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1.
Lasers Med Sci ; 36(7): 1555-1556, 2021 09.
Article in English | MEDLINE | ID: covidwho-1554591
2.
J Invest Surg ; 33(1): 59-66, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-1455005

ABSTRACT

Background: Bipolar sealing devices are routinely used to seal blood vessels. The aim of the study is to evaluate the feasibility and safety of colonic sealing with the use of the bipolar energy devices in rats as model for experimental appendectomy. Methods: Seventy-five male Wistar rats underwent a cecal resection with four different bipolar sealing devices or a linear stapler. The harvesting procedure was performed immediately or at postoperative day (POD) 7. The sealing front bursting pressure (BP) was measured in both groups. At POD7, the resection line was clinically examined and the hydroxyproline (HDP) levels were determined. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the sealing front as well. Results: There was no mortality and no insufficiency. The BPs between the bipolar sealing devices showed no statistical differences. The early phase of the seal (POD 0) provides a low BP with an 30.8% increase until POD 7. The BPs in the stapler group showed significant better values. The hydroxyproline levels did not differ statistically between the groups. Histopathologically, there were more signs of ischemic necrosis in the stapler group than in the sealing devices groups. Conclusion: The resection and sealing of the cecum as an experimental appendectomy model with the use of bipolar energy devices proved feasible and safe in rats. The different energy devices in this study produce comparable results. To justify clinical practice in humans, several studies on the underlying mechanisms of early stage wound healing are needed.


Subject(s)
Appendectomy/instrumentation , Cecum/surgery , Electrocoagulation/instrumentation , Hemostasis, Surgical/instrumentation , Wound Closure Techniques/instrumentation , Animals , Appendectomy/adverse effects , Appendectomy/methods , Electrocoagulation/methods , Feasibility Studies , Hemostasis, Surgical/adverse effects , Hemostasis, Surgical/methods , Male , Models, Animal , Rats , Rats, Wistar , Surgical Staplers/adverse effects , Wound Closure Techniques/adverse effects
3.
Otolaryngol Head Neck Surg ; 164(6): 1186-1192, 2021 06.
Article in English | MEDLINE | ID: covidwho-1455831

ABSTRACT

OBJECTIVE: To analyze patients' return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. STUDY DESIGN: Randomized double-blinded clinical trial based on prospective parallel design. SETTING: Academic medical center and tertiary children's hospital between March 2018 and July 2019. METHODS: Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient's return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. RESULTS: Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P = .89), daily pain scores over 15 postoperative days (P = .46), postoperative narcotic use (P = .61), or return to hospital for any reason (P = .60), including bleeding as an adverse event (P = .13). CONCLUSIONS: As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.


Subject(s)
Adenoidectomy/methods , Electrocoagulation , Radiofrequency Ablation , Tonsillectomy/methods , Adolescent , Child , Child, Preschool , Double-Blind Method , Female , Humans , Male , Prospective Studies , Treatment Outcome
4.
J Laryngol Otol ; 135(10): 848-854, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1454702

ABSTRACT

OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.


Subject(s)
Dissection/adverse effects , Facial Nerve/surgery , Hemostasis, Surgical/instrumentation , Parotid Gland/surgery , Blood Loss, Surgical/statistics & numerical data , Drainage/trends , Electrocoagulation/adverse effects , Facial Paralysis/epidemiology , Female , Humans , Length of Stay/statistics & numerical data , Male , Meta-Analysis as Topic , Middle Aged , Operative Time , Outcome Assessment, Health Care , Postoperative Period , Surgical Instruments/adverse effects
6.
JAMA Otolaryngol Head Neck Surg ; 147(9): 797-803, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1320055

ABSTRACT

Importance: During respiratory disease outbreaks such as the COVID-19 pandemic, aerosol-generating procedures, including tracheostomy, are associated with the risk of viral transmission to health care workers. Objective: To quantify particle aerosolization during tracheostomy surgery and tracheostomy care and to evaluate interventions that minimize the risk of viral particle exposure. Design, Setting, and Participants: This comparative effectiveness study was conducted from August 2020 to January 2021 at a tertiary care academic institution. Aerosol generation was measured in real time with an optical particle counter during simulated (manikin) tracheostomy surgical and clinical conditions, including cough, airway nebulization, open suctioning, and electrocautery. Aerosol sampling was also performed during in vivo swine tracheostomy procedures (n = 4), with or without electrocautery. Fluorescent dye was used to visualize cough spread onto the surgical field during swine tracheostomy. Finally, 6 tracheostomy coverings were compared with no tracheostomy covering to quantify reduction in particle aerosolization. Main Outcomes and Measures: Respirable aerosolized particle concentration. Results: Cough, airway humidification, open suctioning, and electrocautery produced aerosol particles substantially above baseline. Compared with uncovered tracheostomy, decreased aerosolization was found with the use of tracheostomy coverings, including a cotton mask (73.8% [(95% CI, 63.0%-84.5%]; d = 3.8), polyester gaiter 79.5% [95% CI, 68.7%-90.3%]; d = 7.2), humidification mask (82.8% [95% CI, 72.0%-93.7%]; d = 8.6), heat moisture exchanger (HME) (91.0% [95% CI, 80.2%-101.7%]; d = 19.0), and surgical mask (89.9% [95% CI, 79.3%-100.6%]; d = 12.8). Simultaneous use of a surgical mask and HME decreased the particle concentration compared with either the HME (95% CI, 1.6%-12.3%; Cohen d = 1.2) or surgical mask (95% CI, 2.7%-13.2%; d = 1.9) used independently. Procedures performed with electrocautery increased total aerosolized particles by 1500 particles/m3 per 5-second interval (95% CI, 1380-1610 particles/m3 per 5-second interval; d = 1.8). Conclusions and Relevance: The findings of this laboratory and animal comparative effectiveness study indicate that tracheostomy surgery and tracheostomy care are associated with significant aerosol generation, putting health care workers at risk for viral transmission of airborne diseases. Combined HME and surgical mask coverage of the tracheostomy was associated with decreased aerosolization, thereby reducing the risk of viral transmission to health care workers.


