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Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

BACKGROUND: Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthca...

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Autores principales: Uecker, John M., Fagerberg, Austin, Ahmad, Naser, Cohen, Alexander, Gilkey, Mitchell, Alembeigi, Farshid, Idelson, Christopher R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513904/
https://www.ncbi.nlm.nih.gov/pubmed/32974779
http://dx.doi.org/10.1007/s00464-020-08006-4
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author Uecker, John M.
Fagerberg, Austin
Ahmad, Naser
Cohen, Alexander
Gilkey, Mitchell
Alembeigi, Farshid
Idelson, Christopher R.
author_facet Uecker, John M.
Fagerberg, Austin
Ahmad, Naser
Cohen, Alexander
Gilkey, Mitchell
Alembeigi, Farshid
Idelson, Christopher R.
author_sort Uecker, John M.
collection PubMed
description BACKGROUND: Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. METHODS: A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as “dynamic interaction”, which occurs nearly 100% of the time over the course of any procedure. RESULTS: For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. CONCLUSIONS: Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.
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spelling pubmed-75139042020-09-25 Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery Uecker, John M. Fagerberg, Austin Ahmad, Naser Cohen, Alexander Gilkey, Mitchell Alembeigi, Farshid Idelson, Christopher R. Surg Endosc New Technology BACKGROUND: Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. METHODS: A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as “dynamic interaction”, which occurs nearly 100% of the time over the course of any procedure. RESULTS: For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. CONCLUSIONS: Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery. Springer US 2020-09-24 2021 /pmc/articles/PMC7513904/ /pubmed/32974779 http://dx.doi.org/10.1007/s00464-020-08006-4 Text en © Springer Science+Business Media, LLC, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle New Technology
Uecker, John M.
Fagerberg, Austin
Ahmad, Naser
Cohen, Alexander
Gilkey, Mitchell
Alembeigi, Farshid
Idelson, Christopher R.
Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title_full Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title_fullStr Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title_full_unstemmed Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title_short Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
title_sort stop the leak!: mitigating potential exposure of aerosolized covid-19 during laparoscopic surgery
topic New Technology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513904/
https://www.ncbi.nlm.nih.gov/pubmed/32974779
http://dx.doi.org/10.1007/s00464-020-08006-4
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