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Søndergaard SF, Skov T, Andersen AB. The Experiences of Hospital Admission in a Single Room for Older Persons With Dementia and Their Families: A Scoping Review. Int J Older People Nurs 2024; 19:e12626. [PMID: 38970350 DOI: 10.1111/opn.12626] [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: 11/07/2023] [Revised: 05/08/2024] [Accepted: 06/10/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION When older persons with dementia are admitted to hospital, they often feel disoriented and confused and their cognitive impairment may worsen, purely due to the sudden change in their environment. As such hospital design is recognised as an important aspect in the care and well-being of older persons with dementia. As the number of persons with dementia is increasing, the experience of admission to a hospital with, for example, single rooms is more relevant than ever. AIM AND METHODS This scoping review aimed to identify, explore and conceptually map the literature reporting on what older people with dementia and their families experienced during admission to a hospital with single room accommodation. We followed the Joanna Briggs Institute recommendations for undertaking a scoping review. In addition, we used the Preferred Reporting Items for Systematic reviews (PRISMA-ScR) Checklist, which assisted the development and reporting of this scoping review. RESULTS We included 10 sources within a time frame of 23 years (1998-2021). The sources originate from Europe, Australia and Canada. We identified three conceptual maps: Safety and security, Privacy and dignity and Sensorial stimulation. Our review demonstrates that the themes of the three conceptual maps are experienced as mutually interdependent for the older persons with dementia and their families. CONCLUSION We conclude that it is not merely the single room design that determines what the older persons with dementia and their families experience as important; the exposure to sensorial stimulation and the presence of well-trained staff taking a dignified patient-centred approach are also crucial for their experience of high-quality nursing care.
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Affiliation(s)
- Susanne Friis Søndergaard
- School of Nursing, VIA University College, Viborg, Denmark
- Aarhus University, Health, Aarhus C, Denmark
- Central Region Hospital, Center for Research in Nursing and Health, VIA University College, Viborg, Denmark
| | - Tina Skov
- School of Nursing, VIA University College, Viborg, Denmark
| | - Anne Bendix Andersen
- School of Nursing, VIA University College, Viborg, Denmark
- Aarhus University, Health, Aarhus C, Denmark
- Research Centre for Health and Welfare Technology, School of Nursing, VIA University College, Viborg, Denmark
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Yu H. The research on the effect of temperature of electro-surgical unit to surgical smoke distribution in theatre-in vitro and simulation study. PLoS One 2024; 19:e0299369. [PMID: 38457434 PMCID: PMC10923457 DOI: 10.1371/journal.pone.0299369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
In electro-surgery, surgical smoke was hazard to surgeons and patient in theatre. In order to institute effective countermeasures, quantifying of the effect of tip temperature of electro-surgical unit to surgical smoke distribution in theatre was studied. The relation of tip temperature to power of electro-surgical unit through in vitro cutting experiment. Based on experiment data, the mathematical model was established to simulate the electro-surgery in laminar operation room. As the power of electro-surgical knife increased, the knife tip temperature increased. Total content of (CO, CO2, CH4, NH3) in waste gas and net flow rate of waste gas at outlet increased with the rising temperature of knife tip and formation rate of condensed tar droplets and non-viable particles also increased. Based on simulation, it was found that The maximum height of surgical smoke rising right above the incision of electro-surgical unit was increased with rising temperature of electro-surgical knife tip. There was a spread route of dispersed surgical smoke near the walls of theatre through natural convection. The polynomial fitting relationship was derived. As the tip temperature of knife increased from 200 to 500°C, maximum ascending height of surgical smoke right above the incision position of electro-surgical unit increased from 1.1 m to 1.45 m. When the tip temperature of electro-knife was more 400°C, the CO content in the surgeon's operating zone was more than 200 ppm, which would cause the surgeon's HbCO level increased. As the patient's tissue in the wound during operation was open, when the electro-knife of more than 400°C, the content of condensed tar droplets and in-viable particle was higher than 20 g/m3 and 12 g/m3 in the zone around patient's wound of open tissue, which should be hazard to health of patient.
