all blank swabs tested negative, 95% (19/20) of the smoke swabs tested positive, with a total of nine bacteria species identified. The most prevalent species observed in the smoke swabs included Serratia liquefaciens, Lactococcus garvieae, and Hafnia alvei, and so on. Among the positive smoke swabs, 84% (16/19) had one or more bacteria species that were consistent with the cultures of their corresponding tissue swabs. Using a surgical or N95 mask reduced the "infection rate" of the swab. CONCLUSION "Surgical smoke" generated by electrocauterization of porcine spinal tissues contains viable bacteria. Further research in actual spine surgery is needed next.Level of Evidence: N/A.
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Affiliation(s)
- Zhenqi Zhu
- Peking University People's Hospital, Department of Spine Surgery, Beijing, China
| | - Ning Liu
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Weiwei Xia
- Peking University People's Hospital, Department of Spine Surgery, Beijing, China
| | - Haiying Liu
- Peking University People's Hospital, Department of Spine Surgery, Beijing, China
| | - Kirkham B Wood
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Kaifeng Wang
- Peking University People's Hospital, Department of Spine Surgery, Beijing, China
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Watters DA, Foran P, McKinley S, Campbell G. Clearing the air on surgical plume. ANZ J Surg 2021; 92:57-61. [PMID: 34724305 DOI: 10.1111/ans.17340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. METHOD This paper is a narrative review of potential risks, including any associated with COVID-19, and options for mitigation. RESULTS Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID-19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID-19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. CONCLUSION The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.
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Affiliation(s)
- David A Watters
- Victorian Perioperative Consultative Council, Victoria, Australia.,School of Medicine and Health Sciences, Deakin University, Geelong, Australia.,Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Paula Foran
- Victorian Perioperative Consultative Council, Victoria, Australia.,College of Health and Medicine, University of Tasmania, Hobart, Australia.,Mercy Hospital for Women, Heidelberg, Australia
| | - Sharryn McKinley
- Victorian Perioperative Consultative Council, Victoria, Australia.,CURA Day Hospitals Group, Australia
| | - Graeme Campbell
- Victorian Perioperative Consultative Council, Victoria, Australia.,Department of Surgery, Bendigo Health, Bendigo, Australia
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26
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Karveli A, Tzoutzas IG, Raptis PI, Tzanakakis EGC, Farmakis ETR, Helmis CG. Air Quality in a Dental Clinic during Er:YAG Laser Usage for Cavity Preparation on Human Teeth-An Ex-Vivo Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010920. [PMID: 34682658 PMCID: PMC8535664 DOI: 10.3390/ijerph182010920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022]
Abstract
Chemical air pollution in dental clinics consists of the emission of gases and particulate matter (PM), both generated by dental equipment and tooth tissues. One basic application of Erbium Laser devices is cavity preparation on human teeth due to its strong affinity to water and hydroxyapatite. The objective of this study was the evaluation of indoor air quality during the application of an Er:YAG laser, as a dentin removal instrument, in a Dental Clinic. Particulate Matter (PM) was measured using the standard method of EN legislation. In order to measure total Volatile Organic compounds (VOCs), a portable monitor was used. In the first experiment, PM10 and PM2.5 concentrations were increased by approximately 10 and 15 times, respectively. From the second experiment it can be concluded that neither of the measured particle concentrations exceeded the recommended indoor limit values while windows were open, although laser influence was still detectable. Within the limitations applied herein, it was found that Er:YAG laser activity for hard dental tissue removal was associated with high PM and TVOCs concentration values in the working environment, under insufficient or no ventilation. Physical ventilation in the aforementioned setting proved to be an important key factor in improving air quality, as both PM and TVOCs concentrations decreased significantly.
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Affiliation(s)
| | - Ioannis G. Tzoutzas
- Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.G.T.); (E.-G.C.T.)
| | | | - Emmanouil-George C. Tzanakakis
- Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.G.T.); (E.-G.C.T.)
| | - Eleftherios Terry R. Farmakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
| | - Constantinos G. Helmis
- Division of Applied Physics, Department of Physics, University of Athens, 11527 Athens, Greece;
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Byrne H, Chawla A, Gurung G, Hughes G, Rao M. Variations in colorectal cancer surgery practice across the United Kingdom during the COVID-19 pandemic - 'Every land has its own law'. Surgeon 2021; 19:e183-e192. [PMID: 33309261 PMCID: PMC7724990 DOI: 10.1016/j.surge.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/22/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In March 2020 NHS England issued guidelines recognizing the elective component of cancer surgeries may be 'curtailed', due to staffing and supply shortages during the COVID-19 pandemic. However, it suggested, 'local solutions' should be sought in order to protect the delivery of cancer services. We aimed to compare surgeons' practice for the provision of colorectal (CR) cancer surgery across the United Kingdom (UK), against updated Joint Royal Colleges & ACPGBI guidelines and highlight differences in practice, if any. METHOD An online survey was conducted. It examined surgical practice across the UK against current protocols for CR cancer surgeries, during the COVID-19 pandemic. RESULTS 29 individual responses were received from 23 NHS Trusts across the UK. 23/29 (79%) surgeons ceased or experienced delays in their CR cancer surgeries during the pandemic, with 3/29 (10%) yet to reintroduce these services. 19/26 (73%) surgeons instructed their patients to self-isolate prior to surgery, of which 5/19 (26%) correctly enforced a duration of 14 days. 10/19 (53%) participants adhered to guidelines of performing a CT chest within 24 h of surgery. 10/26 (38%) participants believe their patients are experiencing longer hospital admissions in the COVID-19 setting. CONCLUSION This snap shot survey highlights the dramatic variations in CR cancer surgery practice within the UK and inconsistent adherence to protocols. Guidelines will no doubt change as our knowledge of COVID-19 increases both nationally and internationally. It is essential CR surgeons keep up to date with changes in guidance, so uniformity in practice can be maintained.
