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Köze BŞ, Van Giersbergen MY, Özkan E. Bibliometric Analysis of Studies on Surgical Smoke: Bibliometric Analysis. J Perianesth Nurs 2024:S1089-9472(24)00360-5. [PMID: 39387782 DOI: 10.1016/j.jopan.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 10/15/2024]
Abstract
PURPOSE The aim of this study was to examine the studies on surgical smoke by bibliometric analysis and science mapping methods. DESIGN Bibliometric analysis and science mapping methods study. METHODS Data were obtained by searching the SCOPUS database. The keywords "surgical smoke," "operating room," "operating room staff," and "nurse" were used. Due to the ongoing scientific flow to the database, the search was performed on December 25, 2023 as a single day. FINDINGS As a result of the research, a total of 51 studies were reached. We found 49 research articles and 2 review publications in the field of nursing and medicine. Most publications related to surgical smoke were published in 2021 (21.5% n: 11), and the journals with the highest number of publications were the Journal of Perioperative Nursing (5.9% n: 3) and AORN Journal (5.9% n: 3). The most common keyword in the studies was "surgical smoke." "Surgical smoke" was used in common with all other keywords, the most publications on the subject were made in the United States, the most publications were made in English (92% n: 47), and the most citations were made by Barrett and Garber in 2003 with 250 citations (25.4%). CONCLUSIONS This study provides a comprehensive overview of the current state of research on surgical smoke, highlighting its prevalence in recent literature. The findings underscore the need for continued investigation and awareness among health care professionals. The results obtained are important in terms of understanding the current situation in the relevant literature and will provide resources for new studies to be carried out by nursing and other surgical team members in the future.
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Affiliation(s)
- Burçak Şahin Köze
- Department of Surgical Diseases Nursing, Faculty of Nursing, Ege University, Izmir, Turkey.
| | | | - Esra Özkan
- Department of Surgical Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
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2
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Bowdle A, Brosseau LM, Tellier R, MacIntyre CR, Edwards M, Jelacic S. Reducing airborne transmissible diseases in perioperative environments. Br J Anaesth 2024; 133:19-23. [PMID: 38677948 DOI: 10.1016/j.bja.2024.03.025] [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: 02/27/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
The COVID-19 pandemic has transformed our understanding of aerosol transmissible disease and the measures required to minimise transmission. Anaesthesia providers are often in close proximity to patients and other hospital staff for prolonged periods while working in operating and procedure rooms. Although enhanced ventilation provides some protection from aerosol transmissible disease in these work areas, close proximity and long duration of exposure have the opposite effect. Surgical masks provide only minimal additional protection. Surgical patients are also at risk from viral and bacterial aerosols. Despite having recently experienced the most significant pandemic in 100 yr, we continue to lack adequate understanding of the true risks encountered from aerosol transmissible diseases in the operating room, and the best course of action to protect patients and healthcare workers from them in the future. Nevertheless, hospitals can take specific actions now by providing respirators for routine use, encouraging staff to utilise respirators routinely, establishing triggers for situations that require respirator use, educating staff concerning the prevention of aerosol transmissible diseases, and providing portable air purifiers for perioperative spaces with low levels of ventilation.
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Affiliation(s)
- Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Lisa M Brosseau
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Raymond Tellier
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark Edwards
- Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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3
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Law RH, Cena L, Sporn A, Buzi A, Rizzi MD, Ruiz RL, Fedrigo S, Giordano T, Fahmy AN, Dedhia K. Nanoparticle Concentration in Surgical Plume During Tonsillectomy: A Comparison of Four Techniques. Laryngoscope 2024; 134:2444-2448. [PMID: 37983867 DOI: 10.1002/lary.31185] [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: 08/28/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures. METHODS This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups. RESULTS The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels. CONCLUSION Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2444-2448, 2024.
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Affiliation(s)
- Richard H Law
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorenzo Cena
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Alec Sporn
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Adva Buzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D Rizzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan L Ruiz
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Fedrigo
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Terri Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander N Fahmy
- School of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kavita Dedhia
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Meretsky CR, Mahmoodi A, Knecht EM, Popovich J, Schiuma AT. The Impact of Electrocautery Smoke on Surgical Staff and the Efficacy of Normal Surgical Masks Versus N95 Masks. Cureus 2024; 16:e58106. [PMID: 38738122 PMCID: PMC11088792 DOI: 10.7759/cureus.58106] [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] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Electrocautery is a commonly used technique in surgical procedures, generating smoke that poses health risks to surgical staff. This study investigates the comparative efficacy of normal surgical masks versus N95 masks in mitigating the harmful effects of electrocautery smoke. Through a systematic review of literature spanning two decades, we explore the causes and effects of electrocautery smoke exposure, including potential long-term inhalation effects. Our findings highlight significant disparities in the protection offered by different masks and underscore the importance of adequate respiratory protection in surgical settings. In addition, we examine the factors influencing the generation and composition of electrocautery smoke, such as the power settings used, the type of tissue being cauterized, and the duration of the procedure. Furthermore, we discuss the potential health risks associated with long-term exposure to electrocautery smoke, including the possibility of respiratory conditions, cardiovascular effects, and carcinogenicity. Our analysis also addresses the importance of implementing appropriate smoke evacuation systems and optimizing operating room ventilation to minimize the concentration of smoke particles in the surgical environment. Overall, this comprehensive analysis provides valuable insights into the impact of electrocautery smoke in surgical settings and the varying levels of protection offered by different masks.
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Affiliation(s)
| | - Arshia Mahmoodi
- Surgery, St. George's University School of Medicine, Great River, USA
| | - Erik M Knecht
- Surgery, Chicago Medical School at Rosalind Franklin University, Chicago, USA
| | - Jay Popovich
- Internal Medicine, St. George's University School of Medicine, Great River, USA
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5
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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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Vortman RK, Smalley PJ. CE: Our Journey to Pass a Surgical Plume Evacuation Law. Am J Nurs 2024; 124:32-38. [PMID: 38212012 DOI: 10.1097/01.naj.0001006372.54090.69] [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: 01/13/2024]
Abstract
ABSTRACT Surgical plume is produced when heat-generating instruments are used to cut, cauterize, or vaporize tissue during surgery. Surgical plume can rapidly diffuse, and without the use of plume evacuators to ensure it is captured, filtered, and removed, health care workers and patients are at risk for inhalation exposure to airborne contaminants, including smoke and biological hazards. The use of surgical plume evacuators in health care facilities is inconsistent across the United States. This article describes the experience of two nurses who led a grassroots coalition to pass a surgical plume evacuation law in Illinois. It also outlines strategies they used in the legislative process that nurses can apply to their own efforts to advocate for health policy change at the state level.