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Affiliation(s)
- Hui Yu
- Department of Gynaecology and Obstetrics, Huazhong University of Science and Technology Hospital, Wuhan, Hubei Province, China
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Nolan K, Khan MF, Riva P, Kearns E, Reitano E, Irving H, Perretta S, Dallemagne B, Cahill RA. Characterisation and mitigation of gas leaks at laparoscopy: an international prospective, multi-center cohort clinical trial. Surg Endosc 2024; 38:426-436. [PMID: 37985488 DOI: 10.1007/s00464-023-10536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Gas leaks polluting the operating room are common in laparoscopy. Studies defining methods for sensitive leak characterisation and mechanical mitigation in real world settings are, however, lacking. METHODS Mobile optical gas imagers (both a miniaturised Schlieren system and sensitive tripod-mounted near-infrared carbon dioxide camera (GF343, FLIR)) prospectively defined trocar-related gas leaks occurring either spontaneously or with instrumentation during planned laparoscopic surgery at three hospitals. A boutique Matlab-based analyser using sequential frame subtraction categorised leaks (class 0-no observable leak; class 1-marginally detectable leak; class 2-short-lived plume; class 3-energetic, turbulent jet). Concurrently, the usefulness of a novel vacuum-ring device (LeakTrap™, Palliare, Ireland) designed as a universal adjunct for existing standard laparoscopic ports at both abdominal wall and port valve level was determined similarly in a phase I/11 clinical trial along with the device's useability through procedural observation and surgeon questionnaire. RESULTS With ethical and regulatory approval, 40 typical patients (mean age 58.6 years, 20 males) undergoing planned laparoscopic cholecystectomy (n = 36) and hernia repair (n = 4) were studied comprising both control (n = 20) and intervention (n = 20) cohorts. Dual optical gas imaging was successfully performed across all procedures with minimal impact on procedural flow. In total, 1643 trocar instrumentations were examined, 819 in the control group (mean 41 trocar instrumentations/procedure) and 824 in the intervention group (mean 41.2 trocar instrumentations/procedure). Gas leaks were detected during 948(62.6%) visualised trocar instrumentations (in 129-7.8%-the imaging was obscured). 14.8% (110/742) and 60% (445/742) of leaks in control patients were class 0 and 3, respectively, versus 59.1% (456/770) and 8.7% (67/772) in the interventional group (class 3 v non-class 3, p < 0.0001, χ2). The Leaktrap proved surgically acceptable without significant workflow disruption. CONCLUSION Laparoscopic gas leaks can be sensitively detected and consistently, effectively mitigated using straightforward available-now technology with most impact on the commonest, highest energy instrument exchange leaks.
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Affiliation(s)
- Kevin Nolan
- UCD School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Mohammad F Khan
- UCD Centre of Precision Surgery, 47 Eccles Street, Dublin 7, Ireland
| | | | - Emma Kearns
- UCD Centre of Precision Surgery, 47 Eccles Street, Dublin 7, Ireland
| | | | - Hugh Irving
- UCD School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Silvana Perretta
- IRCAD/EITS, Strasbourg, France
- University Hospital, Strasbourg, France
| | | | - Ronan A Cahill
- UCD School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland.
- UCD Centre of Precision Surgery, 47 Eccles Street, Dublin 7, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
- Department of Surgery, Mater Private Hospital, Dublin, Ireland.
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Margue G, Bigot P, Ingels A, Roupret M, Waeckel T, Long JA, Pignot G, Bensalah K, Lang H, Olivier J, Bruyere F, Durand M, Beauval JB, Mallet R, Parier B, De La Taille A, Bernhard JC. Clinical trial protocol for P-NeLoP: a randomized controlled trial comparing the feasibility and outcomes of robot-assisted partial nephrectomy with low insufflation pressure using AirSeal versus standard insufflation pressure (UroCCR no. 85 study). Trials 2023; 24:545. [PMID: 37596613 PMCID: PMC10439590 DOI: 10.1186/s13063-023-07533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023] Open
Abstract
Robot-assisted partial nephrectomy (RAPN) is the standard of care for small, localized kidney tumors. This surgery is conducted within a short hospital stay and can even be performed as outpatient surgery in selected patients. In order to allow early rehabilitation of patients, an optimal control of postoperative pain is necessary. High-pressure pneumoperitoneum during surgery seems to be the source of significant pain during the first hours postoperatively. Our study is a prospective, randomized, multicenter, controlled study which aims to compare post-operative pain at 24 h between patients undergoing RAPN at low insufflation pressure (7 mmHg) and those operated on at standard pressure (12 mmHg) using the AirSeal system.This trial is registered in the US National Library of Medicine Trial Registry (NCT number: NCT05404685).
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Affiliation(s)
- Gaelle Margue
- Urology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Pierre Bigot
- Urology Department, Angers University Hospital, Angers, France
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | | | | | | | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | | | - Richard Mallet
- Urology Department, Polyclinique Francheville, Perigueux, France
| | - Bastien Parier
- Urology Department, Kremlin Bicetre, APHP, Paris, France
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Di Spirito F, Iandolo A, Amato A, Caggiano M, Raimondo A, Lembo S, Martina S. Prevalence, Features and Degree of Association of Oral Lesions in COVID-19: A Systematic Review of Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127486. [PMID: 35742735 PMCID: PMC9224460 DOI: 10.3390/ijerph19127486] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
Regardless of rapidly emerging findings on oral lesions described in adult SARS-CoV-2-positive subjects, the evidence level remains quite low and rather contrasting; therefore, the present systematic review of systematic reviews primarily aims to point out the overall prevalence of diagnosed cases. Secondary aims are to estimate the degree of association between oral lesions and SARS-CoV-2 infection and to grade, based on the reported frequency, the primary oral lesions, with related clinical presentations and microscopic features, in relation to COVID-19 forms. A study protocol compliant with the PRISMA statement was developed. Twelve studies were included, reporting highly heterogeneous and incomplete findings, thus precluding a meta-analysis. Further studies should be conducted to assess the overall prevalence of cases diagnosed with oral lesions among adult SARS-CoV-2-positive subjects, especially considering novel viral variants, and to determine their degree of association with SARS-CoV-2 infection and COVID-19 forms. Moreover, the reported findings noticed the need to evaluate the putative role both of SARS-CoV-2 in oral lesions genesis and of periodontitis and periodontal microbiome in COVID-19 worsening and re-activations. Deeper insights into oral lesions in adult SARS-CoV-2-positive subjects could enhance the comprehension of illness pathogenesis, natural history and clinical presentation, thus improving the preparedness of health professionals in the inter-disciplinary management of COVID-19.