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Affiliation(s)
- Hannah Byrne
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Aastha Chawla
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Ganga Gurung
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Gemma Hughes
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK
| | - Milind Rao
- Department of General Surgery, United Lincolnshire Hospital NHS Trust, Pilgrim Hospital, Boston, UK.
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28
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Vaghef Davari F, Sharifi A. Transmission Possibility of COVID-19 via Surgical Smoke Generated by the Use of Laparoscopic Approaches: A Subject of Debate During the Pandemic. J Laparoendosc Adv Surg Tech A 2021; 31:1106-1113. [PMID: 34534021 DOI: 10.1089/lap.2021.0498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: The smoke created by energy-based devices during surgery may have the potential to transmit viral components to operating room staff. The COVID-19 pandemic has changed staff safety regulations. However, it is not clearly understood whether it can be transmitted via surgical smoke. Laparoscopic approaches have become the standard surgical procedure in many cases, but some of previous investigations have advised to pretermit these approaches due to high risk of COVID-19 transmission. Materials and Methods: We reviewed the English literature that were indexed in the PubMed, Google Scholar, and Scopus databases by using key words including Virus, viral transmission, surgical smoke, surgical plum, laparoscopy, and COVID-19 both solely and in two-word combination. A total of 87 articles were found relevant, and after reviewing the abstract, 33 articles were shortlisted and summarized. Results: Previous studies have focused on different surgical instruments that generate smoke, methods to collect and analyze the smoke and to understand the implications of its exposure after an analysis. A total of 9 out of 11 studies on the potential transmission of human papilloma virus through surgical smoke found evidence in favor of transmission. There were studies on the possible transmission of HIV, hepatitis B virus, and Sabin poliomyelitis vaccine virus 2. Conclusion: We do not believe that laparoscopic procedures may have extra risk for COVID-19 transmission compared with the open procedures, but it is always advised that the operating room staff adhere to the safety instructions during the COVID-19 pandemic.
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Affiliation(s)
- Farzad Vaghef Davari
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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29
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Xie W, Dumas O, Varraso R, Boggs KM, Camargo CA, Stokes AC. Association of Occupational Exposure to Inhaled Agents in Operating Rooms With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses. JAMA Netw Open 2021; 4:e2125749. [PMID: 34542617 PMCID: PMC8453320 DOI: 10.1001/jamanetworkopen.2021.25749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Employment in operating rooms (ORs) may involve exposure to several inhaled agents, including surgical smoke and disinfectants, which are associated with adverse respiratory health effects. However, the association of long-term employment in ORs and chronic obstructive pulmonary disease (COPD) remains unknown. OBJECTIVE To examine the association of working in an OR with incidence of COPD among female nurses in the US. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Nurses' Health Study for US female registered nurses who provided information on questionnaires regarding OR employment history in 1984 and job type in 1982 and who had no history of COPD in 1984 (baseline). Data analyses were conducted from April 1, 2020, to January 31, 2021. EXPOSURES Duration of nursing in the OR and job type. MAIN OUTCOMES AND MEASURES The associations of any employment as an OR nurse, duration of employment, and duration and job type with incidence of self-reported, physician-diagnosed COPD. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression models stratified by age and calendar year. Models were adjusted for covariates, with model 1 adjusting for age, model 2 also adjusting for cigarette smoking status and pack-year of smoking, and model 3 also adjusting for race and ethnicity, US Census region, and body mass index. RESULTS Among 75 011 female nurses included in the analyses, the mean (SD) age at baseline was 50.5 (7.2) years; 29% had a history of employment in an OR, and 3% had 15 or more years of OR experience. In model 3, employment in an OR for 15 or more years was associated with a 46% increased risk of developing COPD compared with no history of OR employment (HR, 1.46; 95% CI, 1.10-1.93). Compared with nurses who never worked in an OR and had an administrative or nursing education function or a nonnursing job in 1982, the risk of developing COPD was greater among nurses who provided outpatient care (HR, 1.24; 95% CI, 1.04-1.47) and nurses employed in inpatient units (HR, 1.31; 95% CI, 1.07-1.59) who had no history of OR employment and was 69% greater among nurses with OR experience of 15 years or more (HR, 1.69; 95% CI, 1.25-2.28). CONCLUSIONS AND RELEVANCE In this cohort study, OR employment of 15 years or more was associated with an increased risk of developing COPD among female nurses. Additional studies with more recent and direct environmental monitoring data of multiple occupational exposures are needed to assess the relative role of exposure to surgical smoke and disinfectants in the observed association.
