Application of a Modified Endoscopy Face Mask for Flexible Laryngoscopy During the COVID‐19 Pandemic

Narwani, Vishal; Kohli, Nikita; Lerner, Michael Z.

doi:10.1177/0194599820928977

Cited by 17 publications

(21 citation statements)

References 7 publications

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“…The use of a mask with a soft face seal also allows for the accommodation of multiple face shapes without needing to manufacture individualized systems. In recent months, several studies have sought to evaluate droplet spread during endoscopic sinus surgery, 16,19,20,[22][23][24][25] but this model is the first to examine the performance of a negative-pressure mask with both respiratory droplet and droplet nuclei simulations.…”

Section: Discussionmentioning

confidence: 99%

Reducing Aerosolized Particles and Droplet Spread in Endoscopic Sinus Surgery during COVID‐19

2020

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Objectives The presence of high SARS‐Cov‐2 viral loads in the upper airway, including the potential for aerosolised transmission of viral particles, has generated significant concern amongst Otolaryngologists worldwide, particularly those performing Endoscopic Sinus Surgery (ESS). We evaluated a simple negative pressure mask technique to reduce viral exposure. Methods Two models simulating respiratory droplets >5‐10 μm and fine respiratory nuclei <5 μm using fluorescein dye and wood smoke respectively were utilised in a fixed cadaveric study in a controlled environment. Using Ultra‐Violet light, fluorescein droplet spread was assessed during simulated ESS with powered microdebrider and powered drilling. Wood smoke ejection was used to evaluate fine particulate escape from a negative pressure mask using digital subtraction image processing. Results The use of a negative pressure mask technique resulted in a 98% reduction in the fine particulate aerosol simulation, and eliminated larger respiratory droplet spread during simulated ESS, including during external drill activation. Conclusions As global ENT services resume routine elective operating, we demonstrate the potential use of a simple negative pressure mask technique to reduce the risk of viral exposure for the operator and theatre staff during ESS.

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Section: Discussionmentioning

confidence: 99%

Reducing Aerosolized Particles and Droplet Spread in Endoscopic Sinus Surgery during COVID‐19

2020

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“…Finally, the Maskpirator may also prove useful for otolaryngologists to perform endoscopic in-office procedures, as they return to offer quality care to their patients amid the COVID-19 pandemic [ 28 ]. In this respect, it is important to study the tolerance of the conscious patient to the use of the proposed device.…”

Section: Discussionmentioning

confidence: 99%

A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era

Viera‐Artiles

Mato

Valdiande

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era. Methods We have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model. Results The pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization. Conclusions The mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke. Electronic supplementary material The online version of this article (10.1007/s00405-020-06462-1) contains supplementary material, which is available to authorized users.

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“…Another IC technique has been to adapt the current facilities such as the endoscopy suite to increase safety during the COVID-19 pandemic. Modified face masks or boxes have been developed as mechanical barriers ( Narwani et al, 2020 ; Tsui, 2020 ). Paired with CO 2 extractors or suction mechanism, they create negative pressure zones with the potential of eliminating (or significantly reducing) aerosols escaping the procedure site and travelling around the suite.…”

Section: Impact Of Covid-19 On Flexible Gi Endoscopymentioning

confidence: 99%

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

et al. 2021

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Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.

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Application of a Modified Endoscopy Face Mask for Flexible Laryngoscopy During the COVID‐19 Pandemic

Cited by 17 publications

References 7 publications

Reducing Aerosolized Particles and Droplet Spread in Endoscopic Sinus Surgery during COVID‐19

Reducing Aerosolized Particles and Droplet Spread in Endoscopic Sinus Surgery during COVID‐19

A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

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