ABSTRACT
Background: Since the onset of the coronavirus disease 2019 pandemic, virtual simulation has emerged as an alternative to traditional teaching methods as it can be employed within the recently established contact-minimizing guidelines. This prospective education study aimed to develop a virtual reality simulator for a lumbar transforaminal epidural block and to demonstrate its efficacy. Methods: We developed a virtual reality simulator using patient image data processing, virtual x-ray generation, spatial registration, and virtual reality technology. For a realistic virtual environment, a procedure room, surgical table, C-arm, and monitor were created. Using the virtual C-arm, X-ray images of the patient's anatomy, the needle, and indicator were obtained in real time. After simulation, trainees could get feedback from adjusting the visibility of the structures (such as skin and bones). The training of lumbar transforaminal epidural block using the simulator was evaluated in 20 inexperienced trainees. Trainees' procedural time, rating score, number of C-arm taken, and overall satisfaction were recorded as primary outcomes. Results: The group using the simulator showed a higher global rating score (p = 0.014), reduced procedural time (p = 0.025), reduced number of C-arm uses (p = 0.001), and higher overall satisfaction score (p = 0.007). Conclusions: We created an accessible and effective virtual reality simulator that can be used to teach a lumbar transforaminal epidural block, without radiation exposure, for inexperienced trainees. The results of this study indicate that the proposed simulator will prove to be a useful aid for teaching a lumbar transforaminal epidural block.
ABSTRACT
Introduction For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. Objective The purpose of the present study was to assess whether the prevalence of pediatric neck abscesses managed with operative drainage decreased compared with previous years. Methods Medical records of all pediatric cases at a tertiary care children's hospital diagnosed with abscess of the neck and treated with incision and drainage were evaluated between the dates of April 1 and November 30 from 2015 to 2020. Outcomes were compared for each year from 2015 to 2019 to 2020, which included location, abscess size, duration of antibiotic treatment, microbiology, and the number of cases per year. Results A total of 201 cases were included. The mean ± standard deviation (SD) presenting age in the 2015 to 2019 group was 5.05 ± 5.03 years old and 2.24 ± 1.91 years old in the 2020 group. The mean number of cases between 2015 and 2019 was 35.6 ± 4.2, whereas the number of cases in 2020 was 23 ( p = 0.002). Of those patients who underwent IV antibiotic therapy prior to presentation ( n = 43), the mean number of days before admission was 1.98 ± 2.95 ( n = 40) from 2015 to 2019 and 12.00 ± 10.39 ( n = 3) in 2020 ( p = 0.008). The percent of cases with multiple strains cultured between 2015 and 2019 was 13.4% versus 18.2% in 2020 ( p = 0.007). Conclusion There was a decrease in the number of operative neck abscesses in 2020 compared with the mean number per year from 2015 to 2019. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery are two possible explanations.
ABSTRACT
Objectives: The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery. Material and Methods: Between March 15th, 2020 and April 30th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded. Results: Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%. Conclusion: With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.