Helman SN, Soriano RM, Tomov ML, Serpooshan V, Levy JM, Pradilla G, Solares CA. Ventilated Upper Airway Endoscopic Endonasal Procedure Mask: Surgical Safety in the COVID-19 Era.
Oper Neurosurg (Hagerstown) 2020;
19:271-280. [PMID:
32472685 PMCID:
PMC7534784 DOI:
10.1093/ons/opaa168]
[Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND
COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to
improving safety have been employed, including the use of personal protective equipment,
preoperative COVID-19 testing, and recently the use of a modified surgical mask
barrier.
OBJECTIVE
To reduce the risks of pathogen transmission during endoscopic skull base surgery.
METHODS
This study was exempt from Institutional Review Board approval. Our study utilizes a
3-dimensional (3D)-printed mask with an anterior aperture fitted with a surgical glove
with ports designed to allow for surgical instrumentation and side ports to accommodate
suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic
surgery trocar served as a port for instruments, and, on the contralateral side, rubber
tubing was used over the endoscrub endosheath to create an airtight seal. Surgical
freedom and aerosolization were tested in both modalities.
RESULTS
The ventilated mask allowed for excellent surgical maneuverability and freedom. The
trocar system was effective for posterior surgical procedures, allowing access to
critical paramedian structures, and afforded a superior surgical seal, but was limited
in terms of visualization and maneuverability during anterior approaches. Aerosolization
was reduced using both the mask and nasal trocar.
CONCLUSION
The ventilated upper airway endoscopic procedure mask allows for a sealed surgical
barrier during endoscopic skull base surgery and may play a critical role in advancing
skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in
instances where 3D printing is not available. Additional studies are needed to validate
these preliminary findings.
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