Northern Ireland regional laparoscopic simulation programme

Objective: To improve training for all obstetrics and gynaecology trainees in Northern Ireland (NI) through access to an agreed simulation programme. Design: Laparoscopic simulation leads were identified in all training units within NI. A regional laparoscopic simulation programme was designed and reviewed by all units to ensure a regional approach was maintained. Laparoscopic boxes were provided to all units alongside a curriculum document to follow. Method: Laparoscopic simulation leads were identified in all training units. A detailed curriculum was developed which ranged from basic to intermediate and advanced laparoscopic skills. All units were provided with laparoscopic simulation boxes to use throughout the 10 week programme. The teaching sessions were held on alternate Friday afternoons over a 20 week period as part of the regional CME programme within NI. This was part of the restoration of gynaecological surgical training in response to the challenges raised by COVID-19. Each week began with a lecture (delivered virtually) was given on the following topics;Theatre set up and equipment Ergonomics in laparoscopy Laparoscopic instruments and electrosurgery Pelvic anatomy Laparoscopic entry techniques Laparoscopic adnexal surgery Laparoscopic hysterectomy Laparoscopic urogynaecology Specimen retrieval Laparoscopic complications Each lecture was then followed by time spent using the laparoscopic simulation boxes under direct consultant supervision. A laparoscopic skills log book was designed to log all procedures performed by trainees including space for consultant feedback. A post course questionnaire was completed by trainees. Conclusion: COVID-19 has significantly impacted training and this programme has addressed concerns voiced by trainees and has made access to simulation training available to all trainees throughout NI. With consultant supervision and the use of an agreed curriculum and log book this has been a welcomed introduction with limited time spent in a live theatre environment. As this was held in each individual unit throughout NI all COVID regulations were met and good quality teaching in the trainees current training unit. This not only simulated laparoscopic skills but also the consultant supervision and feedback they would have experienced in theatre.

A Case of Symptomatic Endobronchial Hamartoma Causing Right Upper Lobe (RUL) Atelectasis

Introduction: Pulmonary Hamartomas are the most common benign tumors of lungs. Hamartomas are usually asymptomatic and are incidentally diagnosed on chest imaging. Symptomatic cases usually involve endobronchial mucosa. We describe a case of a symptomatic patient who was noted to have a right upper lobe collapse by an endobronchial lesion. This lesion was confirmed to be a cartilaginous hamartoma and was definitively treated by electrosurgical by Argon plasma (APC). Description: A 37 year old obese male active smoker presented to the ER for worsening Shortness of air (SOA) for two weeks. He had dry cough for similar duration without any fevers. On physical examination he was afebrile with normal vital signs but without hypoxia and otherwise normal physical examination. Labs revealed normal white cell count. A COVID test was negative. CT chest showed an endobronchial lesion obstructing the right upper lobe (RUL) with some internal fat density measuring at least 1.5cm causing complete collapse of RUL. No mediastinal or hilar adenopathy was noted. A flexible bronchoscopy showed a pedunculated smooth lesion arising from RUL bronchus anteriorly occluding the RUL bronchus. FNA of the lesion did not show any malignant cells. Using electrosurgery by APC the lesion was removed en bloc. A histopathology showed findings of cartilaginous hamartoma. A follow up Chest X-ray showed improvement in RUL atelectasis. Discussion: Pulmonary hamartomas are the most common benign pulmonary tumors and comprise 6% of solitary pulmonary nodules. Mostly detected on chest imaging as an incidental finding however CT chest has characteristic finding of pop corn shaped calcifications, fat density. Symptomatic cases are usually endobronchial and can be definitively treated with endoscopic techniques.

First rigid bronchoscopy in COVID-19 pneumonia to treat a rare endobronchial tumor during extracorporeal membrane oxygenation

During the COVID-19 pandemic in Northern Italy, a young man with fever and dyspnea was admitted to the Emergency Department. The sudden development of severe hypoxemia and respiratory acidosis forced the emergency medical team to intubate the patient. Fiberoptic bronchoscopy and chest CTscan showed the presence of a bleeding neoformation, occluding the majority of tracheal lumen requiring the connection to a veno-venous extracorporeal respiratory support. Arigid bronchoscopy was performed to clear the tracheal lumen, obtaining a diagnosis of "composite hemangioendothelioma."All personnel involved was equipped with personal protective equipment (PPE) and power air-purifying respirators (PAPR). ECMOand mechanical ventilation were soon weaned, lung CTshowed an almost complete patency of tracheo-bronchial tree. To the best of our knowledge, this is the first rigid bronchoscopic procedure reported in a SARS-CoV-2 virus pneumonia respiratory failure requiring ECMO, allowing to diagnose an extremely rare endobronchial tumor.

