scholarly journals Aerosols, airflow, and airspace contamination during laparoscopy

2021 ◽  
Author(s):  
N Hardy ◽  
J Dalli ◽  
M F Khan ◽  
K Nolan ◽  
R A Cahill
Keyword(s):  
Laparoscopic Surgery ◽  
Real Time ◽  
Operating Room ◽  
Best Practice ◽  
Occupational Hazard ◽  
Surgical Smoke ◽  
Operating Team ◽  
Infectious Risk ◽  
Surgical Teams

Lay summary Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment.

scholarly journals COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise (Preprint)

2020 ◽  
Author(s):  
Robert Adrianus de Leeuw ◽  
Nicole Birgit Burger ◽  
Marcello Ceccaroni ◽  
Jian Zhang ◽  
Jurriaan Tuynman ◽  
...  
Keyword(s):  
Health Care ◽  
Laparoscopic Surgery ◽  
High Risk ◽  
Operating Room ◽  
Health Care Providers ◽  
Current Literature ◽  
Scoping Review ◽  
Open Surgery ◽  
Care Providers ◽  
Surgical Smoke

BACKGROUND The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. OBJECTIVE We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. METHODS We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. RESULTS The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. CONCLUSIONS There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO<sub>2</sub> deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.

scholarly journals COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise

10.2196/18928 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e18928 ◽  
Author(s):  
Robert Adrianus de Leeuw ◽  
Nicole Birgit Burger ◽  
Marcello Ceccaroni ◽  
Jian Zhang ◽  
Jurriaan Tuynman ◽  
...  
Keyword(s):  
Health Care ◽  
Laparoscopic Surgery ◽  
High Risk ◽  
Operating Room ◽  
Health Care Providers ◽  
Current Literature ◽  
Scoping Review ◽  
Open Surgery ◽  
Care Providers ◽  
Surgical Smoke

Background The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. Objective We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. Methods We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. Results The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. Conclusions There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.

scholarly journals Use of urinary hippuric acid and o-/p-/m-methyl hippuric acid to evaluate surgical smoke exposure in operating room healthcare personnel

2021 ◽  
Vol 217 ◽  
pp. 112231
Author(s):  
Chun-Hui Chiu ◽  
Chi-Tsung Chen ◽  
Ming-Huei Cheng ◽  
Li-Heng Pao ◽  
Chi Wang ◽  
...  
Keyword(s):  
Operating Room ◽  
Hippuric Acid ◽  
Smoke Exposure ◽  
Healthcare Personnel ◽  
Surgical Smoke

scholarly journals Laparoscopic surgery during the COVID-19 pandemic: detection of SARS-COV-2 in abdominal tissues, fluids, and surgical smoke

2021 ◽  
Author(s):  
Isaac Cheruiyot ◽  
Prabjot Sehmi ◽  
Brian Ngure ◽  
Musa Misiani ◽  
Paul Karau ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Smoke

scholarly journals Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO2 Environmental Dispersion Using Different Devices

2021 ◽  
pp. 155335062110148
Author(s):  
Umberto Bracale ◽  
Vania Silvestri ◽  
Emanuele Pontecorvi ◽  
Immacolata Russo ◽  
Maria Triassi ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Quantitative Analysis ◽  
Flow Rate ◽  
Healthcare Professionals ◽  
Operative Time ◽  
Mean Value ◽  
Operating Theater ◽  
Surgical Smoke ◽  
Smoke Evacuation ◽  
Group A

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery.

New LWD Image Improvement Method to Mitigate Interpretation Risks

2021 ◽  
Author(s):  
Tianhua Zhang ◽  
Shiduo Yang ◽  
Chandramani Shrivastava ◽  
Adrian A ◽  
Nadege Bize-Forest
Keyword(s):  
High Resolution ◽  
Real Time ◽  
Best Practice ◽  
Synthetic Data ◽  
Image Resolution ◽  
Drilling Process ◽  
Drilling Tool ◽  
Stick Slip ◽  
Geological Interpretation ◽  
Wellbore Temperature

Abstract With the advancement of LWD (Logging While Drilling) hardware and acquisition, the imaging technology becomes not only an indispensable part of the drilling tool string, but also the image resolution increases to map layers and heterogeneity features down to less than 5mm scale. This shortens the geological interpretation turn-around time from wireline logging time (hours to days after drilling) to semi-real time (drilling time or hours after drilling). At the same time, drilling motion is complex. The depth tracking is on the surface referenced to the surface block movement. The imaging sensor located downhole can be thousands of feet away from the surface. Mechanical torque and drag, wellbore friction, wellbore temperature and weight on bit can make the downhole sensor movement motion not synchronized with surface pipe depth. This will cause time- depth conversion step generate image artifacts that either stop real-time interpretation of geological features or mis-interpret features on high resolution images. In this paper, we present several LWD images featuring distortion mechanism during the drilling process using synthetic data. We investigated how heave, depth reset and downhole sensor stick/slip caused image distortions. We provide solutions based on downhole sensor pseudo velocity computation to minimize the image distortion. The best practice in using Savitsky-Golay filter are presented in the discussion sections. Finally, some high-resolution LWD images distorted with drilling-related artifacts and processed ones are shown to demonstrate the importance of image post-processing. With the proper processed images, we can minimize interpretation risks and make drilling decisions with more confidence.

Perioperative considerations in the management of cold agglutinin disease in laparoscopic surgery

2021 ◽  
Vol 14 (5) ◽  
pp. e241294
Author(s):  
Yisi D Ji ◽  
Paul M Cavallaro ◽  
Britlyn D Orgill
Keyword(s):  
Case Report ◽  
Laparoscopic Surgery ◽  
Acute Cholecystitis ◽  
Operating Room ◽  
Patient Outcomes ◽  
Cold Agglutinin ◽  
Surgical Team ◽  
Cold Agglutinin Disease ◽  
Disease Exacerbation ◽  
Multidisciplinary Collaboration

An 80-year-old man with idiopathic cold agglutinin disease presented with acute cholecystitis. We describe operating room and anaesthetic considerations for patients with cold agglutinin disease and measures that can be taken to prevent disease exacerbation in this case report. Multidisciplinary collaboration and planning between the operative room staff, anaesthesia team and surgical team are needed to ensure safe surgery and optimal patient outcomes.

scholarly journals Health risk to medical personnel of surgical smoke produced during laparoscopic surgery

2015 ◽  
Vol 28 (5) ◽  
pp. 831-840 ◽  
Author(s):  
Miłosz Dobrogowski ◽  
Wiktor Wesolowski ◽  
Małgorzata Kucharska ◽  
Katarzyna Paduszyńska ◽  
Agnieszka Dworzyńska ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Health Risk ◽  
Medical Personnel ◽  
Surgical Smoke
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