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Affiliation(s)
- Rebecca K Vortman
- Rebecca K. Vortman is a clinical assistant professor in the Department of Population Health Nursing Science at the University of Illinois Chicago College of Nursing in Springfield. Penny J. Smalley is a Chicago-based independent nurse consultant and director of education and regulatory affairs for the International Council on Surgical Plume. Contact author: Rebecca K. Vortman, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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7
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Zhou YZ, Wang CQ, Zhou MH, Li ZY, Chen D, Lian AL, Ma Y. Surgical smoke: A hidden killer in the operating room. Asian J Surg 2023; 46:3447-3454. [PMID: 37002044 DOI: 10.1016/j.asjsur.2023.03.066] [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: 11/16/2022] [Revised: 01/12/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical smoke is a byproduct of aerosols containing several components produced by energy equipment. The characteristics of surgical smoke components produced by different types of tissues or using different kinds of energy devices vary. For example, the average diameter of smoke particles produced by electrocautery is smaller, and the possibility of viable cells and pathogens in surgical smoke produced by an ultrasonic knife is higher. According to the characteristics of its composition, surgical smoke may be an important risk factor affecting the health and safety of operating room staff and patients. The use of surgical masks, suction devices and portable smoke evacuation systems can reduce this risk to some extent. However, most operating room staff members do not implement corresponding measures to protect themselves. In this paper, the characteristics of surgical smoke and the research progress in protective measures are briefly reviewed.
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Affiliation(s)
- Yong-Zhi Zhou
- Department of Minimal Invasive Hepatic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China
| | - Chao-Qun Wang
- Department of Minimal Invasive Hepatic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China
| | - Meng-Hua Zhou
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China; Department of Hepatic Surgery, The First Affliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Zhong-Yu Li
- Department of Minimal Invasive Hepatic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China
| | - Dong Chen
- Department of Minimal Invasive Hepatic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China
| | - Ai-Ling Lian
- Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Yong Ma
- Department of Minimal Invasive Hepatic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, China.
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8
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Yakkanti RR, Sedani AB, Syros A, Aiyer AA, D’Apuzzo MR, Hernandez VH. Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00083. [PMID: 36733707 PMCID: PMC9886518 DOI: 10.2106/jbjs.oa.22.00083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Orthopaedic surgeons are at increased risk for many occupational hazards, both physical and mental. The aim of this study was to evaluate a wide range of work-related injuries among orthopaedic surgeons in the United States. Methods An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate. Results The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work. Conclusions This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ramakanth R. Yakkanti
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Anil B. Sedani
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, Florida,Email for corresponding author:
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Michele R. D’Apuzzo
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Victor H. Hernandez
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
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Carroll GT, Kirschman DL. A Peripherally Located Air Recirculation Device Containing an Activated Carbon Filter Reduces VOC Levels in a Simulated Operating Room. ACS OMEGA 2022; 7:46640-46645. [PMID: 36570243 PMCID: PMC9774396 DOI: 10.1021/acsomega.2c05570] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 06/13/2023]
Abstract
Electrosurgery procedures produce airborne contaminants including volatile organic compounds (VOCs). The effectiveness of commercial grade activated carbon at removing toluene, a typical VOC, from the air in an enclosed simulated operating room (OR) when interfaced with an air recirculation device was tested. The concentration of toluene in the air was measured using gas sensitive semiconductor VOC sensors. When the air recirculation device containing activated carbon was turned on, the concentration of toluene in the air decayed exponentially. When the device was off, the toluene concentration reduced much more slowly. After 130 min, a VOC sensor placed near the air recirculation device showed VOC reductions of approximately 30% when the device is on and less than 1% when the device is off. Changing the activated carbon filter after 22 h of constant use showed an abrupt increase in the rate of toluene removal.
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Affiliation(s)
- Gregory T. Carroll
- Scientific Affairs, Aerobiotix, Inc., 444 Alexandersville Road, Miamisburg, Ohio 45342, United States
| | - David L. Kirschman
- Scientific Affairs, Aerobiotix, Inc., 444 Alexandersville Road, Miamisburg, Ohio 45342, United States
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10
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Singhal R, Dickerson L, Sakran N, Pouwels S, Chiappetta S, Weiner S, Purkayastha S, Madhok B, Mahawar K. Safe Surgery During the COVID-19 Pandemic. Curr Obes Rep 2022; 11:203-214. [PMID: 34709586 PMCID: PMC8552630 DOI: 10.1007/s13679-021-00458-6] [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: 09/02/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. RECENT FINDINGS Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
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Affiliation(s)
- Rishi Singhal
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Luke Dickerson
- Department of General Surgery, Leighton Hospital, Crewe, UK
| | - Nasser Sakran
- Director Bariatric Centre, Department of Surgery, Emek Medical Centre, Afula, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Sonja Chiappetta
- Head Obesity and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Sylvia Weiner
- Department of Obesity and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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11
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Hsu FLT, Ho TW, Chang C, Wu JM, Lin MT. Chemical composition of smoke produced by open versus laparoscopic surgery for cholecystectomy. HPB (Oxford) 2022; 24:1335-1340. [PMID: 35219594 DOI: 10.1016/j.hpb.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Smoke produced by traditional open surgery (TOS) has long been considered hazardous to medical staff. Compared with TOS, minimally invasive surgery under carbon dioxide pneumoperitoneum is associated with a faster recovery and less wound pain. However, the impact of oxygen-deficient environment on the chemical contents of smoke has not been comprehensively assessed. METHODS This research evaluated the chemical composition and volatile organic compound (TVOC) level in smoke produced by open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC) for gallbladder diseases. Smoke samples were collected and analyzed via gas chromatography-mass spectrometry. Chemical compounds were further grouped according to molecular weight and toxicity. RESULTS Compared with the OC, LC had significantly higher halocarbon and TVOC levels but lower cycloalkene and aldehyde levels. No halocarbons were isolated from OC specimens. When stratified based on molecular weight, LC had a bimodal pattern (i.e., high levels of small-sized [<60 Da] and large-sized [>120 Da] compounds). There was no difference in terms of toxicity types, incidence, and severity associated with detected compounds between two groups. CONCLUSION LC is associated with a higher TVOC level and proportion of low- and high-molecular-weight organic compounds. Further strategies of evacuating these health hazards and preventing smoke leakage through trocars should be considered.
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Affiliation(s)
- Francis Li-Tien Hsu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Christopher Chang
- Program in Liberal Medical Education (PLME) and the Department of Molecular Biology, Cell Biology & Biochemistry, Brown University, Providence, RI, USA
| | - Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan; Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County 300, Taiwan.
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
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12
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Ostapovych U, Vortman R. Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project. AORN J 2022; 115:139-146. [PMID: 35084765 DOI: 10.1002/aorn.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Abstract
Energy-generating surgical devices (eg, electrosurgical units, lasers) produce surgical smoke that can cause negative health effects in exposed individuals. In 2019, a review of nursing documentation at an urban teaching hospital revealed that personnel were properly evacuating surgical smoke during less than 0.5% of applicable procedures. To address the noncompliance and reduce exposure to surgical smoke, an interdisciplinary team initiated a quality improvement project to implement a surgical smoke evacuation policy for all smoke-generating procedures. The project included creation and implementation of a smoke evacuation policy, staff member education on the hazards of surgical smoke and proper evacuation device use, and acquisition of the proper smoke evacuation equipment. After instituting the policy in June 2020, results of a three-month chart audit showed that there was nursing documentation confirming personnel used energy-generating devices and the corresponding surgical smoke evacuation devices during 664 of 2,224 procedures, for a compliance rate of 30%.