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Affiliation(s)
- Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Orianne Dumas
- Université Paris-Saclay, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, Villejuif, France
| | - Krislyn M. Boggs
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Carlos A. Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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30
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J A de Boer A, Fransen F, R Bloemen P, A Meesters A, A de Rie M, Wolkerstorfer A. Ultrafine particle concentrations during laser hair removal: Effectiveness of smoke evacuators. Lasers Surg Med 2021; 54:217-223. [PMID: 34396537 DOI: 10.1002/lsm.23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Laser smoke is a biohazard that contains potentially dangerous toxic and biological components. In laser hair removal (LHR), practitioners undergo prolonged exposure as this procedure is widely used without protective measures. Little is known about the effect of smoke evacuators on ultrafine particle concentrations during LHR. This study aims to assess the effect of different laser devices and different smoke evacuators on the ultrafine particle concentrations in the room during LHR. STUDY DESIGN/MATERIALS AND METHODS In a prospective observational study, we included patients with skin phototypes 2-4 for 755 nm Alexandrite LHR at two study sites, receiving treatment in axillae and pubic areas. Ultrafine particle concentrations were measured during LHR for two different alexandrite lasers, with and without an external smoke evacuator. Moreover, we assessed a device for LHR with a smoke evacuator integrated into the handpiece. Primary outcomes were the concentration of ultrafine particles (0.2-0.3 µm) per m3 at 1 min after initiation of treatment and maximum concentrations. RESULTS A total of 15 patients were recruited for routine LHR. Without a smoke evacuator, already at 1 minute after treatment onset, ultrafine particle concentrations rapidly increased. Both external and integrated smoke evacuators were highly effective with a 3.7-7-fold decrease in maximal particle count. Similarly, maximal particle concentrations remained low with both smoke evacuators. At both study sites, particle concentrations decreased slowly (8 min for 50% reduction) when treatment stopped. CONCLUSION LHR procedures generated an increase of ultrafine particles. Both the external and integrated smoke evacuators are highly effective in controlling ultrafine particle concentrations during LHR. Once particle concentrations are elevated and the process had been completed, clearance of ultrafine particles is rather slow.
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Affiliation(s)
- Anne J A de Boer
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Frederike Fransen
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul R Bloemen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arne A Meesters
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Menno A de Rie
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
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31
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Mun DH, Pradere B, Shariat SF, Yurdakul O, Remzi M. COVID-19 crisis and minimally invasive surgery: a narrative review on intraoperative aerosol viral transmission and their impact on guidelines and clinical practice in Austria. Curr Opin Urol 2021; 31:340-345. [PMID: 33965981 PMCID: PMC8183247 DOI: 10.1097/mou.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the risk of intraoperative aerosol viral transmission and the impact of updated COVID-19 guidelines on minimally invasive surgery (MIS) in Austria. RECENT FINDINGS The current literature does not support the risk of intraoperative viral transmission nor does it suggest a harm of minimally invasive procedures in the context of the COVID-19 pandemic. However, medical societies mostly adopted a precautionary approach with a focus on protective measures. Austrian surgeons considered MIS safe during the pandemic and Austria managed to keep the initial outbreak in control. Yet, MIS programs were still affected due to the postponements of elective procedures and switches to other methods by some surgeons. SUMMARY The postponement and cancellation of MIS caused complexities in health-care delivery in Austria, whilst the evidence to substantiate this precautionary approach is missing. It must be noted, both the guidelines and our review are limited by the scarcity of evidence. In further consequence, regional factors should be considered while taking precautions. Specific studies on the severe acute respiratory syndrome coronavirus type 2 transmission risk during MIS are urgently needed.
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Affiliation(s)
- Dong-Ho Mun
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, Netherlands
| | - Ozan Yurdakul
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Chairman of the Laparoscopic and Robotic Surgery Section of the Austrian Urological Association, Vienna, Austria
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32
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Zhou R, Xia M, Zhang L, Cheng Y, Yan J, Sun Y, Wang J, Jiang H. Fine particles in surgical smoke affect embryonic cardiomyocyte differentiation through oxidative stress and mitophagy. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 217:112259. [PMID: 33910067 DOI: 10.1016/j.ecoenv.2021.112259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
Surgical smoke is widespread in operating rooms, and fine particles are the main toxic components. However, the effect of fine particles in surgical smoke on embryonic development has not yet been studied. This study evaluated the effect of fine particles in surgical smoke on embryonic development and compared it with that of atmospheric fine particles. Afterwards, differentiated cardiomyocytes were purified, and the effect of exposure to fine particles in surgical smoke on cardiomyocyte differentiation was evaluated. Fine particles in surgical smoke exhibited weak embryotoxicity toward an embryonic stem cell test model, and their inhibitory effect on cardiomyocyte differentiation was slightly stronger than that of atmospheric fine particles. Fine particles in surgical smoke specifically inhibited the differentiation of the mesoderm lineage and promoted the differentiation of the ectoderm lineage. Furthermore, fine particles in surgical smoke reduced the beating rate of purified cardiomyocytes, promoted mitophagy, reduced ATP production and increased the reactive oxygen species (ROS) content. Antioxidants attenuated the inhibition of cardiomyocyte differentiation and the reduction in the cardiomyocyte beating rate caused by fine particles in surgical smoke and simultaneously restored mitophagy and other processes to the control levels. However, mitophagy inhibitors treatment blocked only the inhibition of cardiomyocyte differentiation caused by fine particles in surgical smoke; it had little effect on other changes caused by fine particles. Based on the results described above, we propose that fine particles in surgical smoke and atmospheric fine particles exhibit similar levels of toxicity toward embryonic development. Fine particles in surgical smoke potentially affect the beating of cardiomyocytes by damaging mitochondria and increasing oxidative stress.