Subject(s)
Aerosols , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Medical Staff, Hospital , Tracheostomy/adverse effects , Virion , Animals , COVID-19/prevention & control , COVID-19/transmission , Comparative Effectiveness Research , Electrocoagulation/adverse effects , Hot Temperature , Humans , Humidity , Manikins , Masks , Risk Factors , SARS-CoV-2 , Swine , Tracheostomy/instrumentation
7.
Dermatol Ther ; 33(6): e14136, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1140163

ABSTRACT

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.


Subject(s)
COVID-19 , Dermatologists/trends , Dermatology/trends , Practice Patterns, Physicians'/trends , Skin Diseases/therapy , Tertiary Care Centers/trends , Adult , Aged , Biological Products/therapeutic use , Biopsy/trends , Electrocoagulation/trends , Female , Humans , Male , Middle Aged , Patient Admission/trends , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/etiology , Time Factors , Turkey/epidemiology , Young Adult
8.
Ann Surg ; 272(3): e257-e262, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1114943

ABSTRACT

OBJECTIVE: The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff. SUMMARY BACKGROUND DATA: Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown. METHODS: This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice. RESULTS: There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems). CONCLUSIONS: The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Diathermy/instrumentation , Electrocoagulation/instrumentation , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , COVID-19/epidemiology , Humans
9.
Am J Otolaryngol ; 42(4): 102970, 2021.
Article in English | MEDLINE | ID: covidwho-1103683

ABSTRACT

INTRODUCTION: The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device. MATERIAL AND METHODS: The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300-10.000 µm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control. RESULTS: No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling. DISCUSSION AND CONCLUSIONS: Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.


Subject(s)
COVID-19/transmission , Electrocoagulation/adverse effects , Infectious Disease Transmission, Patient-to-Professional , Occupational Exposure/adverse effects , Orbit/surgery , SARS-CoV-2/pathogenicity , Aerosols , COVID-19/prevention & control , Cadaver , Humans , Risk Assessment
10.
Environ Sci Technol ; 55(4): 2674-2683, 2021 02 16.
Article in English | MEDLINE | ID: covidwho-1060741

ABSTRACT

It is imperative to understand the behavior of enveloped viruses during water treatment to better protect public health, especially in the light of evidence of detection of coronaviruses in wastewater. We report bench-scale experiments evaluating the extent and mechanisms of removal and/or inactivation of a coronavirus surrogate (ϕ6 bacteriophage) in water by conventional FeCl3 coagulation and Fe(0) electrocoagulation. Both coagulation methods achieved ∼5-log removal/inactivation of ϕ6 in 20 min. Enhanced removal was attributed to the high hydrophobicity of ϕ6 imparted by its characteristic phospholipid envelope. ϕ6 adhesion to freshly precipitated iron (hydr)oxide also led to envelope damage causing inactivation in both coagulation techniques. Fourier transform infrared spectroscopy revealed oxidative damages to ϕ6 lipids only for electrocoagulation consistent with electro-Fenton reactions. Monitoring ϕ6 dsRNA by a novel reverse transcription quantitative polymerase chain reaction (RT-qPCR) method quantified significantly lower viral removal/inactivation in water compared with the plaque assay demonstrating that relying solely on RT-qPCR assays may overstate human health risks arising from viruses. Transmission electron microscopy and computationally generated electron density maps of ϕ6 showed severe morphological damages to virus' envelope and loss of capsid volume accompanying coagulation. Both conventional and electro- coagulation appear to be highly effective in controlling enveloped viruses during surface water treatment.


Subject(s)
Iron , Water Purification , Electrocoagulation , Humans , Virus Inactivation , Waste Water
12.
Clin Spine Surg ; 34(3): 87-91, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-835180

ABSTRACT

Safe spine surgery is possible during the COVID-19 pandemic. Certain urgent procedures must still be performed during this challenging time to prevent permanent long-term disability or death for patients. Precautions must be taken in the operating room to optimize safety, including the use of personal protective equipment and appropriate room setup and anesthesia and equipment optimization. Evidence-based guidelines to create a safe operative paradigm for use in future viral outbreaks are paramount.