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13
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Chen WQ, Zhang XY. 1,3-Butadiene: a ubiquitous environmental mutagen and its associations with diseases. Genes Environ 2022; 44:3. [PMID: 35012685 PMCID: PMC8744311 DOI: 10.1186/s41021-021-00233-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/27/2021] [Indexed: 01/09/2023] Open
Abstract
1,3-Butadiene (BD) is a petrochemical manufactured in high volumes. It is a human carcinogen and can induce lymphohematopoietic cancers, particularly leukemia, in occupationally-exposed workers. BD is an air pollutant with the major environmental sources being automobile exhaust and tobacco smoke. It is one of the major constituents and is considered the most carcinogenic compound in cigarette smoke. The BD concentrations in urban areas usually vary between 0.01 and 3.3 μg/m3 but can be significantly higher in some microenvironments. For BD exposure of the general population, microenvironments, particularly indoor microenvironments, are the primary determinant and environmental tobacco smoke is the main contributor. BD has high cancer risk and has been ranked the second or the third in the environmental pollutants monitored in most urban areas, with the cancer risks exceeding 10-5. Mutagenicity/carcinogenicity of BD is mediated by its genotoxic metabolites but the specific metabolite(s) responsible for the effects in humans have not been determined. BD can be bioactivated to yield three mutagenic epoxide metabolites by cytochrome P450 enzymes, or potentially be biotransformed into a mutagenic chlorohydrin by myeloperoxidase, a peroxidase almost specifically present in neutrophils and monocytes. Several urinary BD biomarkers have been developed, among which N-acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine is the most sensitive and is suitable for biomonitoring BD exposure in the general population. Exposure to BD has been associated with leukemia, cardiovascular disease, and possibly reproductive effects, and may be associated with several cancers, autism, and asthma in children. Collectively, BD is a ubiquitous pollutant that has been associated with a range of adverse health effects and diseases with children being a subpopulation with potentially greater susceptibility. Its adverse effects on human health may have been underestimated and more studies are needed.
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Affiliation(s)
- Wan-Qi Chen
- School of Public Health, Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xin-Yu Zhang
- School of Public Health, Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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14
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Özdemir Y, Temiz A. Surgical treatment of gastrointestinal tumors in a COVID-19 pandemic hospital: Can open versus minimally invasive surgery be safely performed? J Surg Oncol 2021; 124:1217-1223. [PMID: 34411309 PMCID: PMC8426937 DOI: 10.1002/jso.26653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE In order for patients with gastrointestinal cancer not to suffer the consequences of delayed treatment, they should be operated on in pandemic hospitals under adequate conditions. We aimed to discuss the outcomes of our gastrointestinal cancer surgery patients and to present our patient management recommendations to resume operative treatment during the ongoing COVID-19 pandemic while taking into account hospital facilities. MATERIALS AND METHODS This study included 129 gastrointestinal cancer patients who underwent surgery between March 2020 and May 2021 in the gastrointestinal surgery clinic of our hospital, which was assigned as a pandemic hospital in March 2020. Patients' demographic characteristics and preoperative and postoperative findings were recorded. RESULTS Among the patients, 42.6% (n = 55) were female and 57.3% (n = 74) were male. The mean age was 61.89 ± 3.4 years. The primary tumor organs were the stomach 37.2% (n = 48), pancreas 36.4% (n = 47), rectum 11.6% (n = 15), colon 8.5% (n = 11), and esophagus 6.2% (n = 8). The patients were treated with open (75.2%, n = 97) or minimally invasive surgery (24.8%, n = 32; laparoscopic 11.6%, n = 15; robotic 13.2%, n = 17). Eight patients tested positive for COVID-19 before surgery. No patients developed COVID-19 during postoperative intensive care or after being moved to the floor unit. There was no COVID-19-related morbidity or mortality. CONCLUSION Failure to treat gastrointestinal cancer patients during the pandemic may result in undesirable consequences, such as stage shift and mortality. Cancer patients can be treated safely with conventional and minimally invasive surgery guided by current recommendations and experience.
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Affiliation(s)
- Yılmaz Özdemir
- Department of Gastrointestinal Surgery, Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Ayetullah Temiz
- Department of General Surgery, Erzurum Region Education and Research Hospital, Erzurum, Turkey
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15
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Jalisi S, Chen AD, Gomez E, Chigurupati R, Cauley R, Olbricht S, Lee BT, Lin SJ. A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough? Plast Reconstr Surg 2021; 148:467-474. [PMID: 34398101 PMCID: PMC8312336 DOI: 10.1097/prs.0000000000008177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
SUMMARY The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.
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Affiliation(s)
- Scharukh Jalisi
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Austin D. Chen
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ernest Gomez
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Radhika Chigurupati
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ryan Cauley
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Suzanne Olbricht
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Bernard T. Lee
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Samuel J. Lin
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
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16
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Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 24:100189. [PMID: 34179520 PMCID: PMC8214320 DOI: 10.1016/j.pcorm.2021.100189] [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: 02/09/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/28/2022]
Abstract
Background Electrosurgery smoke is the smoke emitted from tissue cauterization when using the electrosurgery device. Accordingly, in this smoke, more than 80 harmful toxins have been discovered. In the current study, we aimed to investigate the level of knowledge reported by the operating room nurses on the effects of electrosurgery smoke during the current COVID-19 pandemic. Methods This descriptive, survey-based cross-sectional study was performed on 533 OR nurses in all the referring hospitals of COVID-19 infection. The required information were collected using a questionnaire regarding the knowledge on the side effects of electrosurgery smoke. The obtained data were then analyzed using t-test and ANOVA by SPSS software. Results Most of the included participants (93.6%) had a low level of awareness and only a small number of them (0.4%) had a good level of knowledge on the effects of electrosurgery smoke. As well, a significant relationship (P˂0.05) was found between the level of knowledge reported by the OR nurses and the type of hospital (educational or private). Most of the studied hospitals used no electrosurgery smoke reduction equipment during electrosurgery. Conclusion The level of knowledge reported by the OR nurses was generally poor. It is recommended that managers and health officials try to increase the level of awareness of OR nurses during the COVID-19 pandemic by providing standard and protective equipment as well as holding some well-organized and related training courses.
