Department of Otolaryngology-Head and Neck Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
Oper Neurosurg (Hagerstown). 2021 Aug 16;21(3):131-136. doi: 10.1093/ons/opab173.
The COVID-19 pandemic has revealed deficiencies in the adequacy of personal protective equipment (PPE) for healthcare workers. Endoscopic endonasal skull base surgery is thought to be among the highest-risk aerosol-generating procedures for surgeons and operating room personnel.
To validate the efficacy and clinical feasibility of a novel surgical device.
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 to quantify aerosols generated during both cadaver and intraoperative human use with high-speed drilling.
Particle counts in the cadaver showed that drilling led to a 2.49-fold increase in particles 0.3 to 5 μm (P = .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 particles 0.3 to 5 μm (P < .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.
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.
COVID-19 大流行暴露了医护人员个人防护设备（PPE）充足性的不足。内镜经鼻颅底手术被认为是对外科医生和手术室人员风险最高的产生气溶胶的手术之一。
验证一种新型手术设备的有效性和临床可行性。
利用 3D 打印和硅酮模塑开发了一种低成本、可修改和易于生产的负压面罩前室。使用光粒子计数器评估功效，以量化尸体和术中人体使用高速钻孔时产生的气溶胶。
尸体中的粒子计数显示，钻孔导致 0.3 至 5μm 的粒子计数增加了 2.49 倍（P=0.001），并且前室有效降低了粒子数，使其与基线无显著差异。在人体中，钻孔导致 0.3 至 5μm 的粒子数增加了 37 倍（P<0.001），前室有效降低了粒子数，使其与基线无显著差异。在前室在 6 例复杂病例中的使用并未干扰手术能力。患者在手术后均未报告与前室使用相关的任何面部不适。
使用负压面罩前室可以有效减少内镜钻孔时的气溶胶化，而不会干扰手术的进行。前室与适当的 PPE 结合使用，在 COVID-19 大流行期间以及流感季节和任何未来的病毒爆发期间都将非常有用。