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Affiliation(s)
- Ren Zhou
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China.
| | - Ming Xia
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Lei Zhang
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Yanyong Cheng
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Jia Yan
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Yu Sun
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Jie Wang
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Hong Jiang
- The Ninth People's Hospital of Shanghai, Jiao Tong University School of Medicine, Shanghai 200011, PR China.
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Chiu CH, Chen CT, Cheng MH, Pao LH, Wang C, Wan GH. Use of urinary hippuric acid and o-/p-/m-methyl hippuric acid to evaluate surgical smoke exposure in operating room healthcare personnel. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 217:112231. [PMID: 33862429 DOI: 10.1016/j.ecoenv.2021.112231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Toluene and xylene are common components of surgical smoke, whereas hippuric acid (HA) and methylhippuric acid (MHA) are the products of toluene and xylene metabolism in humans, respectively. HA and MHA can be used as indicators to evaluate the exposure hazards of toluene and xylene. In this study, we used liquid chromatography tandem mass spectrometry (LC-MS/MS) to simultaneously analyze the HA, o-/m-/p-MHA, and creatinine contents in the urine of healthcare personnel. Concentrations of HA and o-/m-/p-MHAs were normalized to those of creatinine and used to analyze urine samples of 160 operating room (OR) healthcare personnel, including administrative staff, surgical nurses, nurse anesthetists, and surgeons. The results showed that the five analytes could be accurately separated and exhibited good linearity (r > 0.9992). The rate of recovery was between 86% and 106%, and the relative standard deviation was less than 5%. Urine from administrative staff presented the highest median concentration of hippuric acid (0.25 g/g creatinine); this was significantly higher than that found in the urine of surgeons (0.15 g/g). The concentrations of urinary o-/m-/p-MHAs in surgical nurses were higher than those in administrative staff, nurse anesthetists, and surgeons. Furthermore, the type, sex, and age of healthcare personnel were associated with changes in urine HA and o-/m-/p-MHA concentrations. Healthcare personnel should be aware of the risk of exposure to surgical smoke.
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Affiliation(s)
- Chun-Hui Chiu
- Graduate Institute of Health Industry and Technology, Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Chi-Tsung Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ming-Huei Cheng
- Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Li-Heng Pao
- Graduate Institute of Health Industry and Technology, Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Gastroenterology and Hepatology, Linkuo Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chi Wang
- Department of Nursing, Linkuo Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Gwo-Hwa Wan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Obstetrics and Gynaecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Center for Environmental Sustainability and Human Health, Ming Chi University of Technology, Taishan, New Taipei, Taiwan.
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Robertson-More C, Wu T. A knowledge gap unmasked: viral transmission in surgical smoke: a systematic review. Surg Endosc 2021; 35:2428-2439. [PMID: 33495880 PMCID: PMC7833447 DOI: 10.1007/s00464-020-08261-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Concerns regarding the aerosolized transmission of SARS-CoV-2 via SS have caused significant apprehension among surgeons related to the use of minimally invasive surgery (MIS) during the COVID19 pandemic. While a limited number of studies have previously demonstrated the presence of viral material in SS, no comprehensive systematic review exists on the subject of viral transmission in SS. Methods A systematic review of the literature was conducted as per PRISMA guidelines. MEDLINE, EMBASE, and CENTRAL databases were searched for publications reporting the primary outcome of the presence of viral particles in SS and secondary outcomes of indices suggesting transmission of viable virus particles in SS producing clinically important infection. All human, animal, and in vitro studies which used accepted analytic techniques for viral detection were included. A meta-analysis was not complete due to methodologic heterogeneity and inconsistent reporting of outcomes of interest. RESULTS 23 publications addressed the presence of viral components in SS, and 19 (83%) found the presence of viral particles in SS. 21 publications additionally studied the ability of SS to induce clinically relevant infection in host cells, with 9 (43%) demonstrating potential for viral transmission. CONCLUSION Evidence exists for viral transmission via SS. However, HPV remains the only virus with documented transmission to humans via SS. While meaningful translation into practical guidelines during the COVID pandemic remains challenging, no evidence exists to suggest increased risk in MIS.
