Is the ultrasonic scalpel recommended in head and neck surgery during the COVID-19 pandemic? State-of-the-art review

Head Neck. 2020 Jul;42(7):1657-1663. doi: 10.1002/hed.26278. Epub 2020 May 22.

Abstract

Background: Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS-CoV-2 pandemic.

Methods: Literature review of manuscripts with patients, animal models, or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way.

Discussion: Activated devices with tissue produce a biphasic bioaerosol composed (size 68.3-994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene).

Conclusion: It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID-19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.

Keywords: SARS-CoV-2; aerosol; surgical smoke; ultrasonic scalpel; virus transmission.

Publication types

  • Review

MeSH terms

  • Air Pollutants, Occupational / adverse effects*
  • Betacoronavirus*
  • COVID-19
  • Contraindications, Procedure
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission*
  • Humans
  • Infection Control
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Occupational Exposure / prevention & control
  • Otorhinolaryngologic Surgical Procedures / instrumentation*
  • Pandemics / prevention & control*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission*
  • SARS-CoV-2
  • Surgical Instruments
  • Ultrasonic Surgical Procedures / instrumentation*

Substances

  • Air Pollutants, Occupational