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17
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Wiegand MJ, Kubacki GW, Gilbert JL. Electrocautery-induced molten metal particle generation from total joint replacements: Morphology and chemistry. J Biomed Mater Res B Appl Biomater 2021; 109:2057-2067. [PMID: 33915033 DOI: 10.1002/jbm.b.34853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/12/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Abstract
Electrosurgical techniques are used during surgery to cauterize, and their damaging effects have primarily been documented in terms of tissue necrosis, charring, and localized heat accumulation. Metallic implants as well as the surgical blade can experience incidental electrosurgical current arcing that results in the generation and transfer of melted metallic particles. This work examines the composition, particle size distribution, and chemical state of the melted alloy surfaces and particles produced in vitro. Using scanning electron microscopy and energy dispersive spectroscopy, a flash-melting particle generation phenomenon between source 304 SSL blades and polished cobalt-chromium-molybdenum (CoCrMo) and titanium-6-aluminum-4-vandaium (Ti6Al4V) surfaces was documented where 304 SSL mixed heterogeneously with the CoCrMo and Ti6Al4V ejecting "splatter" particles from the cautery site. The spherical micron-sized particles were embedded with sub-micron-sized particles with 42% of the total sample population measuring between 0.25 and 0.35 μm in diameter. CoCrMo-304 SSL particles were principally made of high concentrations of iron, oxygen, and nickel with embedded sub-micron-sized particles containing oxygen, chromium, and cobalt with lower concentrations of iron and molybdenum. Ti6Al4V-304 SSL interactions resulted in similar micron-sized particles made up of high concentrations of iron, nickel, and chromium with embedded sub-micron-sized particles containing titanium, oxygen, and small amounts of aluminum. X-ray photoelectron spectroscopy of damaged CoCrMo surfaces confirmed the presence of chromium (VI) following dry electrocautery contact in coagulation mode. The structural effects of electrocautery-induced damage are becoming visible in retrieval analysis, but the long-term physiological implications during the lifetime of the implant from this damage mode have yet to be defined.
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Affiliation(s)
- Michael J Wiegand
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Clemson University-Medical University of South Carolina Program in Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Gregory W Kubacki
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York, USA.,Syracuse Biomaterials Institute, Syracuse University, Syracuse, New York, USA
| | - Jeremy L Gilbert
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Clemson University-Medical University of South Carolina Program in Bioengineering, Clemson University, Charleston, South Carolina, USA
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18
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Khoiwal K, Chaturvedi J. Gynecological Surgeries During COVID-19 Pandemic: A Laparoscopist's Viewpoint. Gynecol Minim Invasive Ther 2021; 10:69-70. [PMID: 33747781 PMCID: PMC7968597 DOI: 10.4103/gmit.gmit_130_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/12/2020] [Accepted: 11/26/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Kavita Khoiwal
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
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Sayahi T, Nielson C, Yu Y, Neuberger K, Seipp M, Firpo MA, Kelly K, Park AH. Airborne Aerosolized Mouse Cytomegalovirus From Common Otolaryngology Procedures: Implications for COVID-19 Infection. Otolaryngol Head Neck Surg 2021; 164:547-555. [PMID: 32928037 PMCID: PMC7492827 DOI: 10.1177/0194599820957966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether common otolaryngology procedures generate viable aerosolized virus through a murine cytomegalovirus (mCMV) model for infection. STUDY DESIGN mCMV model of infection. SETTING University of Utah laboratory. METHODS Three-day-old BALB/c mice were inoculated with mCMV or saline. Five days later, each mouse underwent drilling, microdebrider, coblation, and electrocautery procedures. Particle size distribution and PM2.5 (particulate matter <2.5 µm) concentration were determined with a scanning mobility particle sizer and an aerosol particle sizer in the range of 15 nm to 32 µm. Aerosolized samples from these procedures were collected with an Aerosol Devices BioSpot sampler for viral titer based on polymerase chain reaction and for viable virus through viral culture. RESULTS As compared with the background aerosol concentrations, coblation and electrocautery showed statistically significant increases in airborne aerosols (Tukey-adjusted P value <.040), while microdebrider and drilling at 30,000 rpm did not (.870 < Tukey-adjusted P value < .930). We identified viral DNA in samples from coblation and drilling procedures, although we did not identify viable viruses in aerosol samples from any of the 4 procedures. CONCLUSION Coblation and electrocautery procedures generate >100-fold increases in aerosol concentrations over background; only coblation and drilling produce aerosolized viral DNA. The high concentration of aerosols from coblation and electrocautery suggests the need for appropriate safeguards against particle exposure to health care workers. The presence of viral DNA from drilling and coblation procedures warrants the need for appropriate protection against droplet and aerosol exposure.
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Affiliation(s)
- Tofigh Sayahi
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Christopher Nielson
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Yuan Yu
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kaden Neuberger
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Seipp
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Matthew A. Firpo
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kerry Kelly
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Albert H. Park
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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Ryu RC, Behrens PH, Malik AT, Lester JD, Ahmad CS. Are we putting ourselves in danger? Occupational hazards and job safety for orthopaedic surgeons. J Orthop 2021; 24:96-101. [PMID: 33716416 DOI: 10.1016/j.jor.2021.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
As physicians, we strive to meet the needs of our patients. In doing so, we are often exposed to hazards that have the potential to not only compromise our health, but also our ability to deliver the best possible healthcare. Occupational hazards specific to the field of orthopaedics include infectious organisms, radiation, surgical smoke, chemicals, hazardous noise, musculoskeletal injury, and psychosocial stressors. Even though orthopaedic surgeons acknowledge the risk, most lack in-depth knowledge of the associated long-term harm associated with these hazards and ways of reducing risk of exposure. Orthopaedic surgeons should increase awareness, follow established guidelines, and integrate preventative measures to create the safest possible work environment. It is our hope that by improving our own health, we will be better equipped to address the health concerns of those we serve-our patients.