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Affiliation(s)
- Connal Robertson-More
- Department of Surgery, North Island Hospital, Vancouver Island Health Authority, 375 2 Ave, Campbell River, BC, V9W 3V1, Canada.
| | - Ted Wu
- Department of Surgery, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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35
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Kondo A, Watanabe Y, Ishida M, Suzuki Y, Hirano S. Particle Size Distributions in Surgical Smoke Generated by Advanced Energy Devices: A Meaningful Perspective From an Experimental Study in the Time of COVID-19. Ann Surg 2021; 273:e168-e170. [PMID: 33824251 DOI: 10.1097/sla.0000000000004807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yusuke Watanabe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan
| | - Minoru Ishida
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan
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36
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Hirota M, Takahashi H, Miyazaki Y, Takahashi T, Kurokawa Y, Yamasaki M, Eguchi H, Doki Y, Nakajima K. Surgical plume from tissue infected with human hepatitis B virus can contain viral substances. MINIM INVASIV THER 2021; 31:728-736. [PMID: 33853487 DOI: 10.1080/13645706.2021.1910848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Evidence on the biological danger associated with surgical plume is lacking. We examined whether surgical plume, generated by the energy devices ultrasonically activated scalpel (US) or electrocautery (EC) contains virus-related substances. MATERIAL AND METHODS Experiment 1, ex-vivo model: Tumor mass of a hepatocellular carcinoma line was prepared in a Nod/SCID mouse. Surgical plume generated on the mass by US or EC was collected and detection of HBs gene fragment and antigens (HBsAg or AFP) was conducted. Experiment 2, clinical specimen: Detection of HBV-DNA and HBsAg was conducted following the collection of surgical plume generated from clinically obtained liver specimens from six HBV-associated hepatocellular carcinoma patients. RESULTS Experiment 1: HBs gene fragment was detected in the solutions regardless of the device used. HBsAg was detected in US and EC solutions and AFP was also detected in a US solution. Experiment 2: HBV-DNA was detected in both devices, in all three cases whose preoperative serum HBV-DNA was positive. In the other serum-negative cases, HBV-DNA was not detected. While serum HBsAg was positive in five of six cases, it was not detected in any solution. CONCLUSIONS DNA fragments or antigens of virus can exist in the surgical plume generated by EC or US.
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Affiliation(s)
- Masashi Hirota
- Department of Next Generation Endoscopic Intervention, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Bracale U, Podda M, Castiglioni S, Peltrini R, Sartori A, Arezzo A, Corcione F, Agresta F. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study. Updates Surg 2021; 73:731-744. [PMID: 33656697 PMCID: PMC7926077 DOI: 10.1007/s13304-021-01010-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. METHODS The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020). RESULTS Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. CONCLUSION This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Policlinico Universitario Di Monserrato, Azienda Ospedaliero-Universitaria Di Cagliari, Cagliari, Italy
| | - Simone Castiglioni
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
- Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Roberto Peltrini
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Alberto Sartori
- Department of General, Oncological and Metabolic Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ospedale Di Vittorio Veneto, ULSS 2, Marca Trevigiana, Italy
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da Costa KM, Saxena AK. Coronavirus disease 2019 pandemic and identifying insufflators with desufflation mode and surgical smoke evacuators for safe CO 2 removal. Asian J Endosc Surg 2021; 14:165-169. [PMID: 32715659 DOI: 10.1111/ases.12834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Given the propensity of severe acute respiratory syndrome coronavirus 2 to spread, it is imperative that those continuing to perform surgery take precautions to limit the potential generation of contaminated aerosols in smoke from energy-based instruments. The aim of this study was to report current data regarding insufflators with desufflation mode and similar options to safely remove CO2 in minimal access surgery. METHODS A non-systematic review of the scientific literature was conducted using the PubMed database, and the main companies that provide surgical devices were contacted for information. RESULTS Most commercially available smoke evacuators use a combination of suction and mechanical filtering. There are also electrostatic precipitators that charge surgical smoke and retain the particles via electrostatic attraction. The search identified three insufflators with desufflation mode, four modular smoke evacuators using mechanical filtration, and only one device using electrostatic precipitation. However, none of these devices has been tested with viruses. CONCLUSION This review identified commercially available equipment that employs mechanical filtering and electrostatic attraction principles that can be used for pneumoperitoneum evacuation during the present coronavirus disease 2019 pandemic. This pandemic should assist in raising awareness regarding protection measures and the risk of occupational exposure in surgery.
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Affiliation(s)
- Karina M da Costa
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.,Division of Pediatric Surgery, Department of Pediatrics, Regional University Hospital of Maringá, State University of Maringá, Maringá, Brazil
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
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Ferrari G, Ferrari AM, Campobasso D, Modenese A, Rijo E, Misrai V, Rosa R, Cindolo L. Environmental Safety of the 180-W GreenLight Laser: A Pilot Study On Plume And Irrigating Fluids. Urology 2021; 154:227-232. [PMID: 33785403 DOI: 10.1016/j.urology.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the chemical composition of the surgical smoke and the outflow irrigation fluid produced during a common endourological surgical procedure to treat benign prostatic obstruction (BPO). METHODS A prospective study was performed to analyze the surgical smoke generated during photoselective vaporization of the prostate (PVP) using the 180-W GL-XPS GreenLight Laser system. Surgical smoke samples were collected from 5 patients, and irrigation fluid samples were collected from 5 different patients. Qualitative organic compound determination was performed on both types of collected specimens using headspace-gas chromatography/mass spectrometry (HS-GC/MS) analysis. RESULTS Four organic compounds were identified in the analyses of the smoke samples: tetradecane, hexadecane, 7-methylpentadecane and 2,6-dimethyleptadecane. In the analysis of fluid samples, 16 organic elements were identified. Interestingly, two compounds present in the first group (7-methylpentadecane and 2,6-dimethyleptadecane) were not detected in the fluid samples from the second group. None of the sixteen compounds detected in the fluids were present in all of the samples. Overall, seven of these compounds can be classified as toxic for acute exposure, while 4 others may represent a health hazard. CONCLUSION We found that the different types of surgical smoke and irrigation fluids produced during PVP with a GreenLight Laser contain a limited number of organic compounds with a potential inhalation hazard. More studies are needed to understand the potential hazard for the exposed employees.