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Sivaraj J, Loukogeorgakis S, Costigan F, Giuliani S, Mullassery D, Blackburn S, Curry J, Cross K, De Coppi P. Maintaining a minimally invasive surgical service during a pandemic. Pediatr Surg Int 2022; 38:769-775. [PMID: 35338381 PMCID: PMC8956142 DOI: 10.1007/s00383-022-05107-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The safety of minimally invasive surgery (MIS) was questioned in the COVID-19 pandemic due to concern regarding disease spread. We continued MIS during the pandemic with appropriate protective measures. This study aims to assess the safety of MIS compared to Open Surgery (OS) in this setting. METHODS Operations performed during 2020 lockdown were compared with operations from the same time-period in 2019 and 2021. Outcomes reviewed included all complications, respiratory complications, length of stay (LOS) and operating surgeon COVID-19 infections (OSI). RESULTS In 2020, MIS comprised 52% of procedures. 29% of MIS 2020 had complications (2019: 24%, 2021: 15%; p = 0.08) vs 47% in OS 2020 (p = 0.04 vs MIS). 8.5% of MIS 2020 had respiratory complications (2019: 7.7%, 2021: 6.9%; p = 0.9) vs 10.5% in OS 2020 (p = 0.8 vs MIS). Median LOS[IQR] for MIS 2020 was 2.5[6] days vs 5[23] days in OS 2020 (p = 0.06). In 2020, 2 patients (1.2%) were COVID-19 positive (MIS: 1, OS: 1) and there were no OSI. CONCLUSION Despite extensive use of MIS during the pandemic, there was no associated increase in respiratory or other complications, and no OSI. Our study suggests that, with appropriate protective measures, MIS can be performed safely despite high levels of COVID-19 in the population.
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Affiliation(s)
- Jayaram Sivaraj
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Stavros Loukogeorgakis
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK.
- NIHR Biomedical Research Center, Great Ormond Street Hospital, London, UK.
- UCL GOSH Institute of Child Health, London, UK.
| | - Fiona Costigan
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Stefano Giuliani
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Dhanya Mullassery
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Simon Blackburn
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Joe Curry
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Kate Cross
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
| | - Paolo De Coppi
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London, UK
- NIHR Biomedical Research Center, Great Ormond Street Hospital, London, UK
- UCL GOSH Institute of Child Health, London, UK
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Lee PE, Kozak R, Alavi N, Mbareche H, Kung RC, Murphy KE, Perruzza D, Jarvi S, Salvant E, Ladhani NNN, Yee AJM, Gagnon LH, Jenkinson R, Liu GY. Detection of SARS-CoV-2 contamination in the operating room and birthing room setting: a cross-sectional study. CMAJ Open 2022; 10:E450-E459. [PMID: 35609928 PMCID: PMC9259417 DOI: 10.9778/cmajo.20210321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers. METHODS We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers' masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties). RESULTS A total of 32 patients (age 20-88 yr) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic or trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20 of 332 (6%) patient and environmental samples collected: 4 of 24 (17%) patient samples, 5 of 60 (8%) floor samples, 1 of 54 (2%) air samples, 10 of 23 (43%) surgical instrument or equipment samples, 0 of 24 cautery filter samples and 0 of 143 (95% confidence interval 0-0.026) inner surface of mask samples. INTERPRETATION During the study period of November 2020 to May 2021, we found evidence of SARS-CoV-2 RNA in a small but important number of samples obtained in the surgical and obstetric operative environment. The finding of no detectable virus inside the masks worn by the health care teams would suggest a low risk of infection for health care workers using appropriate personal protective equipment.
