Male and female sterilisation

Male and female sterilisation are important forms of contraception worldwide despite declining popularity in developed countries and limited access during the Covid-19 global pandemic. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilisation, particularly long-acting reversible contraception (LARC), should be discussed in detail as they are at least as effective and have the advantage of reversibility. Hysteroscopic techniques for female sterilisation are no longer available. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilisation and requests for reversal are more common in patients under 30 years and in men with no children.Copyright © 2023

Chemical constituents, viable micro-organism and malignant cell content in ultrasonic scalpel plume: A literature review.

PURPOSE: To identify all published data on the chemical, micro-organism and malignant cell contents of ultrasonic scalpel plume, if any, and on any clinical implications of the contents on patients and operating staff. METHODS: Searches were conducted aiming to identify all published evidence on the chemical constituents, presence/absence of viable micro-organisms and malignant cells in ultrasonic scalpel plume. Attempts were made to source unpublished industry data. RESULTS: There is evidence from human and in vitro studies of the presence of a range of harmful, and some human carcinogenic, chemicals within ultrasonic plume, mostly at very low concentrations. Any clinical relevance of this has not been studied. There is evidence from experimental studies of the presence of hepatitis virus, human coronavirus and human papillomavirus material within ultrasonic plume. Any clinical effect of this has not been studied. There is conflicting evidence from combined in vitro and mouse model studies of the presence of viable malignant cells within ultrasonic plume. Any clinical relevance of this has also not been studied. CONCLUSION: Overall, relatively little research into the plume has been published, and further study is required to more clearly delineate any potential risk to patients, surgeons and other theatre staff. Current safety recommendations are discussed.

Trends in Front of Neck Access - A bibliometric analysis

Background: Front of Neck Access (FONA) is a critical skill Anaesthetists must be able to perform in the 'Can't Intubate, Can't oxygenate' (CICO) scenario, and is a core technical skill ANZCA registrars must develop during training (ANZCA 2020). However, since the Covid-19 pandemic, opportunities for first hand emergency airway experience have reduced. To gain an understanding of trends in the field of FONA and to guide future advancement, we conducted a bibliometric analysis of the 100 most cited papers for Front of Neck Access. Methods: The Thomas Reuters Web of Science database was searched on 13th of June 2021 using the terms;“Front of Neck Access”, “FONA”, “Cricothyroidotomy”, “Surgical cricothyroidotomy”, “Scalpel Cricothyroidotomy”, “Needle Cricothyroidotomy”. The 100 most cited papers relevant to FONA were analysed by design, topic, author, publication year and institution. The journal impact factor for the year 2019 along with Eigenfactor scores were recorded. Results: A total of 787 papers were retrieved from our search. These were ranked by total number of citations. The median number of citations for the top 100 articles was 56.5 (IQR 28), with 44% of articles originating from the USA. The top five cited papers made up 37% of total citations. Anesthesia (n=9) and The British Journal of Anesthesia (n=9) had the greatest number of papers, whilst the greatest number of citations came from Academic Emergency Medicine (n=2456). The years 2011 (n=9) and 2015 (n=9) had the greatest number of papers published. Technique for emergent FONA was the most common theme. Conclusions: The most influential articles in the FONA literature have each been cited at least 35 times, reflecting considerable impact and quality. The USA has produced most research in this area, allowing the widespread dispersion of indications, technique and guidelines at a time when practical experience may be limited due to the pandemic.

Dynamics of surgical smoke in the operating room during spinal surgery: Comparison of particulate matter 2.5-air concentration between the electric scalpel with and without a smoke evacuation pencil: A cross-sectional study.

