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1.
Otolaryngol Clin North Am ; 54(1): 11-23, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1235961

ABSTRACT

A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope now are shared with rigid endoscopes and exoscopes. These 2 modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal-up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared with binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.


Subject(s)
COVID-19 , Endoscopes/standards , Endoscopy/instrumentation , Neurotology/instrumentation , Otolaryngology/instrumentation , Pandemics , Ear Canal/surgery , Endoscopy/standards , Equipment Design/standards , Humans , Mastoidectomy/instrumentation , Microsurgery/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Neurosurgical Procedures/instrumentation , Neurotology/standards , Otolaryngology/standards , Standard of Care/standards , United States
3.
Neurosurg Focus ; 49(6): E15, 2020 12.
Article in English | MEDLINE | ID: covidwho-954715

ABSTRACT

OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, neurosurgeons all around the globe continue to operate in emergency cases using new self-protective measures. Personal protective equipment (PPE) use is recommended in all surgeries. The authors have experienced varying degrees of field of view (FOV) loss under the surgical microscope with different PPE. Herein, they aimed to investigate the effects of different PPE on FOV while using the surgical microscope. METHODS: Fifteen neurosurgeons and neurosurgery residents participated in this study. Three kinds of PPE (safety spectacles, blast goggles, and face shields) were tested while using a surgical microscope. FOV was measured using a 12 × 12-cm checkered sheet of paper on which every square had an area of 25 mm2 under the microscope. The surgical microscope was positioned perpendicular to the test paper, and the zoom was fixed. Each participant marked on the test sheet the peripheral borders of their FOV while using different PPE and without wearing any PPE. A one-way repeated-measures ANOVA was performed to determine if there was a significant difference in FOV values with the different PPE. RESULTS: FOV was significantly different between each PPE (F[3, 42] = 6339.845, p < 0.0005). Post hoc analysis revealed a significant decrease in the FOV from the naked eye (9305.33 ± 406.1 mm2) to blast goggles (2501.91 ± 176.5 mm2) and face shields (92.33 ± 6.4 mm2). There were no significant FOV changes with the safety spectacles (9267.45 ± 410.5 mm2). CONCLUSIONS: While operating under a surgical microscope safety spectacles provide favorable FOVs. Face shields increase the eye piece-pupil distance, which causes a severe reduction in FOV.


Subject(s)
COVID-19/prevention & control , Microsurgery/trends , Neurosurgeons/trends , Neurosurgical Procedures/trends , Personal Protective Equipment/trends , Visual Fields , COVID-19/transmission , Humans , Microscopy/instrumentation , Microscopy/trends , Microsurgery/instrumentation , Neurosurgical Procedures/instrumentation , Personal Protective Equipment/adverse effects , Visual Fields/physiology
4.
Otol Neurotol ; 42(4): 606-613, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-913295

ABSTRACT

BACKGROUND: During the Covid-19 pandemic, otolaryngologists are at risk due to aerosol-generating procedures such as mastoidectomy and need enhanced personal protective equipment (PPE). Eye protection can interfere with the use of a microscope due to a reduction in the field of vision. We aimed to study the effect of PPE on the microsurgical field. METHODS: Five surgeons measured the visual field using digital calipers at different power settings. They were done with no PPE, a surgical mask, FFP3 mask (N99), and with the addition of small goggles, large vistamax goggles, vistamax plus a face shield, and only a face shield. The measurements were repeated with rings of 5 mm increments. We also measured the "eye relief" of the microscope which is the ideal distance for maximum field of view. RESULTS: There was no major reduction of the field with the surgical or FFP3 mask. But even simple goggles reduced the field up to 31.6% and there were progressive reductions of up to 75.7% with large goggles, 76.8% when a face shield was added, and 61.9% when only face shield was used. The distance rings more than 5 mm also affected the field of view.The eye relief of our eyepiece was found to be 15 mm. CONCLUSION: The current PPE eye protection is not compatible with the use of a microscope. There is scope for research into better eye protection. Mitigation strategies including barrier drapes and alternative techniques such as endoscopic surgery or use of exoscopes should also be considered.


Subject(s)
COVID-19/prevention & control , Microsurgery , Otolaryngologists , Personal Protective Equipment/adverse effects , Visual Fields , COVID-19/transmission , Humans , Mastoidectomy/adverse effects , Microsurgery/instrumentation , Microsurgery/methods , SARS-CoV-2
5.
J Laryngol Otol ; 134(8): 739-743, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-678485

ABSTRACT

OBJECTIVE: Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. METHODS: ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. RESULTS: Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4-16 per cent). CONCLUSION: The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.


Subject(s)
Mastoidectomy/instrumentation , Microsurgery/instrumentation , Otorhinolaryngologic Surgical Procedures/instrumentation , Personal Protective Equipment/adverse effects , Aerosols , Betacoronavirus/isolation & purification , Body Fluids/virology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Infection Control/methods , Mastoidectomy/trends , Microscopy/instrumentation , Microsurgery/trends , Otolaryngologists/statistics & numerical data , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Pandemics , Personal Protective Equipment/standards , Personal Protective Equipment/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2 , Surgeons/statistics & numerical data
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