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Affiliation(s)
- Robert C Ryu
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phillip H Behrens
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Azeem T Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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21
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Kirschbaum S, Hommel H, Strache P, Horn R, Falk R, Perka C. Laminar air flow reduces particle load in TKA-even outside the LAF panel: a prospective, randomized cohort study. Knee Surg Sports Traumatol Arthrosc 2021; 29:3641-3647. [PMID: 33165633 PMCID: PMC7649711 DOI: 10.1007/s00167-020-06344-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Released particles are a major risk of airborne contamination during surgery. The present prospective study investigated the quantitative and qualitative particle load in the operating room (OR) depending on location, time of surgery and use of laminar air flow (LAF) system. METHODS The particle load/m3 was measured during the implantation of 12 total knee arthroplasties (6 × LAF, 6 × Non-LAF) by using the Met One HHPC 6 + device (Beckmann Coulter GmbH, Germany). Measurement was based on the absorption and scattering of (laser) light by particles and was performed at three different time-points [empty OR, setting up, ongoing operation) at 3 fixed measurement points [OR table (central LAF area), anaesthesia tower (marginal LAF area), surgical image amplifier (outside LAF area)]. RESULTS Independent of time and location, all measurements showed a significantly higher particle load in the Non-LAF group (p < 0.01). With ongoing surgical procedure both groups showed increasing particle load. While there was a major increase of fine particles (size < 1 µm) with advancing activity in the LAF group, the Non-LAF group showed higher particle gain with increasing particle size. The lowest particle load in the LAF group was measured at the operating column, increasing with greater distance from the operating table. The Non-LAF group presented a significantly higher particle load than the LAF group at all locations. CONCLUSION The use of a LAF system significantly reduces the particle load and therefore potential bacterial contamination regardless of the time or place of measurement and therefore seems to be a useful tool for infection prevention. As LAF leads to a significant decrease of respirable particles, it appears to be a protective factor for the health of the surgical team regardless of its use in infection prevention. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité - University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hagen Hommel
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
- Academic Teaching Hospital of the Medical School of Brandenburg Theodor Fontane, Fehrbelliner Strase 38, 16816, Neuruppin, Germany
| | - Peggy Strache
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Roland Horn
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Roman Falk
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité - University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
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22
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Manejo de pacientes de Ortopedia y Traumatología en el contexto de la contingencia por covid-19: revisión de conceptos actuales revisión de la literatura. REVISTA COLOMBIANA DE ORTOPEDIA Y TRAUMATOLOGÍA 2021. [PMCID: PMC7229917 DOI: 10.1016/j.rccot.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
El objetivo del presente estudio es presentar una revisión de la literatura disponible, que permita abordar de forma ordenada la evidencia actual con respecto a la organización de un servicio de cirugía ortopédica y traumatología durante la pandemia por covid-19, el manejo de los pacientes y las medidas de protección para el personal de salud involucrado. Se realizó una búsqueda de literatura en bases de datos (PUBMED y Scielo), instituciones gubernamentales de salud y sociedades científicas. Los autores seleccionaron los artículos que consideraron pertinentes para la presente revisión. Se plantean recomendaciones para los distintos escenarios de la práctica ortopédica: consulta externa, hospitalización, cirugía (electiva y de urgencias) y urgencias; así como recomendaciones específicas para algunas subespecialidades (cirugía de columna, cirugía de mano y ortopedia pediátrica).
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23
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Chan Y, Banglawala SM, Chin CJ, Côté DWJ, Dalgorf D, de Almeida JR, Desrosiers M, Gall RM, Gevorgyan A, Hassan Hassan A, Janjua A, Lee JM, Leung RM, Mechor BD, Mertz D, Monteiro E, Nayan S, Rotenberg B, Scott J, Smith KA, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan A, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:81. [PMID: 33272328 PMCID: PMC7714255 DOI: 10.1186/s40463-020-00476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/25/2020] [Indexed: 01/19/2023] Open
Abstract
Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.
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Affiliation(s)
- Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - Sarfaraz M Banglawala
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Saint John, NB, Canada
| | - David W J Côté
- University of Montreal Hospital Center (CHUM) and Research Center (CRCHUM), Montreal, QC, Canada
| | - Dustin Dalgorf
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Richard M Gall
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Artur Gevorgyan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - A Hassan Hassan
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John M Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Randy M Leung
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John Scott
- Department of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kristine A Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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Buggisch JR, Göhler D, Le Pape A, Roger S, Ouaissi M, Stintz M, Rudolph A, Giger-Pabst U. Experimental Model to Test Electrostatic Precipitation Technology in the COVID-19 Era: A Pilot Study. J Am Coll Surg 2020; 231:704-712. [PMID: 32891798 PMCID: PMC7470820 DOI: 10.1016/j.jamcollsurg.2020.08.759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the COVID-19 crisis, laparoscopic surgery is in focus as a relevant source of bioaerosol release. The efficacy of electrostatic aerosol precipitation (EAP) and continuous aerosol evacuation (CAE) to eliminate bioaerosols during laparoscopic surgery was verified. STUDY DESIGN Ex-vivo laparoscopic cholecystectomies (LCs) were simulated ± EAP or CAE in Pelvitrainer equipped with swine gallbladders. Release of bioaerosols was initiated by performing high-frequency electrosurgery with a monopolar electro hook (MP-HOOK) force at 40 watts (MP-HOOK40) and 60 watts (MP-HOOK60), as well as by ultrasonic cutting (USC). Particle number concentrations (PNC) of arising aerosols were analyzed with a condensation particle counter (CPC). Aerosol samples were taken within the Pelvitrainer close to the source, outside the Pelvitrainer at the working trocar, and in the breathing zone of the surgeon. RESULTS Within the Pelvitrainer, MP-HOOK40 (6.4 × 105 cm-3) and MP-HOOK60 (7.3 × 105 cm-3) showed significantly higher median PNCs compared to USC (4.4 × 105 cm-3) (p = 0.001). EAP led to a significant decrease of the median PNCs in all 3 groups. A high linear correlation with Pearson correlation coefficients of 0.852, 0.825, and 0.759 were observed by comparing MP-HOOK40 (± EAP), MP-HOOK60 (± EAP), and USC (± EAP), respectively. During ex-vivo LC and CAE, significant bioaerosol contaminations of the operating room occurred. Ex-vivo LC with EAP led to a considerable reduction of the bioaerosol concentration. CONCLUSIONS EAP was found to be efficient for intraoperative bioaerosol elimination and reducing the risk of bioaerosol exposure for surgical staff.
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Affiliation(s)
| | - Daniel Göhler
- Technologie-orientierte Partikel-, Analysen- und Sensortechnik, Topas GmbH, Dresden, Germany
| | - Alain Le Pape
- CNRS UPS44, CIPA, PHENOMIN-TAAM, Orléans, Tours, France
| | - Sébastien Roger
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, Tours, France; Institut Universitaire de France, Paris, Tours, France
| | - Mehdi Ouaissi
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, Tours, France; Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, University Hospital of Tours, Tours, France
| | - Michael Stintz
- Research Group Mechanical Process Engineering, Institute of Process Engineering and Environmental Technology, Technische Universität Dresden, Dresden, Germany
| | - Andreas Rudolph
- Technologie-orientierte Partikel-, Analysen- und Sensortechnik, Topas GmbH, Dresden, Germany
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Levine D, Petroski GF, Haertling T, Beaudoin T. Electrostatic Precipitation in Low Pressure Laparoscopic Hysterectomy and Myomectomy. JSLS 2020; 24:e2020.00051. [PMID: 33100818 PMCID: PMC7550014 DOI: 10.4293/jsls.2020.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to evaluate the impact of using electrostatic precipitation to manage the surgical plume during low pressure laparoscopic gynecologic procedures. METHODS This was a prospective, blinded, randomized controlled study of women with a clinical indication for laparoscopic hysterectomy (n = 30) or myomectomy (n = 5). Patients were randomized to either use electrostatic precipitation (EP) during the procedure, or not (No EP, hysterectomy group only). RESULTS Low pressure surgery could be undertaken in 87% of hysterectomy cases (13/15) when using EP to manage the surgical plume, compared to only 53% (8/15) in the No EP group. Overall average rating of the visual field was excellent with EP vs fair for No EP. Average CO2 consumption was reduced by 29% when using EP (16.7L vs 23.5L, p = 0.152). The average number of procedural pauses to vent smoke was lower with EP than the No EP group (1.5 per case vs. 3.7 per case, p = 0.005). Average procedure duration for the EP vs No EP group was 40.5 min vs. 46.9 min (p = 0.987). There were no measurable differences between groups for body temperature, end-tidal CO2, and discharge pain scores. In myomectomy, all five cases could be performed at low pressure, with an excellent visual field rating. CONCLUSION Electrostatic precipitation enhances low pressure laparoscopic hysterectomy and myomectomy. This was achieved by minimizing interruptions to surgery and exchange of CO2; providing a clear visual field throughout the procedure; and eliminating surgical smoke at the site of origin.