Subject(s)
COVID-19/prevention & control , Orthopedic Procedures/methods , Practice Guidelines as Topic , Spinal Diseases/surgery , Air Filters , Airway Extubation , Electrocoagulation , Fluoroscopy , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intraoperative Neurophysiological Monitoring , Intubation, Intratracheal , N95 Respirators , Operating Rooms , Personal Protective Equipment , Postoperative Care , SARS-CoV-2 , Ventilation
13.
Eur Arch Otorhinolaryngol ; 278(4): 1237-1245, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-746582

ABSTRACT

INTRODUCTION: Based on current knowledge, the SARS-CoV-2 is transmitted via droplet, aerosols and smear infection. Due to a confirmed high virus load in the upper respiratory tract of COVID-19 patients, there is a potential risk of infection for health care professionals when performing surgical procedures in this area. The aim of this study was the semi-quantitative comparison of ENT-typical interventions in the head and neck area with regard to particle and aerosol generation. These data can potentially contribute to a better risk assessment of aerogenic SARS-CoV-2-transmission caused by medical procedures. MATERIALS AND METHODS: As a model, a test chamber was created to examine various typical surgical interventions on porcine soft and hard tissues. Simultaneously, particle and aerosol release were recorded and semi-quantitatively evaluated time-dependently. Five typical surgical intervention techniques (mechanical stress with a passive instrument with and without suction, CO2 laser treatment, drilling and bipolar electrocoagulation) were examined and compared regarding resulting particle release. RESULTS: Neither aerosols nor particles could be detected during mechanical manipulation with and without suction. The use of laser technique showed considerable formation of aerosol. During drilling, mainly solid tissue particles were scattered into the environment (18.2 ± 15.7 particles/cm2/min). The strongest particle release was determined during electrocoagulation (77.2 ± 30.4 particles/cm2/min). The difference in particle release between electrocoagulation and drilling was significant (p < 0.05), while particle diameter was comparable. In addition, relevant amounts of aerosol were released during electrocoagulation (79.6% of the maximum flue gas emission during laser treatment). DISCUSSION: Our results demonstrated clear differences comparing surgical model interventions. In contrast to sole mechanical stress with passive instruments, all active instruments (laser, drilling and electrocoagulation) released particles and aerosols. Assuming that particle and aerosol exposure is clinically correlated to the risk of SARS-CoV-2-transmission from the patient to the physician, a potential risk for health care professionals for infection cannot be excluded. Especially electrocautery is frequently used for emergency treatment, e.g., nose bleeding. The use of this technique may, therefore, be considered particularly critical in potentially infectious patients. Alternative methods may be given preference and personal protective equipment should be used consequently.


Subject(s)
Aerosols/adverse effects , COVID-19/prevention & control , COVID-19/transmission , Electrocoagulation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laser Therapy , Otorhinolaryngologic Surgical Procedures/adverse effects , Animals , COVID-19/virology , Humans , Otorhinolaryngologic Surgical Procedures/methods , Otorhinolaryngologic Surgical Procedures/standards , Pandemics , SARS-CoV-2 , Swine
14.
J Int Med Res ; 48(8): 300060520949772, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-742337

ABSTRACT

OBJECTIVE: This study was performed to introduce an easy method of surgical smoke evacuation for patients with confirmed or suspected COVID-19 undergoing emergency surgery. METHODS: An easy, inexpensive, protective, and practical surgical smoke evacuation device/system was developed and is herein described. RESULTS: The use of this surgical smoke evacuation device/system in open surgery is convenient and effective. It allows for easy, economic, useful, and protective surgical smoke evacuation. CONCLUSIONS: COVID-19 infection causes direct mortality and morbidity, and its incidence has recently increased. Protection from electrosurgery-related smoke is recommended particularly during the current pandemic. This surgical smoke evacuation device/system is easy to use and provides a convenient and effective method of smoke evacuation during both open surgery and all cauterization interventions.


Subject(s)
Coronavirus Infections/surgery , Electrocoagulation/instrumentation , Electrosurgery/instrumentation , Pneumonia, Viral/surgery , Suction/instrumentation , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/pathology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Electrocoagulation/methods , Electrosurgery/methods , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2 , Smoke/prevention & control
15.
Int J Surg ; 80: 21-25, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-638076

ABSTRACT

The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reserves worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of the COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients' selection and management plans with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up sheds lights on the impact of the COVID-19, big data analytics of response of medical personnel in understanding and curtailing the disease process and the consensus guidelines for carrying out laparoscoendoscopic procedures.


Subject(s)
Coronavirus Infections/prevention & control , Disposable Equipment , Endoscopy/methods , Health Care Rationing , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Neoplasms/surgery , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Betacoronavirus , Big Data , COVID-19 , Clinical Protocols , Coronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Data Science , Elective Surgical Procedures/methods , Electrocoagulation/methods , Equipment Contamination/prevention & control , Health Personnel , Humans , Operating Rooms , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Ultrasonic Surgical Procedures/methods
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