J Neurol Surg B Skull Base 2021; 82(S 02): S65-S270
DOI: 10.1055/s-0041-1725261
Presentation Abstracts
Live Session Abstracts

Intraoperative Use and Validation of a Novel Negative Pressure, Face-Mounted Antechamber to Minimize Aerosolization of Particles during Endoscopic Skull Base Surgery

Matthew Kim
1   Westchester Medical Center, Valhalla, New York, United States
,
Mark Lee
2   Weill Cornell Medical College, New York City, New York, United States
,
Justin Schwarz
2   Weill Cornell Medical College, New York City, New York, United States
,
Ashutosh Kacker
2   Weill Cornell Medical College, New York City, New York, United States
,
Theodore H. Schwartz
2   Weill Cornell Medical College, New York City, New York, United States
› Author Affiliations
 
 

    Background: The COVID-19 pandemic has revealed deficiencies in the adequacy of personal protective equipment (PPE) for health care workers. Endoscopic endonasal skull base surgery (ESBS) is thought to be among the highest risk aerosol-generating procedures (AGPs) for surgeons and operating room personnel.

    Objective: To validate the efficacy and clinical feasibility of a novel surgical device.

    Methods: A low-cost, modifiable, and easily producible negative pressure, face-mounted antechamber was developed utilizing 3D printing and silicone molding. Efficacy was evaluated using an optical particle sizer (OPS) to quantify aerosols generated during both cadaver and intraoperative human use with high-speed drilling.

    Results: Particle counts in the cadaver showed that drilling led to a 2.49-fold increase in particles ≤5 μm (p = 0.001), and that the chamber was effective at reducing particles to levels not significantly different than baseline. In humans, drilling led to a 37-fold increase in in particles ≤5 μm (p < 0.001), and the chamber was effective at reducing particles to a level not significantly different than baseline. Use of the antechamber in 6 complex cases did not interfere with the ability to perform surgery. Patients did not report any facial discomfort after surgery related to antechamber use.

    Conclusions: The use of a negative pressure facial antechamber can effectively reduce aerosolization from endoscopic drilling without disturbing the flow of the operation. The antechamber, in conjunction with appropriate PPE, will be useful during the COVID-19 pandemic, as well as during flu season and any future viral outbreaks.

    Zoom Image
    Fig. 1 The first (A) and second (B) device prototypes featured an open triangular operative port and a rectangular port featuring a silicone diaphragm. The third prototype (C and D) featured a semicircular operative port with silicone diaphragm and a tapered design for improved ergonomics. All prototypes included an exhaust port (arrowhead) and a cutout for the endotracheal tube (*).
    Zoom Image
    Fig. 2 Median particle counts during cadaver experiments. Mann–Whitney pairwise testing performed for each operative scenario compared to baseline.
    Zoom Image
    Fig. 3 Whisker plot depicting median particle counts during endoscopic skull base surgery. Kruskal–Wallis one-way analysis of variance performed for each particle stratum.
    Zoom Image
    Fig. 4 Median particle counts during endoscopic skull base surgery. Mann–Whitney pairwise testing performed for each operative scenario compared to baseline.

    #

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    12 February 2021

    © 2021. Thieme. All rights reserved.

    Georg Thieme Verlag KG
    Rüdigerstraße 14, 70469 Stuttgart, Germany

     
    Zoom Image
    Fig. 1 The first (A) and second (B) device prototypes featured an open triangular operative port and a rectangular port featuring a silicone diaphragm. The third prototype (C and D) featured a semicircular operative port with silicone diaphragm and a tapered design for improved ergonomics. All prototypes included an exhaust port (arrowhead) and a cutout for the endotracheal tube (*).
    Zoom Image
    Fig. 2 Median particle counts during cadaver experiments. Mann–Whitney pairwise testing performed for each operative scenario compared to baseline.
    Zoom Image
    Fig. 3 Whisker plot depicting median particle counts during endoscopic skull base surgery. Kruskal–Wallis one-way analysis of variance performed for each particle stratum.
    Zoom Image
    Fig. 4 Median particle counts during endoscopic skull base surgery. Mann–Whitney pairwise testing performed for each operative scenario compared to baseline.