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Affiliation(s)
- Giovanni Ferrari
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy
| | - Anna Maria Ferrari
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla ed Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | | | - Roberto Rosa
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy
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Mun DH, Pradere B, Shariat SF, Remzi M. Intraoperative aerosol viral transmission in minimally invasive surgery: a scoping review and impact on clinical guidelines and practice during the onset of the coronavirus disease 2019 (COVID-19) pandemic. BJU Int 2021; 127:349-360. [PMID: 32937006 DOI: 10.1111/bju.15247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify the available evidence on aerosol viral transmission risk during minimally invasive surgery (MIS) and evaluate its impact on guidelines development and clinical activity worldwide during the coronavirus disease 2019 (COVID-19) pandemic. METHODS We performed a scoping review on PubMed, Cochrane, the Excerpta Medica dataBASE (EMBASE), Clinical Trial Register, and the Grey Literature Repository databases, to identify reports on viral transmission via surgical smoke or aerosolisation. A systematic review of all available national and international guidelines was also performed to report their recommendations. Additionally, a worldwide transdisciplinary survey was performed to capture the actual compliance to dedicated guidelines and their impact on MIS activity. RESULTS Based on a selection of 17 studies, there was no evidence to support the concerns of an intraoperative viral transmission via pneumoperitoneum aerosolisation. Most national surgical and urological societies either did address this topic or referred to international guidelines. The guidelines of the American College of Surgery, the Royal College of Surgeons, and the European Association of Urology Robotic Urology Section, recommended an avoidance of MIS due to an increased risk of intraoperative aerosol-enhanced transmission. The results of the survey completed by 334 respondents, from different surgical abdominal specialties, suggested a lack of compliance with the guidelines. CONCLUSION There seems to be a dissonance between contemporary guidelines and ongoing surgical activity, possibly due to the perceived lack of evidence. Recommendations regarding changes in clinical practice should be based on the best available research evidence and experience. A scoping review of the evidence and an assessment of the benefits and harms together with a survey showed that laparoscopic procedures do not seem to increase the risk of viral transmission. Nevertheless, the few publications and low quality of existing evidence limits the validity of the review.
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Affiliation(s)
- Dong-Ho Mun
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, The Netherlands
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Chairman of the Laparoscopic and Robotic Surgery Section of the Austrian Urological Association, Vienna, Austria
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Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era. Surg Endosc 2021; 36:1243-1250. [PMID: 33616729 PMCID: PMC7899056 DOI: 10.1007/s00464-021-08394-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Background Surgical smoke during operation is a well-known health hazard for medical staff. This study aimed to investigate the dynamics of surgical smoke during open surgery or laparoscopic surgery for colorectal disease. Methods This study quantitated particulate matter (PM) counts as part of surgical smoke in 31 consecutive patients who underwent colectomy at the Niigata City General Hospital using a laser particle counter. Particles were graded by size as ≤ 2.5 μm PM (PM2.5) or > 2.5 μm PM (large PM). Operative procedures were categorized as either open surgery (n = 14) or laparoscopic surgery (n = 17). Results The median patient age was 72 (range 41–89) years and 58.1% were male. The total PM2.5, PM2.5 per hour, and maximum PM2.5 per minute counts during operation were significantly higher in open surgery than in laparoscopic surgery (P = 0.001, P < 0.001, and P = 0.029, respectively). Large PM counts (total, per hour, and maximum per minute) were also higher in the open surgery group than in the laparoscopic surgery group. The maximum PM2.5 concentration recorded was 38.6 µm/m3, which is considered “unhealthy for sensitive groups” according to the U.S. Environment Protection Agency air quality index standards, if it was a 24-h period mean value. Conclusion Exposure to surgical smoke is lower during laparoscopic surgery than during open surgery for colorectal diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08394-1.
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Pasquier J, Villalta O, Sarria Lamorú S, Balagué C, Vilallonga R, Targarona EM. Are Smoke and Aerosols Generated During Laparoscopic Surgery a Biohazard? A Systematic Evidence-Based Review. Surg Innov 2021; 28:485-495. [PMID: 33573518 DOI: 10.1177/1553350621992309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background. Laparoscopic surgery generates end products that can have potentially harmful effects for the surgical team from short- or long-time exposure. In view of the current SARS-CoV-2 circumstances, controversy has risen concerning the safety of surgical smoke (SS) and aerosols and the perception of an increased risk of exposure during laparoscopic surgery. Methods. The present qualitative systematic review was conducted according to Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). A literature search was performed from March 2020 up to May 10, 2020, using the PubMed database, Cochrane, and Google Scholar to assess the risk of airborne transmission of viruses and the potential health risk of surgical smoke- and aerosol-generating procedures produced during laparoscopic surgery. The keywords were introduced in combination to obtain better search results. Application of the inclusion and exclusion criteria identified 44 relevant articles. Results. Genetic material from certain viruses, or the virus itself, has been detected in SS and aerosols. However, in the current SARS-CoV-2, as in other coronavirus situations, studies analyzing the presence of airborne transmission of viruses in surgical smoke are lacking. Conclusion. Despite the lack of clear evidence regarding the risk of diseases as the result of smoke- and aerosol-generating procedures during laparoscopic surgery, further investigation is needed. Meanwhile, all available precautions must be taken.
