A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era

Development of protective equipment for endoscopic treatment and surgery in otorhinolaryngology

Objective

The coronavirus disease pandemic has raised concerns regarding the transmission of infections to healthcare workers. We developed a new protective device to reduce the risk of aerosol diffusion and droplet infection among healthcare workers. Here, we report the results of a theoretical evaluation of the efficacy of this device.

Methods

We used suction-capable masks with and without rubber slits, sleeves for the insertion section of endoscopes and treatment tools, and a cover for the control section of the endoscope. To simulate droplet spread from patients, we created a droplet simulation model and an aerosol simulation model. The results with and without the devices attached and with and without the suction were compared.

Results

The droplet simulation model showed a 95% reduction in droplets with masks with rubber slits; furthermore, a reduction of 100% was observed when the insertion sleeve was used. Evaluation of aerosol simulation when suction was applied revealed an aerosol reduction of 98% and >99% with the use of the mask without rubber slits and with the combined use of the mask and insertion sleeve, respectively. The elimination of droplet emission upon instrument removal confirmed that the instrument sleeve prevented the diffusion of droplets. The elimination of droplets upon repeated pressing of the suction button confirmed that the cover prevented the diffusion of droplets.

Conclusion

We developed a device for infection control, in collaboration with a gastrointestinal endoscopist and Olympus Medical Systems Corporation, that was effective in reducing droplet and aerosol diffusion in this initial theoretical assessment.

COVID-19 and rhinological surgery

The Coronavirus-19 (COVID-19) pandemic has caused disruptions in the normal patient care workflow, necessitating adaptations within the healthcare profession. The objective of this article is to outline some of these adaptations and considerations necessitated by COVID-19 within the subspeciality of rhinology and endoscopic skull base surgery.

[Endoscopic endonasal surgery during COVID-19 pandemic: Management guideline]

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.

Endoscopic endonasal surgery during COVID-19 pandemic: Management guideline

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.

Development and Assessment of an Inexpensive Smartphone-Based Respiratory Droplet Simulation Model

Background. Droplet simulation often requires expensive and inaccessible equipment. Herein, we develop and assess a low-cost droplet simulation model using easily accessible materials, open-source software, and a smartphone-based cobalt blue light. Methods. The simulation model was developed using commercial-grade materials and fluorescein dye. A clear face shield was assessed ten times following a simulated cough using fluorescein dye. A conventional ultraviolet Woods lamp was compared to a smartphone-based cobalt blue light to detect fluorescein illumination. Results. The simulation platform and smartphone-based cobalt blue light cost $20.18. A Wilcoxon signed rank test revealed that the median droplet area of fluorescence under the UV Wood's lamp was not significantly different than that of the smartphone-based cobalt blue light (2.89 vs 2.94, P = .386). Conclusions. This simulation model is inexpensive and easily reproducible. The smartphone application may be a convenient alternative to standard ultraviolet lights. This model has great potential for use in financially restricted academic centers during the COVID-19 pandemic and beyond.

Desarrollo de una máscara de bajo costo para prevenir la propagación de aerosoles en endoscopia endonasal en la base del cráneo durante la pandemia del COVID-19

Objetivo: desarrollar una máscara que sea reutilizable, esterilizable, fácil de usar y económica para reducir los riesgos de transmisión del COVID-19 durante los procedimientos endoscópicos endonasales. Métodos: modelo diseñado en Autodesk Fusion 360 y Meshmixer, construido con ácido poliláctico (PLA) utilizando una impresora 3D (PRUSA IK3 MK3s, Praga, República Checa) en el laboratorio de Anatomía de la Universidad de los Andes, Bogotá, Colombia. Se ajustaron tres orificios a la mascarilla, uno para el tubo endotraqueal, otro más grande en el medio para la instrumentación quirúrgica que permite la adaptación de una membrana translúcida estéril y el superior para adaptar la punta de la succión y generar un ambiente de presión negativa dentro de la máscara. Se utilizó un colchón de silicona y tres puntos para sujetar tiras y crear un ajuste a la cabeza durante largos períodos sin causar lesiones en la piel. Se realizaron diferentes pruebas, incluida la verificación con luz ultravioleta de la propagación de la fluoresceína después de la perforación ósea, la esterilización química y por calor de la máscara, y la succión de los aerosoles producidos al fumar un cigarrillo electrónico. Ambiente: laboratorio experimental. Resultados: las pruebas demostraron una reducción del efecto aerosol y de la dispersión de las gotas cuando se usa la máscara ventilada. Se consiguió una excelente maniobrabilidad y libertad. Sin embargo, fue limitado en términos de visualización durante la entrada nasal de los instrumentos al cráneo. Conclusiones: los resultados preliminares muestran que esta máscara ventilada permite una barrera quirúrgica para disminuir la transmisión del SARS-COV-2 durante los procedimientos endoscópicos endonasales.