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Affiliation(s)
- Patricia E Lee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.
| | - Robert Kozak
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Nasrin Alavi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Hamza Mbareche
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Rose C Kung
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Kellie E Murphy
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Darian Perruzza
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Stephanie Jarvi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Elsa Salvant
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Noor Niyar N Ladhani
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Albert J M Yee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Louise-Helene Gagnon
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Richard Jenkinson
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Grace Y Liu
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
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8
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Fabbri N, Pesce A, Ussia A, D'Urbano F, Pizzicotti S, Greco S, Feo CV. Swab test in biological fluids as predictor of COVID-19 transmission risk during surgery: a prospective cross-sectional study from an Italian COVID center. BMC Surg 2022; 22:119. [PMID: 35351083 PMCID: PMC8964243 DOI: 10.1186/s12893-022-01571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The contamination of body fluids by Severe Acute Respiratory Syndrome Coronavirus 2 during surgery is current matter of debate in the scientific literature concerning CoronaVIrus Disease 2019. Surgical guidelines were published during the first wave of the COVID-19 pandemic and recommended to avoid laparoscopic surgery as much as possible, in fear that the chimney effect of high flow intraperitoneal gas escape during, and after, the procedure would increase the risk of viral transmission. AIM The aim of this study was to evaluate the possibility of SARS-CoV-2 transmission during surgery by searching for viral RNA in serial samplings of biological liquids. METHODS This is a single center prospective cross-sectional study. We used a real-time reverse transcriptase (RT) polymerase chain reaction (PCR) test to perform swab tests for the qualitative detection of nucleic acid from SARS-CoV-2 in abdominal fluids, during emergency surgery and on the first post-operative day. In the case of thoracic surgery, we performed a swab test of pleural fluids during chest drainage placement as well as on the first post-operative day. RESULTS A total of 20 samples were obtained: 5 from pleural fluids, 13 from peritoneal fluids and two from biliary fluid. All 20 swabs performed from biological fluids resulted negative for SARS-CoV-2 RNA detection. CONCLUSION To date, there is no scientific evidence of possible contagion by laparoscopic aerosolization of SARS-CoV-2, neither is certain whether the virus is effectively present in biological fluids.
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Affiliation(s)
- N Fabbri
- General Surgery Unit, Azienda USL Di Ferrara, Via Valle Oppio, 2, Ferrara, Italy.
| | - A Pesce
- General Surgery Unit, Azienda USL Di Ferrara, Via Valle Oppio, 2, Ferrara, Italy
| | - A Ussia
- General Surgery Unit, Azienda USL Di Ferrara, Via Valle Oppio, 2, Ferrara, Italy
| | - F D'Urbano
- Department of Translational Medicine, Azienda Ospedaliero-Universitaria Di Ferrara, Ferrara, Italy
| | - S Pizzicotti
- Biochemical Analysis Laboratory - Clinics and Microbiology, Azienda Ospedaliero-Universitaria Di Ferrara, Ferrara, Italy
| | - S Greco
- Department of Translational Medicine, Azienda Ospedaliero-Universitaria Di Ferrara, Ferrara, Italy
| | - C V Feo
- General Surgery Unit, Azienda USL Di Ferrara, Via Valle Oppio, 2, Ferrara, Italy
- Department of Medical Sciences, Università Di Ferrara, Ferrara, Italy
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9
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Miyo M, Hata T, Sekido Y, Ogino T, Miyoshi N, Takahashi H, Uemura M, Nishimura J, Ikenaga M, Eguchi H, Doki Y, Mizushima T. Colorectal Surgery in the COVID-19 Pandemic Era. J Anus Rectum Colon 2022; 6:1-8. [PMID: 35128131 PMCID: PMC8801245 DOI: 10.23922/jarc.2021-074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread at a very fast rate, overwhelming and disrupting healthcare systems around the world since its outbreak in December 2019 in China. As of October 2021, the total number of COVID-19 cases exceeds 240,000,000, and the total number of deaths is close to 5,000,000. In the situation of widespread SARS-CoV-2 infection, restrictions on the medical system due to shifts in medical care to accommodate the pandemic will occur, and its impact on surgical and endoscopic treatment for colorectal cancer is inevitable. Therefore, it is necessary to satisfy all of the following requirements: patient safety, prevention of exposure of healthcare workers including surgeons, prevention of nosocomial infection, and a decision on how to treat the primary disease. Surgical triage is also required, based on comprehensive consideration of the patient's condition, the severity of the disease, the SARS-CoV-2 infection situation in the region, and the medical supply system at each facility, including medical resources, human resources, and the availability of medical equipment. Understanding the diagnostic and treatment environment that the COVID-19 pandemic has dramatically changed is important in providing appropriate surgical care to patients who require surgery while taking utmost care to prevent the spread of COVID-19.