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Affiliation(s)
- Jorge Pasquier
- Service of General and Digestive Surgery, 16689Hospital de La Santa Creu I Sant Pau, Hospital Universitari de la Universitat Autònoma de Barcelona, Spain
| | - Oscar Villalta
- Service of General and Digestive Surgery, 16689Hospital de La Santa Creu I Sant Pau, Hospital Universitari de la Universitat Autònoma de Barcelona, Spain
| | - Sunaymy Sarria Lamorú
- Service of General and Digestive Surgery, 16689Hospital de La Santa Creu I Sant Pau, Hospital Universitari de la Universitat Autònoma de Barcelona, Spain
| | - Carmen Balagué
- Service of General and Digestive Surgery, 16689Hospital de La Santa Creu I Sant Pau, Hospital Universitari de la Universitat Autònoma de Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Eduardo M Targarona
- Service of General and Digestive Surgery, 16689Hospital de La Santa Creu I Sant Pau, Hospital Universitari de la Universitat Autònoma de Barcelona, Spain
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Sullivan JR, Rademaker M, Goodman G, Bekhor P, Al‐Niaimi F. Guidance on infection control and plume management with Laser and Energy-Based Devices taking into consideration COVID-19. Australas J Dermatol 2021; 62:37-40. [PMID: 32815148 PMCID: PMC7461075 DOI: 10.1111/ajd.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted the practice of medicine. Dermatologic laser and energy-based device (EBD) treatments carry a potential risk for the transmission of SARS-CoV-2 both for the patient and the practitioner. These risks include close practitioner to patient proximity, the treatment of higher viral load areas such as the face, the potential for infective bioparticles being carried by generated plumes and aerosols, and the direct contact between device, practitioner and patient. OBJECTIVES SARS-CoV-2 is a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions, medically generated aerosols and via its transfer from contaminated fomites. This requires a review of the appropriateness of infection control protocols in regard to dermatologic laser and energy-based device treatments. METHODS A critical evaluation of patient skin preparation including skin asepsis, device disinfection, laser and electrosurgical plume management and PPE in regard to SARS-CoV-2 was performed. RESULTS The adherence to a high standard of skin preparation and asepsis, device disinfection, laser and electrosurgical plume and aerosol management and appropriate PPE should help mitigate or reduce some of the inherent treatment risks. Head and neck treatments along with aerosol and laser plume generating treatments likely carry greater risk. CONCLUSIONS COVID-19 needs to be considered in the clinic set-up along with the planning, treatment and post-treatment care of patients utilising EBD procedures. Some of these treatment precautions are COVID-19 specific; however, most represent adherence to good infectious disease and established laser and EBD safety precautions.
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Affiliation(s)
- John R Sullivan
- The Sutherland HospitalCaringbahAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Marius Rademaker
- Waikato Clinical CampusUniversity of Auckland’s Faculty of Medical and Health SciencesHamiltonNew Zealand
| | - Greg Goodman
- Monash UniversityClaytonVictoriaAustralia
- University College of LondonLondonUK
| | - Philip Bekhor
- The Royal Children’s HospitalVictoria The University of MelbourneParkvilleVictoriaAustralia
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Comment on: A Low-cost, Safe, and Effective Method for Smoke Evacuation in Laparoscopic Surgery for Suspected Coronavirus Patients. Ann Surg 2021; 274:e895. [PMID: 33443900 DOI: 10.1097/sla.0000000000004745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hu L, Chen M, Liu PX, Xu S. A vortex method of 3D smoke simulation for virtual surgery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105813. [PMID: 33152674 DOI: 10.1016/j.cmpb.2020.105813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE A realistic virtual surgery simulation needs to simulate smoke as electrical cutting causes thermal tissue damage. The vortex particle method of simulating smoke can realistically present the vortex details and motion trajectory of the smoke, but there is high computational cost. METHODS To address this problem, we propose the 3D Vortex Particles in Cube Algorithm (3D-VPICA). 3D-VPICA can realistically show the visual effect of smoke and reduce the computational cost. In addition, in order to enhance the reality of the smoke, we propose the Auxiliary Particles Algorithm (APA) method to deal with the collision problem of smoke. RESULTS The 3D-VPICA can calculate the velocity of the vortex particles speedily with the help of cube grids and with the complexity decreasing from O(N2) to O(N) + O(Mlog 2M). The APA can ensure that boundary conditions are satisfied when the smoke collides with irregular surfaces. Experimental results show that 3D-VPICA is faster than traditional methods of smoke simulation and that APA is successful in simulating smoke colliding with moving objects with irregular surfaces. CONCLUSIONS The proposed 3D smoke simulation method was applied to a virtual surgery system using a high frequency electric knife. The cutting and coagulate operations were fluent and the smoke flowed with fidelity.
