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Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic

OBJECTIVE: The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal pr...

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Autores principales: Sharma, Dhruv, Rubel, Kolin E., Ye, Michael J., Shipchandler, Taha Z., Wu, Arthur W., Higgins, Thomas S., Burgin, Sarah J., Ting, Jonathan Y., Illing, Elisa A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240308/
https://www.ncbi.nlm.nih.gov/pubmed/32423283
http://dx.doi.org/10.1177/0194599820929274
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author Sharma, Dhruv
Rubel, Kolin E.
Ye, Michael J.
Shipchandler, Taha Z.
Wu, Arthur W.
Higgins, Thomas S.
Burgin, Sarah J.
Ting, Jonathan Y.
Illing, Elisa A.
author_facet Sharma, Dhruv
Rubel, Kolin E.
Ye, Michael J.
Shipchandler, Taha Z.
Wu, Arthur W.
Higgins, Thomas S.
Burgin, Sarah J.
Ting, Jonathan Y.
Illing, Elisa A.
author_sort Sharma, Dhruv
collection PubMed
description OBJECTIVE: The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures. STUDY DESIGN: Cadaver simulation series. SETTING: Dedicated surgical laboratory. SUBJECTS AND METHODS: After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition. RESULTS: There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm). CONCLUSION: Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.
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spelling pubmed-72403082020-05-21 Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic Sharma, Dhruv Rubel, Kolin E. Ye, Michael J. Shipchandler, Taha Z. Wu, Arthur W. Higgins, Thomas S. Burgin, Sarah J. Ting, Jonathan Y. Illing, Elisa A. Otolaryngol Head Neck Surg Research Articles OBJECTIVE: The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures. STUDY DESIGN: Cadaver simulation series. SETTING: Dedicated surgical laboratory. SUBJECTS AND METHODS: After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition. RESULTS: There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm). CONCLUSION: Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination. SAGE Publications 2020-05-19 2020-07 /pmc/articles/PMC7240308/ /pubmed/32423283 http://dx.doi.org/10.1177/0194599820929274 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Research Articles
Sharma, Dhruv
Rubel, Kolin E.
Ye, Michael J.
Shipchandler, Taha Z.
Wu, Arthur W.
Higgins, Thomas S.
Burgin, Sarah J.
Ting, Jonathan Y.
Illing, Elisa A.
Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title_full Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title_fullStr Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title_full_unstemmed Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title_short Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic
title_sort cadaveric simulation of endoscopic endonasal procedures: analysis of droplet splatter patterns during the covid-19 pandemic
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240308/
https://www.ncbi.nlm.nih.gov/pubmed/32423283
http://dx.doi.org/10.1177/0194599820929274
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