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Affiliation(s)
- Masaaki Miyo
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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10
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Favier V, Lescroart M, Pequignot B, Grimmer L, Florentin A, Gallet P. Measurement of airborne particle emission during surgical and percutaneous dilatational tracheostomy COVID-19 adapted procedures in a swine model: Experimental report and review of literature. PLoS One 2022; 17:e0278089. [PMID: 36417482 PMCID: PMC9683587 DOI: 10.1371/journal.pone.0278089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Surgical tracheostomy (ST) and Percutaneous dilatational tracheostomy (PDT) are classified as high-risk aerosol-generating procedures and might lead to healthcare workers (HCW) infection. Albeit the COVID-19 strain slightly released since the vaccination era, preventing HCW from infection remains a major economical and medical concern. To date, there is no study monitoring particle emissions during ST and PDT in a clinical setting. The aim of this study was to monitor particle emissions during ST and PDT in a swine model. METHODS A randomized animal study on swine model with induced acute respiratory distress syndrome (ARDS) was conducted. A dedicated room with controlled airflow was used to standardize the measurements obtained using an airborne optical particle counter. 6 ST and 6 PDT were performed in 12 pigs. Airborne particles (diameter of 0.5 to 3 μm) were continuously measured; video and audio data were recorded. The emission of particles was considered as significant if the number of particles increased beyond the normal variations of baseline particle contamination determinations in the room. These significant emissions were interpreted in the light of video and audio recordings. Duration of procedures, number of expiratory pauses, technical errors and adverse events were also analyzed. RESULTS 10 procedures (5 ST and 5 PDT) were fully analyzable. There was no systematic aerosolization during procedures. However, in 1/5 ST and 4/5 PDT, minor leaks and some adverse events (cuff perforation in 1 ST and 1 PDT) occurred. Human factors were responsible for 1 aerosolization during 1 PDT procedure. ST duration was significantly shorter than PDT (8.6 ± 1.3 vs 15.6 ± 1.9 minutes) and required less expiratory pauses (1 vs 6.8 ± 1.2). CONCLUSIONS COVID-19 adaptations allow preventing for major aerosol leaks for both ST and PDT, contributing to preserving healthcare workers during COVID-19 outbreak, but failed to achieve a perfectly airtight procedure. However, with COVID-19 adaptations, PDT required more expiratory pauses and more time than ST. Human factors and adverse events may lead to aerosolization and might be more frequent in PDT.
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Affiliation(s)
- Valentin Favier
- Department of Otolaryngology-Head and Neck Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR Team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
- * E-mail:
| | - Mickael Lescroart
- Intensive Care Unit Brabois, University Regional Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Benjamin Pequignot
- Intensive Care Unit Brabois, University Regional Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Léonie Grimmer
- Department of Hygiene, Environmental Risks and Healthcare Associated Risks, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Arnaud Florentin
- Department of Hygiene, Environmental Risks and Healthcare Associated Risks, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Infection Prevention and Control Team, Regional University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Patrice Gallet
- ENT Department, Regional University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
- Virtual Hospital of Lorraine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- NGERE, INSERM U1256 Lab, University of Lorraine, Vandoeuvre-lès-Nancy, France
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11
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Characterisation of trocar associated gas leaks during laparoscopic surgery. Surg Endosc 2022; 36:4542-4551. [PMID: 34731302 PMCID: PMC8565170 DOI: 10.1007/s00464-021-08807-1] [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: 05/11/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. METHODS A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. RESULTS Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. CONCLUSIONS We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.
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12
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Granata AM, Palmisano F, Fenizia C, Rossi RS, Talso M, Vanetti C, Tonello C, Romanò AL, Zerbi P, Carsana L, Trabattoni D, Nebuloni M, Gregori A. Is there a risk of virus contamination through pneumoperitoneum during laparoscopic surgery in patients with COVID-19? A cadaveric study. Minerva Urol Nephrol 2021; 74:242-244. [PMID: 34791864 DOI: 10.23736/s2724-6051.21.04614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Antonio M Granata
- Department of Urology, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy
| | - Franco Palmisano
- Department of Urology, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy -
| | - Claudio Fenizia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Roberta S Rossi
- Pathology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy
| | - Claudia Vanetti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Cristina Tonello
- Pathology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Ai L Romanò
- Department of Urology, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Luca Carsana
- Pathology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Daria Trabattoni
- Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Manuela Nebuloni
- Pathology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Sacco University Hospital, University of Milan, Milan, Italy
| | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy
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13
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Zattoni F, Marra G, Kretschmer A, Preisser F, Tilki D, Kesch C, Radtke JP, Hoffmann N, Morlacco A, Dal Moro F, Soeterik TFW, van den Bergh RCN, Barletta F, Briganti A, Montorsi F, Gandaglia G. Has the COVID-19 outbreak changed the way we are treating prostate cancer? An EAU - YAU Prostate Cancer Working Group multi-institutional study. Cent European J Urol 2021; 74:362-365. [PMID: 34729226 PMCID: PMC8552935 DOI: 10.5173/ceju.2021.0211] [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: 08/25/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction The COVID-19 outbreak has become the dominant issue throughout the world whilst the governments, nations and health services are trying to deal with its impact. The aim of our study is to assess the impact of COVID-19 on patients treated with radical prostatectomy (RP) for prostate cancer (PCa) at European referral centers in terms of surgical volume (SV), waiting list meant as time from biopsy to surgery (WL) and risk of adverse pathologic findings at RP due to the selection of men with more adverse disease characteristics at final pathology. Material and methods Consecutive patients with a diagnosis of histologically proven PCa treated with RP between March 2020 (WHO declaration of pandemic) and December 2020 were identified. Patients with metastatic disease not eligible to local treatment and recurrent prostate cancer after RP or RT were excluded. Patients treated at the same institutions between March 2019 and December 2019 were considered as the control group. Multivariable logistic regression analysis tested the impact of the COVID-19 outbreak on the risk of adverse pathologic findings at RP after adjusting for confounders. The percentage change of SV and WL was assessed comparing the months of pandemic with the equivalent timespan of the previous year. Results A total of 2,574 patients treated with RP (927 cases and 1647 controls) were identified in 8 European tertiary referral centers. At multivariable analysis patients who were treated during the pandemic had higher risk of extra prostatic disease (OR:1.35, p = 0.038) and lymph node invasion (LNI) (OR:1.72, p = 0.048). An average 23% reduction of the SV with the equivalent timespan of the previous year allowed an illusory reduction of the WL after the peak gained during the first wave of COVID-19. Conclusions Our results showed that the COVID-19 outbreak resulted in a delay in the administration of curative-intent therapies in patients with localized PCa. This, in turn, resulted in a stage migration phenomenon with a potential impact on oncologic control.
