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Comparison of Unnoticed Glove Perforations during Minimally Invasive versus Open Surgeries: A Systematic Review and
Sachit Anand1, Zenon Pogorelić2,3, Apoorv Singh4
1Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India.
Objective:
Various studies have depicted the incidence of glove perforations during open (OS) and minimally invasive surgeries (MIS). The aim of this meta-analysis was to compare the incidence of macroscopic and microscopic glove perforations during MIS and OS.
Methods:
The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Web of Science, Scopus, and EMBASE) were systematically searched for comparative studies depicting the glove perforation rates during MIS and OS. Risk ratios (RR) were calculated for both the outcomes (dichotomous) and the Mantel-Haenszel method was utilized for the estimation of pooled RR. The methodological quality assessment was performed by two independent investigators using the Downs and Black scale. The main outcomes of the study were the proportion of gloves with gross (macroscopic) perforations and the proportion of gloves with microscopic perforations.
Results:
Four comparative studies including a total of 1428 gloves (435 from the MIS group) were included. Pooling the data demonstrated no difference in the incidence of macroscopic glove perforations among the MIS and OS groups (RR 0.57, 95% CI 0.21 to 1.54, p = 0.27). On the other hand, the incidence of microscopic perforations was significantly higher in the OS group versus the MIS group (RR 0.72, 95% CI 0.55 to 0.95, p = 0.02). However, all the studies had a moderate risk of bias.
Conclusions:
When compared to OS, the macroscopic glove perforation rate during MIS showed no significant difference. The incidence of microscopic glove perforations was significantly higher during OS as compared to MIS. However, due to the moderate risk of bias of the available comparative studies, the level of evidence of these studies is limited.
Insights
Minimally invasive surgery (MIS) and open surgery (OS) have similar rates of macroscopic glove perforations. However, open surgery shows a higher incidence of microscopic glove perforations, though evidence is limited by study bias.
Area of Science:
- Surgical Safety
- Medical Device Performance
- Infection Control
Background:
- Glove perforations are a known risk during surgical procedures, potentially compromising patient safety and increasing infection risk.
- Both open surgery (OS) and minimally invasive surgery (MIS) involve the use of surgical gloves, necessitating an understanding of perforation rates in different surgical approaches.
Purpose of the Study:
- To conduct a meta-analysis comparing the incidence of macroscopic and microscopic glove perforations between minimally invasive surgery (MIS) and open surgery (OS).
- To evaluate the available evidence on glove integrity in MIS versus OS.
Main Methods:
- Systematic literature search of scientific databases (PubMed, Web of Science, Scopus, EMBASE) following PRISMA guidelines.
- Inclusion of four comparative studies analyzing glove perforation rates in MIS and OS.
- Calculation of pooled risk ratios (RR) for macroscopic and microscopic perforations using the Mantel-Haenszel method; methodological quality assessed using the Downs and Black scale.
Main Results:
- No significant difference was found in the incidence of macroscopic glove perforations between MIS and OS (RR 0.57, p=0.27).
- The incidence of microscopic glove perforations was significantly higher in the OS group compared to the MIS group (RR 0.72, p=0.02).
- All included studies exhibited a moderate risk of bias.
Conclusions:
- Macroscopic glove perforation rates do not differ significantly between MIS and OS.
- Open surgery is associated with a significantly higher rate of microscopic glove perforations compared to MIS.
- The current evidence is limited due to the moderate risk of bias in the included comparative studies.