BACKGROUND: Surgical smoke is a vaporous by-product generated during tissue incision and cauterization with an electric scalpel. This smoke contains tissue- and blood/vascular-derived substances, bacteria, viruses, and chemical substances. Among them, it contains many fine particles called particulate matter (PM) 2.5, which are harmful and hazardous to the human body. We aimed to investigate the occurrence of PM2.5 in surgical smoke produced during spinal surgery and to evaluate the efficacy of an electric scalpel with a smoke evacuation pencil. METHODS: In this retrospective observational study, 89 patients who underwent spinal surgery between June 2019 and May 2021 were included. A dust monitor was installed in the operating room to measure the PM2.5 air concentration during the surgery. During each surgery, the total amount of PM2.5, the maximum PM2.5 air concentration, the exposure time to PM2.5, and the average value of PM2.5 air concentration from the start to the end of the surgery were calculated. RESULTS: We found that in 29 of the 89 cases (32.6%), the air concentration of PM2.5 increased to a level that could cause health damage during the surgery. Twelve cases (13.4%) reached the level that could cause serious health damage, and 8 cases (9%) reached an emergency warning level. The total amount and the maximum and average levels of PM2.5 were significantly suppressed in the surgery with a smoke evacuation pencil group than in the surgery without a smoke evacuation pencil group. CONCLUSION: We detected hazardous levels of PM2.5 in the air during spinal surgery, highlighting the importance of considering smoke control or reduction during spinal surgery. We recommend using an electric scalpel with a smoke evacuation pencil for regulating PM2.5 levels in the operating room.

Online surgical journal clubs: Are they effective?

Aim: Much of medical education has been abruptly forced online during the COVID-19 pandemic. Traditional journal clubs thrive on group interaction and debate. The aim of this project is to assess whether an online surgical journal club could replicate this experience and learning. Method: A fortnightly, chat-based online surgical journal club with national reach was re-launched under SCALPEL (Manchester Medical School's surgical society) with defined learning objectives, inclusion of studies from different surgical sub-specialities and a proforma to aid critical appraisal. Anonymous feedback forms were sent to participants to assess confidence in critically appraising the literature before and after attendance, and differences in means were analysed using paired ttest. Results: 32 feedback forms from participants, the majority of whom were final year medical students (34.4%) were analysed. 28.1% had previously attended a journal club. 65.6% of attendees had prior involvement in a research project which led to a publication for 18.8%, while 59.4% were interested in applying for the Academic Foundation Programme (AFP). The self-reported confidence of participants to identify the study design, interpret the results and statistical analyses;and scrutinise the strengths and weaknesses of a study increased by 12.2%, 14.7% and 15.9% respectively (p=<0.001). Furthermore, 96.9% of attendees stated they would attend another online journal club in the future, with 59.4% favouring an online format. Conclusions: Online surgical journal clubs are effective and are here to stay following the conclusion of social distancing. They have the advantage of further outreach and may encourage greater participation than traditional journal clubs.

Detection of human coronavirus RNA in surgical smoke generated by surgical devices.

BACKGROUND: Gaseous by-products generated by surgical devices - collectively referred to as 'surgical smoke' - present the hazard of transmitting infective viruses from patients to surgical teams. However, insufficient evidence exists to evaluate and mitigate the risks of SARS-CoV-2 transmission via surgical smoke. AIM: To demonstrate the existence and infectivity of human coronavirus RNA in surgical smoke using a model experiment and to evaluate the possibility of lowering transmission risk by filtration through a surgical mask. METHODS: Pelleted HeLa-ACE2-TMPRSS2 cells infected with human coronavirus were incised by electric scalpel and ultrasonic scalpel, separately. A vacuum system was used to obtain surgical smoke in the form of hydrosol. Reverse transcription-quantitative polymerase chain reaction was used to analyse samples for the presence of viral RNA, and infectivity was determined through plaque assay. Furthermore, a surgical mask was placed centrally in the vacuum line to evaluate its ability to filter viral RNA present in the surgical smoke. FINDINGS: In this model, 1/106 to 1/105 of the viral RNA contained in the incision target was detected in the collected surgical smoke. The virus present in the smoke was unable to induce plaque formation in cultured cells. In addition, filtration of surgical smoke through a surgical mask effectively reduced the amount of viral RNA by at least 99.80%. CONCLUSION: This study demonstrated that surgical smoke may carry human coronavirus, though viral infectivity was considerably reduced. In clinical settings, surgical mask filtration should provide sufficient additional protection against potential coronavirus, including SARS-CoV-2, infection facilitated by surgical smoke.

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

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.