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Affiliation(s)
- Fabio Zattoni
- Urology Clinic, Academical Medical Centre Hospital, Udine, Italy.,Department of Surgical, Oncological and Gastroenterological Sciences-Urological Clinic, University of Padua, Padua, Italy
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Nils Hoffmann
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Alessandro Morlacco
- Department of Surgical, Oncological and Gastroenterological Sciences-Urological Clinic, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgical, Oncological and Gastroenterological Sciences-Urological Clinic, University of Padua, Padua, Italy
| | - Timo F W Soeterik
- Department of Urology, St Antonius Hospital, Utrecht, The Netherlands
| | | | - Francesco Barletta
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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14
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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: 0.7] [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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15
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Matta I, Laganà AS, Ghabi E, Bitar L, Ayed A, Petousis S, Vitale SG, Sleiman Z. COVID-19 transmission in surgical smoke during laparoscopy and open surgery: a systematic review. MINIM INVASIV THER 2021; 31:690-697. [PMID: 34612141 DOI: 10.1080/13645706.2021.1982728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the risk of SARS-CoV-2 transmission in surgical smoke and aerosols during laparoscopy and open surgery. MATERIAL AND METHODS A systematic review (PROSPERO ID: CRD42021268366) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were selected based on the title and abstract as well as the type of publication. Primary objectives of the study were to assess potential risk of contamination as well as comparing laparoscopic and open procedures in terms of danger of SARS-COV-2 transmission. RESULTS Fifty-three articles were identified and included in the review. No case of SARS-CoV-2 transmission to operating room personnel during open or minimally invasive surgery was identified at the time the review was conducted. Furthermore, no significant difference was observed between smoke and aerosols generated from open surgery and those generated from minimally invasive surgery. CONCLUSION COVID-19 transmission in surgical smoke and aerosols has yet to be observed. However, given the potential risk of viral transmission, caution should be exercised when performing surgery to ensure the safety of the operating room personnel. When clinically indicated and when protective measures can be implemented, minimally invasive surgery should be performed instead of open surgery to ensure optimal patient outcomes.
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Affiliation(s)
- Imad Matta
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Elie Ghabi
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Lynn Bitar
- Saint Joseph University, Beirut, Lebanon
| | - Amal Ayed
- Department of Obstetrics and Gynecology, Farwanya Hospital, MOH, Farwanya, Kuwait
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
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16
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Nugroho A, Saunar R, Lalisang TJM, Wiradisuria E. Local adaptation of laparoscopic smoke evacuator in COVID-19 pandemic situation. Asian J Endosc Surg 2021; 14:620-623. [PMID: 33145973 DOI: 10.1111/ases.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
The pandemic of COVID-19 has been a game changer in many aspects of medical care, including laparoscopic surgery service. Uncertainty in the early pandemic has led to the fear of doing laparoscopic surgery with regard to the possibility of SARS-COV-2 transmission through surgical smoke. We carried out laparoscopic surgery during the COVID-19 pandemic with intention to test our local adaptation of a laparoscopic smoke evacuator. Twenty-five laparoscopic cases for digestive surgery were performed with uneventful results. In summary, a low cost local adaptation of laparoscopic smoke and safe surgical behavior should be the standard of care when delivering laparoscopic surgery service in the pandemic era and forward.
