Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Laryngoscope. 2024 May;134(5):2444-2448. doi: 10.1002/lary.31185. Epub 2023 Nov 20.
Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures.
This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups.
The mean concentrations (particles/cm) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels.
Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel.
3 Laryngoscope, 134:2444-2448, 2024.
手术烟雾已知具有潜在的职业健康危害。本研究比较了不同小儿扁桃体切除术手术技术产生的手术烟雾中的纳米颗粒浓度，并评估了缓解措施的效果。
这是在一家三级保健学术中心进行的横断面研究。在 60 例患者中使用 4 种技术进行包膜外或包膜内扁桃体切除术，并在另外 10 例患者中使用缓解措施进行治疗。使用两个纳米颗粒计数器测量颗粒物浓度：CPC™ 和 DiSCmini™。扁桃体切除术技术包括：（1）微钻（MD），（2）助手手动吸引的 Bovie（B），（3）内置烟雾排空系统的 Bovie（BS），和（4）Coblator™（CB）。在缓解组（BSY）和（CBY）中还使用了额外的 Yankauer 吸引器。使用单向秩和 ANOVA 进行比较分析，并对各组进行两两比较。
DiSCmini 颗粒物计数器的平均浓度（颗粒/cm）和变异系数为 MD：5140（1.6），B：30700（1.5），BS：25001（0.8），CB：54814（1.7），CBY：2395（1.3）和 BSY：11552（1.0）。CPC 颗粒物计数器的平均浓度为 MD：1223（1.4），B：3405（0.7），BS：5002（0.9），CB：13273（1.0），CBY：1048（1.2）和 BSY：3046（0.6）。使用 MD 的情况下平均浓度最低，使用 CB 的情况下平均浓度最高。然而，经过缓解后，CBY 的总体水平最低。
扁桃体切除术技术确实会影响手术烟雾中释放的纳米颗粒水平，这可能对手术室人员构成职业危害。
3 级喉镜，134：2444-2448，2024。
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