Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, Georgia.
Oper Neurosurg (Hagerstown). 2020 Sep 1;19(3):271-280. doi: 10.1093/ons/opaa168.
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.
To reduce the risks of pathogen transmission during endoscopic skull base surgery.
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.
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.
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.
COVID-19 对内镜颅底外科医生构成风险。为提高安全性，已采取重大措施，包括使用个人防护设备、术前 COVID-19 检测，以及最近使用改良的手术口罩屏障。
降低内镜颅底手术中病原体传播的风险。
本研究获得机构审查委员会豁免。我们的研究使用带有前部开口的 3D 打印口罩，该开口配有带有端口的手术手套，设计用于容纳手术器械，并带有侧端口以容纳抽吸通气和气管内管。作为替代方案，改良的腹腔镜手术穿刺器用作器械的端口，而在对侧，橡胶管套在 endoscrub 内镜鞘上，以形成密封。在这两种方式下都测试了手术自由度和雾化效果。
通风口罩允许进行出色的手术操作和自由。套管系统对于后颅底手术有效，可进入关键的正中旁结构，并提供了优越的手术密封，但在前入路时在可视化和操作灵活性方面受到限制。使用口罩和鼻套管均可减少雾化。
通风上呼吸道内镜手术口罩允许在进行内镜颅底手术时形成密封的手术屏障，并且可能在 COVID-19 时代推进颅底手术中发挥关键作用。在无法使用 3D 打印的情况下，鼻套管可能是一种有用的替代方案。需要进一步的研究来验证这些初步发现。