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Affiliation(s)
- David Levine
- Department of Obstetrics and Gynecology, Mercy Hospital, 621 S. New Ballas Rd, St. Louis, Missouri
| | - Gregory F Petroski
- Biostatistics & Research Design Unit, University of Missouri - Columbia School of Medicine, 182C Galena Hall, Columbia, Missouri
| | - Tracy Haertling
- Mercy Research, 3231 S. National Ave., Ste 210, Springfield, Missouri
| | - Teresa Beaudoin
- Mercy Research, 615 S. New Ballas Rd, Ste 2010, St. Louis, Missouri
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Thomas V, Maillard C, Barnard A, Snyman L, Chrysostomou A, Shimange-Matsose L, Van Herendael B. International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 253:133-140. [PMID: 32866856 PMCID: PMC7448735 DOI: 10.1016/j.ejogrb.2020.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.
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Affiliation(s)
- Viju Thomas
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Charlotte Maillard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa; Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), 1200 Brussels, Belgium.
| | - Annelize Barnard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Leon Snyman
- Department of Obstetrics and Gynecology, Kalafong Tertiary Hospital, University of Pretoria, Pretoria, South Africa
| | - Andreas Chrysostomou
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Lusandolwethu Shimange-Matsose
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Bruno Van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium,Università degli Studi dell’Insubria, Varese, Italy
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27
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American Neurotology Society, American Otological Society, and American Academy of Otolaryngology - Head and Neck Foundation Guide to Enhance Otologic and Neurotologic Care During the COVID-19 Pandemic. Otol Neurotol 2020; 41:1163-1174. [PMID: 32925832 DOI: 10.1097/mao.0000000000002868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
: This combined American Neurotology Society, American Otological Society, and American Academy of Otolaryngology - Head and Neck Surgery Foundation document aims to provide guidance during the coronavirus disease of 2019 (COVID-19) on 1) "priority" of care for otologic and neurotologic patients in the office and operating room, and 2) optimal utilization of personal protective equipment. Given the paucity of evidence to inform otologic and neurotologic best practices during COVID-19, the recommendations herein are based on relevant peer-reviewed articles, the Centers for Disease Control and Prevention COVID-19 guidelines, United States and international hospital policies, and expert opinion. The suggestions presented here are not meant to be definitive, and best practices will undoubtedly change with increasing knowledge and high-quality data related to COVID-19. Interpretation of this guidance document is dependent on local factors including prevalence of COVID-19 in the surgeons' local community. This is not intended to set a standard of care, and should not supersede the clinician's best judgement when managing specific clinical concerns and/or regional conditions.Access to otologic and neurotologic care during and after the COVID-19 pandemic is dependent upon adequate protection of physicians, audiologists, and ancillary support staff. Otolaryngologists and associated staff are at high risk for COVID-19 disease transmission based on close contact with mucosal surfaces of the upper aerodigestive tract during diagnostic evaluation and therapeutic procedures. While many otologic and neurotologic conditions are not imminently life threatening, they have a major impact on communication, daily functioning, and quality of life. In addition, progression of disease and delay in treatment can result in cranial nerve deficits, intracranial and life-threatening complications, and/or irreversible consequences. In this regard, many otologic and neurotologic conditions should rightfully be considered "urgent," and almost all require timely attention to permit optimal outcomes. It is reasonable to proceed with otologic and neurotologic clinic visits and operative cases based on input from expert opinion of otologic care providers, clinic/hospital administration, infection prevention and control specialists, and local and state public health leaders. Significant regional variations in COVID-19 prevalence exist; therefore, physicians working with local municipalities are best suited to make determinations on the appropriateness and timing of otologic and neurotologic care.
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28
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Andrews BT, Garg R, Przylecki W, Habal M. COVID-19 Pandemic and its Impact on Craniofacial Surgery. J Craniofac Surg 2020; 31:e620-e622. [PMID: 32398624 PMCID: PMC7282405 DOI: 10.1097/scs.0000000000006574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/26/2022] Open
Abstract
In late 2019, a novel coronavirus strain, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), also known as coronavirus disease 2019 (COVID-19), triggered a global pandemic as the virus spread from the Wuhan Province, China, across all continents. Although infrequent, severe respiratory infection and death caused by SARS-CoV-2 is disproportionately high amongst healthcare providers such as craniofacial surgeons who work in the head and neck region. Factors this impact SARS-CoV-2 transmission include: (1) high viral loads in the mucosa of the oral and nasopharynx, (2) limited and/or imprecise disease screening/confirmation testing, (3) access to and appropriate use of personal protective equipment (PPE).
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Affiliation(s)
- Brian T. Andrews
- Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Ravi Garg
- Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Wojciech Przylecki
- Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Mutaz Habal
- Tampa Bay Craniofacial Center, Tampa Bay, FL
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Cahill RA, Dalli J, Khan M, Flood M, Nolan K. Solving the problems of gas leakage at laparoscopy. THE BRITISH JOURNAL OF SURGERY 2020; 107:1401-1405. [PMID: 32856306 PMCID: PMC7461047 DOI: 10.1002/bjs.11977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 01/08/2023]
Affiliation(s)
- R A Cahill
- Centre for Precision Surgery, Section of Surgery and Surgical Specialties, School of Medicine, Dublin, Ireland.,Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Dalli
- Centre for Precision Surgery, Section of Surgery and Surgical Specialties, School of Medicine, Dublin, Ireland
| | - M Khan
- Centre for Precision Surgery, Section of Surgery and Surgical Specialties, School of Medicine, Dublin, Ireland.,Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Flood
- School of Mechanical and Materials Engineering, College of Engineering and Architecture, University College Dublin, Dublin, Ireland
| | - K Nolan
- School of Mechanical and Materials Engineering, College of Engineering and Architecture, University College Dublin, Dublin, Ireland
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30
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Bowdle A, Jelacic S, Shishido S, Munoz-Price LS. Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. Anesth Analg 2020; 131:1342-1354. [DOI: 10.1213/ane.0000000000005169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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31
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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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32
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Assessment of the absorbed dose after exposure to surgical smoke in an operating room. Toxicol Lett 2020; 328:45-51. [PMID: 32311378 DOI: 10.1016/j.toxlet.2020.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Abstract
Surgical smoke produced by electrosurgery contains various chemical substances such as volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). The aim of this study is to investigate airborne concentrations of VOCs and PAHs during electrosurgery in an operating room, in relation to metabolites in urine in order to assess the absorbed dose. A 5-day exposure study was set up in a general surgery operation room including surgeons, scrub assistants and circulation nurses (n = 15). Stationary and personal air sampling for VOCs and PAHs were carried out. Pre-, mid- and end-shift analysis of urinary S-phenylmercapturic acid (SPMA), o-cresol, mandelic acid and 1-hydroxypyrene was performed to assess the internal exposure to respectively benzene, toluene, styrene and PAHs. Several VOCs (styrene, ethyl benzene, benzene and toluene), ranging from 0.7 to 3.27 μg/m3 were detected in the air samples, along with one PAH (naphthalene, ranging from 0.012 to 0.39 μg/m3). There was no significant correlation between air monitoring and urinary biomonitoring. O-cresol levels were increased, especially among assistants and nurses at mid- and end-shift, exceeding current biological exposure indices several times. External and internal exposure for assistants and nurses was substantially more, compared to surgeons. This study confirms the presence of VOCs and PAHs in surgical smoke and shows the presence of their metabolites in urine, but the association is unclear. Urinary biomonitoring shows especially high concentrations of o-cresol.
