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Analysis of Droplet Splatter Patterns During Coblation Tonsil Surgery in the Covid-19 Pandemic
Grace C Khong1, Jaya Bhat1, Ravi S Sharma1
1Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK.
Objectives:
To assess droplet splatter around the surgical field and surgeon during simulated Coblation tonsil surgery to better inform on mitigation strategies and evaluate choice of personal protective equipment.
Methods:
This was an observational study performed using a life-size head model to simulate tonsil surgery and fluorescein-soaked strawberries to mimic tonsils. The Coblation wand was activated over the strawberries for 5 minutes. This was repeated 5 times with 2 surgeons (totalling 10 data sets). The presence of droplet around the surgical field and anatomical subsites on the surgeon was assessed in binary fashion: present or not present. The results were collated as frequency of droplet detection and illustrated as a heatmap; 0 = white, 1-2 = yellow, 3-4 = orange, and 5 = red.
Results:
Fluorescein droplets were detected in all 4 quadrants of the surgical field. The frequency of splatter was greatest in the upper (nearest to surgeon) and lower quadrants. There were detectable splatter droplets on the surgeon; most frequently occurring on the hands followed by the forearm. Droplets were also detected on the visor, neck, and chest albeit less frequently. However, none were detected on the upper arms.
Conclusion:
Droplet splatter can be detected in the immediate surgical field as well as on the surgeon. Although wearing a face visor does not prevent splatter on the surgical mask or around the eyes, it should be considered when undertaking tonsil surgery as well as a properly fitted goggle.
Level Of Evidence:
5.
Insights
Droplet splatter occurs during simulated Coblation tonsil surgery, reaching the surgical field and surgeon. Enhanced personal protective equipment, including goggles, is recommended to mitigate exposure risks.
Area of Science:
- Surgical Safety
- Minimally Invasive Procedures
- Infection Control
Background:
- Coblation tonsil surgery generates droplet splatter, posing potential risks to surgical teams.
- Understanding splatter patterns is crucial for developing effective mitigation strategies and selecting appropriate personal protective equipment (PPE).
Purpose of the Study:
- To assess droplet splatter during simulated Coblation tonsil surgery.
- To evaluate the effectiveness of current PPE and inform the choice of enhanced protective gear.
Main Methods:
- An observational study using a life-size head model and fluorescein-soaked strawberries to simulate tonsil tissue.
- Coblation wand activation for 5 minutes, repeated 10 times with two surgeons.
- Binary assessment of droplet presence in the surgical field and on the surgeon, visualized as a heatmap.
Main Results:
- Fluorescein droplets were detected in all surgical field quadrants, with highest frequency in upper and lower areas.
- Splatter reached the surgeon, primarily on hands and forearms, and less frequently on the visor, neck, and chest.
- No droplets were detected on the upper arms, and face visors did not prevent splatter on surgical masks or around the eyes.
Conclusions:
- Droplet splatter is a significant concern during Coblation tonsil surgery, affecting both the surgical field and personnel.
- Current PPE, such as face visors, may be insufficient; enhanced protection, including properly fitted goggles, is recommended for surgeons.
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