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Affiliation(s)
| | - Rofi Saunar
- Digestive Surgery, Fatmawati Hospital, Jakarta, Indonesia
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17
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Ficarra V, Novara G, Giannarini G, De Nunzio C, Abrate A, Bartoletti R, Crestani A, Esperto F, Galfano A, Gregori A, Liguori G, Pavan N, Simonato A, Trombetta C, Tubaro A, Porpiglia F, Scarpa RM, Mirone V. Urology practice during the COVID-19 vaccination campaign. Urologia 2021; 88:298-305. [PMID: 33983086 PMCID: PMC8127017 DOI: 10.1177/03915603211016321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: The current scenario of the COVID-19 pandemic is significantly different from that of the first, emergency phase. Several countries in the world are experiencing a second, or even a third, wave of contagion, while awaiting the effects of mass vaccination campaigns. The aim of this report was to provide an update of previously released recommendations on prioritization and restructuring of urological activities. Methods: A large group of Italian urologists directly involved in the reorganization of their urological wards during the first and second phase of the pandemic agreed on a set of updated recommendations for current urology practice. Results: The updated recommendations included strategies for the prioritization of both surgical and outpatient activities, implementation of perioperative pathways for patients scheduled for elective surgery, management of urological conditions in infected patients. Future scenarios with possible implementation of telehealth and reshaping of clinical practice following the effects of vaccination are also discussed. Conclusion: The present update may be a valid tool to be used in the clinical practice, may provide useful recommendations for national and international urological societies, and may be a cornerstone for further discussion on the topic, also considering further evolution of the pandemic after the recently initiated mass vaccination campaigns.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urology Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Alberto Abrate
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urology Unit, University of Pisa, Pisa, Italy
| | | | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Galfano
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Gregori
- Urology Unit, ASST Fatebenefratelli Sacco, Sacco Hospital, Milan, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Carlo Trombetta
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Vincenzo Mirone
- Department of Urology, Federico II University of Naples, Naples, Italy
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18
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Operating room air delivery design to protect patient and surgical site results in particles released at surgical table having greater concentration along walls of the room than at the instrument tray. Am J Infect Control 2021; 49:593-596. [PMID: 33039512 PMCID: PMC7544698 DOI: 10.1016/j.ajic.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022]
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, recommendations have included that personnel not involved in procedures releasing airborne contaminants reduce their exposure by moving >2 m away. We tested whether air particle concentrations in operating rooms (ORs) are greater in the periphery, downstream from the supply airflow. Methods We analyzed data from 15 mock surgical procedures performed in 3 ORs. Two ORs were modern, one with a single large diffuser system above the surgical table, and the other using a multiple diffuser array design. An air particle counting unit was located on the instrument table, another adjacent to an air return grille. Results Concentrations of air particles were greater at return grille than instrument table for the single large diffuser at 26 air exchanges per hour, and the multiple diffuser array at both 26 and 20 air exchanges per hour (all P ≤ .0044), including during electrocautery (all P ≤ .0072). The ratios of concentrations, return grille versus instrument table, were greater during electrocautery for 0.5 to 1.0-micron particles and 1.0 to 5.0-micron particles (both P < .0001). Conclusions Modern OR airflow systems are so effective at protecting the surgical field and team from airborne particles emitted during surgery that concentrations of particles released at the OR table are greater at the OR walls than near the center of the room.
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Alasmar M, Kausar A, Borgstein ABJ, Moons J, Doran S, de Pascale S, Restrepo R, Verrengia A, Alloggio M, Delgado AM, Kumar S, Del Val ID, Giocapuzzi S, Baiocchi GL, de Vega Irañeta M, Salcedo G, Vorwald P, Fumagalli Romario U, Nafteux P, Gisbertz S, Chaudry MA, Alkhaffaf B. Is Re-introducing Major Open and Minimally Invasive Surgery during COVID-19 Safe for Patients and Healthcare Workers? An International, Multi-centre Cohort Study in the Field of Oesophago-gastric Surgery. Ann Surg Oncol 2021; 28:4816-4826. [PMID: 33866473 PMCID: PMC8053024 DOI: 10.1245/s10434-021-09885-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
Introduction The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related risks to patients and healthcare workers following the re-introduction of major oesophago-gastric (EG) surgery. Patients and Methods This was an international, multi-centre, observational study of consecutive patients treated by open and minimally invasive oesophagectomy and gastrectomy for malignant or benign disease. Patients were recruited from nine European centres serving regions with a high population incidence of COVID-19 between 1 May and 1 July 2020. The primary endpoint was 30-day COVID-19-related mortality. All staff involved in the operative care of patients were invited to complete a health-related survey to assess the incidence of COVID-19 in this group. Results In total, 158 patients were included in the study (71 oesophagectomy, 82 gastrectomy). Overall, 87 patients (57%) underwent MIS (59 oesophagectomy, 28 gastrectomy). A total of 403 staff were eligible for inclusion, of whom 313 (78%) completed the health survey. Approaches to mitigate against the risks of COVID-19 for patients and staff varied amongst centres. No patients developed COVID-19 in the post-operative period. Two healthcare workers developed self-limiting COVID-19. Conclusions Precautions to minimise the risk of COVID-19 infection have enabled the safe re-introduction of minimally invasive and open EG surgery for both patients and staff. Further studies are necessary to determine the minimum requirements for mitigations against COVID-19. Electronic supplementary material The online version contains supplementary material available at (10.1245/s10434-021-09885-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohamed Alasmar