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Dulskas A, Klimovskij M, Senkus L, Samalavicius NE. Comment on: Disposable customized aerosol containment chamber for oral cancer biopsy: A novel technique during COVID-19 pandemic. J Surg Oncol 2020; 122:992-993. [PMID: 32617985 PMCID: PMC7361626 DOI: 10.1002/jso.26083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius, Lithuania
| | - Michail Klimovskij
- General Surgery Department, East Sussex Healthcare NHS Trust, Hastings, UK
| | - Linas Senkus
- Department of Head and Neck Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius, Lithuania.,Surgical Department, Klaipeda University Hospital, Klaipeda, Lithuania.,Faculty of Health Sciences, Health Research and Innovation Science Center, Klaipeda University, Klaipeda, Lithuania
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Bogani G, Raspagliesi F. Minimally Invasive Surgery at the Time of COVID-19: The OR Staff Needs Protection. J Minim Invasive Gynecol 2020; 27:1221. [PMID: 32294548 PMCID: PMC7154518 DOI: 10.1016/j.jmig.2020.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/14/2022]
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35
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Ngaserin S, Tan BKT. Smoke evacuation in endoscopic breast surgery can enhance operative visualization and respect surgical safety. Breast J 2020; 26:2106-2107. [PMID: 32558030 DOI: 10.1111/tbj.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sabrina Ngaserin
- Division of Surgery, Sengkang General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
| | - Benita Kiat-Tee Tan
- Division of Surgery, Sengkang General Hospital, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore
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36
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Choi SY, Shin J, Park W, Choi N, Kim JS, Choi CI, Ko JH, Chung CR, Son YI, Jeong HS. Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea. Oral Oncol 2020; 109:104861. [PMID: 32590297 PMCID: PMC7298512 DOI: 10.1016/j.oraloncology.2020.104861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. MATERIALS AND METHODS Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. RESULTS Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. CONCLUSION Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.
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Affiliation(s)
- Sung Yong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbo Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woori Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Sei Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan I Choi
- Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Wang TJV, Ito M. Spine Surgery: Precautions and Strategies to Minimize Perioperative Risks Amid COVID-19 Outbreak. Spine Surg Relat Res 2020; 4:192-198. [PMID: 32864484 PMCID: PMC7447339 DOI: 10.22603/ssrr.2020-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) outbreak is an ongoing pandemic that has shocked the world. It has brought severe socioeconomic disruptions on a global scale that is unprecedented. On the frontline, the medical world is facing mounting pressure and challenges to clinical work. During this escalating worldwide crisis, spine care providers around the world are needing accurate and precise information on how surgical safety for themselves and the patients can be ensured. With the ultimate objective of formulating a standardized work process for spine practices, this article aimed to summarize some key principles from various international recommendations/consensus and combined evidence- and experience-based practice from medical communities around the world.
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Affiliation(s)
- Tzong-Jing Victor Wang
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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COVID 19 and laparoscopic surgeons, the Indian scenario - Perspective. Int J Surg 2020; 79:165-167. [PMID: 32479915 PMCID: PMC7258808 DOI: 10.1016/j.ijsu.2020.05.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/22/2023]
Abstract
Coronavirus Disease 2019(COVID 19) had emerged as a global pandemic in recent times. The healthcare sector is at the epicentre of this unprecedented global pandemic challenge. Hospitals all over the world have reduced the number of non-emergency surgeries in order to utilise the staff and resources in a more efficient way. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is most transmitted via respiratory droplets, but risk of transmission is hugely increased while doing aerosol generating procedures (AGPs). Laparoscopy remains the preferred surgical approach for most surgical indications. There is theoretical possibility of generation of aerosols contaminated with COVID-19 from leaked CO2 and smoke generation after energy device use. The aim of this paper is to review available evidence evaluating the risk of spread of COVID-19 during necessary laparoscopic procedures and to compile guidelines from relevant professional organizations to minimize this risk. The healthcare sector is at the epicentre of this COVID-19 pandemic challenge. Leaked CO2 and smoke are theoretically contaminated with COVID-19. India has a huge population with many people in Below poverty line category. Monetary burden for surgeries is borne either by government or patients. Recommendations for laproscopic surgeons during this pandemic to for safe surgery.
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The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review. Surg Endosc 2020; 34:3298-3305. [PMID: 32458289 PMCID: PMC7250491 DOI: 10.1007/s00464-020-07652-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
Background Surgical smoke is a well-recognized hazard in the operating room. At the beginning of the COVID-19 pandemic, surgical societies quickly published guidelines recommending avoiding laparoscopy or to consider open surgery because of the fear of transmission of SARS-CoV-2 through surgical smoke or aerosol. This narrative review of the literature aimed to determine whether there are any differences in the creation of surgical smoke/aerosol between laparoscopy and laparotomy and if laparoscopy may be safer than laparotomy. Methods A literature search was performed using the Pubmed, Embase and Google scholar search engines, as well as manual search of the major journals with specific COVID-19 sections for ahead-of-print publications. Results Of 1098 identified articles, we critically appraised 50. Surgical smoke created by electrosurgical and ultrasonic devices has the same composition both in laparoscopy and laparotomy. SARS-CoV-2 has never been found in surgical smoke and there is currently no data to support its virulence if ever it could be transmitted through surgical smoke/aerosol. Conclusion If laparoscopy is performed in a closed cavity enabling containment of surgical smoke/aerosol, and proper evacuation of smoke with simple measures is respected, and as long as laparoscopy is not contraindicated, we believe that this surgical approach may be safer for the operating team while the patient has the benefits of minimally invasive surgery. Evidence-based research in this field is needed for definitive determination of safety.
