Endoscopic skull base and transoral surgery during COVID-19 pandemic: Minimizing droplet spread with negative-pressure otolaryngology viral isolation drape

Head Neck. 2020 Jul;42(7):1577-1582. doi: 10.1002/hed.26239. Epub 2020 May 30.

Abstract

Background: The coronavirus disease (COVID-19) pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery.

Methods: Retrospective review. We introduce the negative-pressure otolaryngology viral isolation drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient's head and surgical field with a smoke evacuator suction placed inside the chamber.

Results: Four patients underwent endonasal (4) and endo-oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein-treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high-speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination.

Conclusions: Negative-pressure aspiration of air under a chamber barrier, which appears to successfully keep aerosol and droplet contamination to a minimum.

Keywords: COVID-19; aerosolization; endoscopic surgery; negative-pressure; skull base.

MeSH terms

  • Air Pollutants, Occupational / analysis*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission
  • Fluorescein
  • Fluorescent Dyes
  • Humans
  • Infection Control / methods*
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control*
  • Occupational Exposure / analysis
  • Occupational Exposure / prevention & control*
  • Otorhinolaryngologic Surgical Procedures*
  • Pandemics / prevention & control*
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission
  • Retrospective Studies
  • SARS-CoV-2
  • Surgical Drapes*
  • Ultraviolet Rays

Substances

  • Air Pollutants, Occupational
  • Fluorescent Dyes
  • Fluorescein