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Affiliation(s)
- Lingyan Hu
- School of Information and Engineering, Nanchang University, Nanchang, China 330031; Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada K1S 5B6.
| | - Majun Chen
- School of Information and Engineering, Nanchang University, Nanchang, China 330031
| | - Peter X Liu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Shaoping Xu
- School of Information and Engineering, Nanchang University, Nanchang, China 330031
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Díaz-Bello S, Hernández-Hernández A, Guinto-Nishimura GY, Mondragón-Soto MG, Lem-Carrillo M, González-Aguilar A, Calleja-Castillo JM, Leyva-Rendón A, León-Ortiz P, Chávez-Piña CM, Pando-Tarín GA, Mejía-Pérez SI, Taboada-Barajas J, Zavala-Álvarez ED, Soto-Hernández JL, Cárdenas G, Gómez-Amador JL. Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center. Neurosurg Focus 2020; 49:E4. [PMID: 33260129 DOI: 10.3171/2020.9.focus20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications. METHODS The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: "Neurosurgery," "COVID-19/SARS-CoV-2," "reconversion/modification," "practice," "academy," and "teaching." Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel. RESULTS According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology. CONCLUSIONS The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.
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Affiliation(s)
- Sergio Díaz-Bello
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alan Hernández-Hernández
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Michel G Mondragón-Soto
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Monica Lem-Carrillo
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alberto González-Aguilar
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Juan M Calleja-Castillo
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Adolfo Leyva-Rendón
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Pablo León-Ortiz
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Carmen M Chávez-Piña
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Gustavo A Pando-Tarín
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Sonia I Mejía-Pérez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,5Medical Education
| | - Jesús Taboada-Barajas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,6Neuroradiology, and
| | - Elsa D Zavala-Álvarez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - José L Soto-Hernández
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Graciela Cárdenas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Juan L Gómez-Amador
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
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Tuli IP, Trehan S, Khandelwal K, Chamoli P, Nagendra S, Tomar A, Sharma S. Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review. Braz J Otorhinolaryngol 2020; 87:469-477. [PMID: 33358322 PMCID: PMC7837198 DOI: 10.1016/j.bjorl.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS‐CoV‐2, COVID‐19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.
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Affiliation(s)
- Isha Preet Tuli
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
| | - Sandeep Trehan
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India.
| | - Kirti Khandelwal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
| | - Priyanka Chamoli
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
| | - Sneha Nagendra
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
| | - Aashish Tomar
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
| | - Shilpam Sharma
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
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48
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Kanthasamy V, Schilling RJ. Electrophysiology in the Era of Coronavirus Disease 2019. Arrhythm Electrophysiol Rev 2020; 9:167-170. [PMID: 33240513 PMCID: PMC7675140 DOI: 10.15420/aer.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Richard J Schilling
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,NHS Nightingale Hospital, London, UK
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49
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Garbey M, Joerger G, Furr S. Gastroenterology Procedures Generate Aerosols: An Air Quality Turnover Solution to Mitigate COVID-19's Propagation Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8780. [PMID: 33256004 PMCID: PMC7731398 DOI: 10.3390/ijerph17238780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022]
Abstract
The growing fear of virus transmission during the 2019 coronavirus disease (COVID-19) pandemic has called for many scientists to look into the various vehicles of infection, including the potential to travel through aerosols. Few have looked into the issue that gastrointestinal (GI) procedures may produce an abundance of aerosols. The current process of risk management for clinics is to follow a clinic-specific HVAC formula, which is typically calculated once a year and assumes perfect mixing of the air within the space, to determine how many minutes each procedural room refreshes 99% of its air between procedures when doors are closed. This formula is not designed to fit the complex dynamic of small airborne particle transport and deposition that can potentially carry the virus in clinical conditions. It results in reduced procedure throughput as well as an excess of idle time in clinics that process a large number of short procedures such as outpatient GI centers. We present and tested a new cyber-physical system that continuously monitors airborne particle counts in procedural rooms and also at the same time automatically monitors the procedural rooms' state and flexible endoscope status without interfering with the clinic's workflow. We use our data gathered from over 1500 GI cases in one clinical suite to understand the correlation between air quality and standard procedure types as well as identify the risks involved with any HVAC system in a clinical suite environment. Thanks to this system, we demonstrate that standard GI procedures generate large quantities of aerosols, which can potentially promote viral airborne transmission among patients and healthcare staff. We provide a solution for the clinic to improve procedure turnover times and throughput, as well as to mitigate the risk of airborne transmission of the virus.
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Affiliation(s)
- Marc Garbey
- ORintelligence, Houston, TX 77021, USA; (G.J.); (S.F.)
- LaSIE, UMR CNRS 7356, Université de La Rochelle, 17000 La Rochelle, France
| | | | - Shannon Furr
- ORintelligence, Houston, TX 77021, USA; (G.J.); (S.F.)
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50
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Pena RCF, Khatri D, Kwan K, D'Amico RS. In Reply to the Letter to the Editor Regarding "Coronavirus Neurosurgical/Head and Neck Drape to Prevent Aerosolization of Coronavirus Disease 2019 (COVID-19): The Lenox Hill Hospital/Northwell Health Solution". World Neurosurg 2020; 143:617-618. [PMID: 33167144 PMCID: PMC7608009 DOI: 10.1016/j.wneu.2020.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Robert C F Pena
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Kevin Kwan
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA.
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