Faculty of Medicine, University of Helsinki, Finland.
Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Finland.
J Laryngol Otol. 2023 Jul;137(7):732-740. doi: 10.1017/S0022215123000324. Epub 2023 Mar 27.
Coronavirus disease 2019 can spread through aerosols produced by surgical procedures, but knowledge of the extent of aerosol production and the risk posed by many common procedures does not exist. This study analysed aerosol generation during tonsillectomy and how it differs between distinct surgical techniques and instruments. The results can be used in risk assessment during current and future pandemics and epidemics.
An optical particle sizer was used to measure particle concentrations generated during tonsillectomy from the perspectives of the surgeon and other staff. Coughing is commonly used as a reference for high-risk aerosol generation; therefore, coughing and the operating theatre's background concentration were chosen as reference values. Different instruments were also compared to find the safest way to perform the tonsillectomy from the perspective of airborne transmission.
Eighteen tonsillectomies were evaluated; all techniques mostly generated less than 1 μm particles. For the surgeon, bipolar electrocautery significantly exceeded the particle generation of coughing in both total and less than 1 μm particles and was found to produce significantly higher total and less than 1 μm aerosol concentrations than cold dissection and BiZact. No technique exposed other staff to a greater aerosol concentration than is generated by a cough.
Bipolar electrocautery generated high aerosol concentrations during tonsillectomy; cold dissection generated significantly less. The results support cold dissection as the primary tonsillectomy technique, particularly during the epidemics of airborne diseases.
COVID-19 可通过手术产生的气溶胶传播，但我们对于许多常见手术产生气溶胶的程度及其带来的风险知之甚少。本研究分析了扁桃体切除术过程中的气溶胶产生情况，并比较了不同手术技术和器械之间的差异。这些结果可用于当前和未来大流行和疫情期间的风险评估。
采用光粒子计数器从术者和其他医护人员的角度测量扁桃体切除术中产生的颗粒浓度。咳嗽通常被用作产生高危气溶胶的参考，因此选择咳嗽和手术室背景浓度作为参考值。还比较了不同器械，以找到从空气传播角度来看进行扁桃体切除术的最安全方法。
评估了 18 例扁桃体切除术；所有技术产生的 1μm 以下颗粒均较少。对于术者，双极电凝在总颗粒和小于 1μm 颗粒的颗粒生成方面明显超过咳嗽，并且发现其总颗粒和小于 1μm 的气溶胶浓度明显高于冷剥离和 BiZact。没有任何技术会使其他医护人员暴露于比咳嗽产生的气溶胶浓度更高的环境中。
双极电凝在扁桃体切除术中产生了高浓度的气溶胶；冷剥离产生的气溶胶浓度明显较低。结果支持冷剥离作为主要的扁桃体切除术技术，特别是在空气传播疾病流行期间。