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European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic. Hernia 2020; 24:977-983. [PMID: 32415652 PMCID: PMC7227454 DOI: 10.1007/s10029-020-02212-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 12/26/2022]
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Fox-Lewis A, Allum C, Vokes D, Roberts S. Human papillomavirus and surgical smoke: a systematic review. Occup Environ Med 2020; 77:809-817. [DOI: 10.1136/oemed-2019-106333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023]
Abstract
ObjectiveTo evaluate what is currently known about the risk to surgeons and other operating theatre (OT) staff of human papillomavirus (HPV) transmission and HPV-related disease following surgical smoke exposure.MethodsA systematic literature search of Embase and Ovid-MEDLINE was undertaken for primary studies relevant to the presence of HPV in surgical smoke, contamination of OT staff with HPV after performing or attending smoke-generating surgical procedures, and the presence of HPV or HPV-related disease in OT staff following occupational surgical smoke exposure. Additional articles were identified by searching the reference lists of relevant published papers.ResultsTwenty-one relevant articles were identified. These demonstrate that surgical smoke from the treatment of HPV-related lesions can contain HPV DNA, and that this can contaminate the upper airways of OT staff. Whether this corresponds to infectious virus is not known. Increased prevalence of HPV infection or HPV-related disease in OT staff following occupational exposure to surgical smoke has not been convincingly shown.ConclusionsWhile HPV transmission to OT staff from surgical smoke remains unproven, it would be safest to treat surgical smoke as potentially infectious. Necessary precautions should be taken when performing smoke-generating procedures, consisting of: (1) local exhaust ventilation, (2) general room ventilation and (3) full personal protective equipment including a fit tested particulate respirator of at least N95 grade. There is currently insufficient evidence to recommend HPV vaccination for OT staff or to state that the above precautions, when used properly, would not be effective at preventing HPV transmission from surgical smoke.
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Swerdlow BN. Surgical smoke and the anesthesia provider. J Anesth 2020; 34:575-584. [PMID: 32296937 DOI: 10.1007/s00540-020-02775-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/07/2020] [Indexed: 01/19/2023]
Abstract
Surgical smoke generated by use of electrosurgical units (ESUs), lasers, and ultrasonic scalpels constitutes a physical, chemical, and biological hazard for anesthesia personnel. Inhalation of particulate matter with inflammatory consequences, pulmonary injury from products of tissue pyrolysis, exposure to mutagens and carcinogens, and the transmission of human papillomavirus (HPV) and possibly other pathogens represent a spectrum of adverse effects associated with the occupational exposure to surgical plume. While adequate operating room ventilation and use of high filtration-efficiency masks offer some protection from these conditions, the most effective method of safeguarding against surgical smoke involves its removal with a dedicated smoke evacuation device (SED). Despite the fact that many professional and governmental agencies have endorsed widespread usage of SEDs, anesthesia providers have been largely silent on this subject, with few reports within the field of anesthesiology and perioperative medicine regarding these hazards. SED use is relatively infrequent in most surgeries, and this condition reflects surgeons' reluctance to employ these devices, likely resulting from lack of education and less than optimal technology. Anesthesia societies and academic centers can serve critical roles in advocating employment of SEDs in much the same way that they have supported perioperative smoking cessation.
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Affiliation(s)
- Barry N Swerdlow
- Nurse Anesthesia Program, Oregon Health and Science University, SON #521, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
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Ridha AM, Mahdi AJ, Abed JK, Fahad S. PID Fuzzy Control Applied to an Electrosurgical Unit for Power Regulation. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2020; 11:72-80. [PMID: 33584906 PMCID: PMC7851982 DOI: 10.2478/joeb-2020-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 06/12/2023]
Abstract
The electrosurgical unit (ESU) is the most common device in modern surgery for cutting and coagulation of tissues. It produces high-frequency alternating current to prevent the stimulation of muscles and nerves. The commercial ESUs are generally expensive and their output power is uncontrolled. The main objective of the proposed study is to propose an economic ESU with an additional feature of output power regulation using a fuzzy logic controller (FLC) based proportional integral derivative (PID) tuned controller. Unlike the previous studies, the proposed controller is designed in a fully closed-loop control fashion to regulate the output power of the ESU to a fixed value under the consideration of highly dynamic tissue impedance. The performance of the proposed method is tested in the MATLAB/SIMULINK environment. In order to validate the superiority of the proposed method, a comparative analysis with a simple (PID) controller based ESU is presented.
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Affiliation(s)
| | - Ali Jafer Mahdi
- Department of Electrical and Electronics Engineering, University of Kerbala, Karbala, Iraq
| | - Jameel Kadhim Abed
- Department of Medical Instrumentation Techniques Engineering, Middle Technical University, Baghdad, Iraq
| | - Shah Fahad
- Department of Electrical Engineering, Zhejiang University, P.R of China
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Barnes S, Twomey C, Carrico R, Murphy C, Warye K. OR Air Quality: Is It Time to Consider Adjunctive Air Cleaning Technology?: 1.3 www.aornjournal.org/content/cme. AORN J 2019; 108:503-515. [PMID: 30376172 DOI: 10.1002/aorn.12391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patients undergoing surgery may be at risk for infection from airborne particles such as dust, skin scales, respiratory aerosols, and hair fibers emanating from multiple sources in the OR, including personnel, heater-cooler devices, and surgical smoke. This risk is increased in surgical patients undergoing procedures involving implanted devices. Surgical personnel also are at risk from exposure to surgical smoke, which can contain viable viral particles including human papillomavirus infection. Air quality in the OR is improved by engineering controls (eg, maintaining positive pressure). During the past decade, innovations in the field of adjunctive technology designed to improve OR air quality include using ultraviolet disinfection and mobile ultraviolet disinfection plus high-efficiency particulate air filtration. Some of these technologies additionally provide continuous monitoring of circulating air particle counts. Additional research regarding the benefits of adjunctive air-cleaning technology in the OR is warranted.
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Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer 2019; 10:2788-2799. [PMID: 31258787 PMCID: PMC6584931 DOI: 10.7150/jca.31464] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/29/2019] [Indexed: 12/31/2022] Open
Abstract
Surgical smoke is the gaseous by-product produced by heat generating devices in various surgical operations including laser conization and loop electrosurgical procedures that often are performed by gynecologists. Surgical smoke contains chemicals, blood and tissue particles, bacteria, and viruses, which has been shown to exhibit potential risks for surgeons, nurses, anesthesiologists, and technicians in the operation room due to long term exposure of smoke. In this review, we describe the detailed information of the components of surgical smoke. Moreover, we highlight the effects of surgical smoke on carcinogenesis, mutagenesis, and infection in gynecologists. Furthermore, we discussed how to prevent the surgical smoke via using high-filtration masks and smoke evacuation systems as well as legal guidelines for protection measures among the gynecologists.
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Affiliation(s)
- Yi Liu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yizuo Song
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Hu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linzhi Yan
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqiong Zhu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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