Hysteroscopy in COVID 19 pandemic: safety concerns.

The coronavirus disease (COVID-19) pandemic is a global health crisis that negatively impacts the health infrastructure by diverting resources to manage this infection. The long-term impact on the health of patients due to a lack of appropriate medical care to avoid COVID-19 infection is already visible in the mortality rates of the general population. The presence of the severe acute respiratory syndrome coronavirus 2 in the female genital tract is not clear. Bubbles produced during hysteroscopy tend to cool down to the temperature of the distension medium and then dissolve. Hence, aerosols are not produced during hysteroscopy, which is usually performed in an office setting. If anesthesia is required, conscious sedation or regional anesthesia should preferably be used to reduce aerosol production. Hence, hysteroscopy is not an aerosol-generating procedure and the risk of COVID-19 infection is low; therefore, hysteroscopy should not be ruled out in emergencies.

Electrosurgery Turbinate Reduction Revisited: Can Comparable Volumetric Heating be Achieved Without Feedback Control?

BACKGROUND AND OBJECTIVES: Temperature-controlled radiofrequency inferior turbinate ablation (TCRFA) uses a feedback system to control thermal injury and achieve precise volumetric heating to induce specific scar formation. However, it requires costly single-use proprietary consumables. Comparable volumetric tissue heating may be achieved for a fraction of the cost by adjusting the power settings on traditional monopolar electrosurgery devices that use low-cost needle tips. This pre-clinical study aims to determine the optimized power parameters to achieve electrosurgical coagulum volume similar to that of TCRFA. STUDY DESIGN/MATERIALS AND METHODS: An electrosurgery submucosal diathermy (SMD) system (cut mode, 4-32 W, 5-120 seconds) and a temperature-controlled radiofrequency ablation system (standard clinical parameters for treating inferior turbinate hypertrophy) were used to coagulate egg white and chicken breast. Coagulum major and minor axis were measured, and lesion volume was approximated as prolate spheroid. RESULTS: No significant difference in volume was found between the temperature-controlled system and the electrosurgery system at 8 W for 30 seconds, 8 W for 60 seconds, 16 W for 30 seconds, 32 W for 5 seconds, and 32 W for 15 seconds. The time to achieve equivalent lesion size was significantly less in the SMD system when compared to the temperature-controlled system (P < 0.05). CONCLUSION: Electrosurgery handpieces may achieve similar lesion volume effects as the temperature feedback-controlled, single-use handpieces when set to the optimized parameters. SMD handpieces are significantly more cost and time effective than proprietary devices, and they are easily used in the office. SMD devices may be a more affordable alternative to temperature-controlled systems with comparable lesion volume effect and may be valuable for office-based therapy. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Electrosurgery smoke is the smoke emitted from tissue cauterization when using the electrosurgery device. Accordingly, in this smoke, more than 80 harmful toxins have been discovered. In the current study, we aimed to investigate the level of knowledge reported by the operating room nurses on the effects of electrosurgery smoke during the current COVID-19 pandemic. METHODS: This descriptive, survey-based cross-sectional study was performed on 533 OR nurses in all the referring hospitals of COVID-19 infection. The required information were collected using a questionnaire regarding the knowledge on the side effects of electrosurgery smoke. The obtained data were then analyzed using t-test and ANOVA by SPSS software. RESULTS: Most of the included participants (93.6%) had a low level of awareness and only a small number of them (0.4%) had a good level of knowledge on the effects of electrosurgery smoke. As well, a significant relationship (P˂0.05) was found between the level of knowledge reported by the OR nurses and the type of hospital (educational or private). Most of the studied hospitals used no electrosurgery smoke reduction equipment during electrosurgery. CONCLUSION: The level of knowledge reported by the OR nurses was generally poor. It is recommended that managers and health officials try to increase the level of awareness of OR nurses during the COVID-19 pandemic by providing standard and protective equipment as well as holding some well-organized and related training courses.