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The challenge of performing mastoidectomy using the operating microscope with coronavirus disease 2019 personal

P J Clamp1, S J Broomfield1

  • 1Department of ENT Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, St Michael's Hospital, Bristol, UK.

The Journal of Laryngology and Otology
|July 29, 2020
PubMed
Abstract

Insights

Wearing personal protective equipment, such as full-face visors, significantly reduces the surgical field of view during mastoidectomy. New solutions are needed for adequate eye protection during aerosol-generating procedures using an operating microscope.

Area of Science:

  • Otolaryngology
  • Surgical Technology
  • Infection Control

Background:

  • Mastoidectomy is an aerosol-generating procedure, increasing infection risk.
  • Personal protective equipment (PPE) is crucial for surgeon safety during such procedures.
  • The impact of PPE on surgical visualization, particularly with operating microscopes, requires investigation.

Purpose of the Study:

  • To evaluate how different types of personal protective equipment (PPE) affect the visual field when using an operating microscope.
  • To determine the compatibility of standard PPE with the operating microscope for procedures like mastoidectomy.

Main Methods:

  • ENT surgeons assessed the visible area of a calibrated target through an operating microscope while wearing various PPE.
  • Surgeons also wore prescription glasses when needed.
  • The working distance between the surgeon's eye and the microscope was recorded for each PPE condition.

Main Results:

  • A shorter eye-to-microscope distance correlated with a larger visible area (p < 0.001).
  • Wearing a filtering facepiece code 3 mask and full-face visor reduced the median visible area to 4% (range, 4-16%).

Conclusions:

  • Full-face visors are incompatible with operating microscopes, severely limiting the surgical view.
  • Urgent development of PPE is needed to provide adequate eye protection for aerosol-generating procedures requiring microscope use.
  • Low-profile safety goggles with a working distance <20mm and prescription lens compatibility are recommended.
Keywords:
AerosolsCOVID-19CoronavirusMastoidectomyMicrosurgeryNeurotologyOtolaryngologyPersonal Protective Equipment

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