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford Royal Hospital, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Afsana Kausar
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford Royal Hospital, Manchester, UK
| | | | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Doran
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Rafael Restrepo
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Apollonia Verrengia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Sacheen Kumar
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Gabriel Salcedo
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Peter Vorwald
- Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | | | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Suzanne Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford Royal Hospital, Manchester, UK. .,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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20
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Alkhaffaf B, Alasmar M. Major Complex and Minimally Invasive Cancer Surgery Can Be Delivered Safely During the COVID-19 Pandemic. Ann Surg Oncol 2021; 28:4827-4828. [PMID: 33796998 PMCID: PMC8015926 DOI: 10.1245/s10434-021-09888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal Foundation Trust, Salford Royal Hospital, Manchester, UK. .,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Mohamed Alasmar
- Department of Oesophago-Gastric Surgery, Salford Royal Foundation Trust, Salford Royal Hospital, Manchester, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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21
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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: 5] [Impact Index Per Article: 1.7] [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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22
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Hoffman HT, Walsh JE, Pratt A, Miller RM, Schwalje A, Stegall HR, Nonnenmann M. Laser plume containment during flexible transnasal laryngoscopy. Laryngoscope Investig Otolaryngol 2021; 6:234-243. [PMID: 33821216 PMCID: PMC8013799 DOI: 10.1002/lio2.526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate a negative pressure microenvironment designed to contain laser plume during flexible transnasal laryngoscopy. Methods The Negative Pressure Face Shield (NPFS) was previously reported as well tolerated with initial use on 30 patients. Diagnostic transnasal laryngoscopy was performed on an additional 108 consecutive patients who were evaluated by questionnaires and sequential pulse oximetry. Further study addressed operative transnasal potassium‐titanyl‐phosphate (KTP) laser laryngoscopy with biopsy done on four patients employing the NPFS. Results The previously described NPFS version 3 (v.3), a transparent acrylic barrier with two anterior instrumentation ports, was modified by repositioning the side suction port closer to the level of the nose and deepening the lateral sides, squaring off the lower projection. A post‐procedure questionnaire employing a 5‐point Likert scale ranging from no symptoms (rating of 1) to intolerable (rating of 5) identified excellent patient tolerance of the new design (v.4), among 22 patients evaluated and similar in the comparison to the 116 patients using version 3. Among the 138 patients analyzed, only one patient rated the experience as greater than “mild claustrophobia.” 100% of patients answered either “none” or “mild” to the pain and shortness of breath questions. The NPFS (v.4) was then successfully used in four patients for laser laryngoscopy with biopsy of laryngeal papilloma (3/4) and hemorrhagic polyp (1/4). Post‐procedure questionnaire identified no shortness of breath (4/4), no claustrophobia (4/4), no pain (4/4) and no significant changes in pulse oximetry during use. Conclusion Extensive experience in performing diagnostic laryngoscopy with the NPFS directed design changes leading to successful use for transnasal flexible laser laryngoscopy with biopsy in a negative pressure microenvironment. Level of Evidence Level 2b (Cohort Study).
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Affiliation(s)
- Henry T Hoffman
- Department of Otolaryngology University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Jarrett E Walsh
- Department of Otolaryngology University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Alessandra Pratt
- Department of Occupational and Environmental Health University of Iowa College of Public Health Iowa City Iowa USA
| | - Robert M Miller
- Engineering Services University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Adam Schwalje
- Department of Otolaryngology University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Helen R Stegall
- Department of Otolaryngology University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Matt Nonnenmann
- Department of Occupational and Environmental Health University of Iowa College of Public Health Iowa City Iowa USA
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23
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Ekci B. Easy-to-use electrocautery smoke evacuation device for open surgery under the risk of the COVID-19 pandemic. J Int Med Res 2020; 48:300060520949772. [PMID: 32844707 PMCID: PMC7453469 DOI: 10.1177/0300060520949772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study was performed to introduce an easy method of surgical smoke evacuation for patients with confirmed or suspected COVID-19 undergoing emergency surgery. METHODS An easy, inexpensive, protective, and practical surgical smoke evacuation device/system was developed and is herein described. RESULTS The use of this surgical smoke evacuation device/system in open surgery is convenient and effective. It allows for easy, economic, useful, and protective surgical smoke evacuation. CONCLUSIONS COVID-19 infection causes direct mortality and morbidity, and its incidence has recently increased. Protection from electrosurgery-related smoke is recommended particularly during the current pandemic. This surgical smoke evacuation device/system is easy to use and provides a convenient and effective method of smoke evacuation during both open surgery and all cauterization interventions.
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Affiliation(s)
- Baki Ekci
- Department of General Surgery, Halic University School of Medicine, Sutluce, Istanbul, Turkey
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