Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy

Abstract

Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.

COVID-19 and laryngological surgery

“…Similarly, the use of microdebrider was associated with a 1.53-fold drop in the concentration of microparticles less than 1 μm, and a 1.39-fold drop in particles sizes 1-5 μm compared to CO 2 laser. 36 These studies, and others, show the benefits of using cold steel or microdebrider instruments over CO 2 laser, if possible, such as in cases of laryngeal papillomatosis debridement. 13 , 36 , 37 , 38 While it appears that extensive use of CO 2 laser creates substantial opportunities for aerosol transmission, it is also often a necessary tool in laryngology procedures.…”

“… 36 These studies, and others, show the benefits of using cold steel or microdebrider instruments over CO 2 laser, if possible, such as in cases of laryngeal papillomatosis debridement. 13 , 36 , 37 , 38 While it appears that extensive use of CO 2 laser creates substantial opportunities for aerosol transmission, it is also often a necessary tool in laryngology procedures. Thus, in cases during which its use cannot be avoided, it is imperative to maintain maximal PPE precautions.…”

“…Several studies analyzing the risk of aerosol generation during voice surgery have provided direct evidence that CO 2 laser use was associated with significantly higher levels of microparticle generation compared to baseline, microdebrider, and cold instrument use. 13 , 36 In one study, CO 2 laser during laryngology surgery was associated with a 14.70% rise in microparticles approximately 2.5 μm in diameter compared to baseline (P<0.0001). 13 In a study by Sanmark et al, 36 using CO 2 laser was associated with the highest concentration of particles less than 1 μm, as well as particles 1-5 μm in size.…”

“… 13 , 36 In one study, CO 2 laser during laryngology surgery was associated with a 14.70% rise in microparticles approximately 2.5 μm in diameter compared to baseline (P<0.0001). 13 In a study by Sanmark et al, 36 using CO 2 laser was associated with the highest concentration of particles less than 1 μm, as well as particles 1-5 μm in size. In addition, in contrast to cold instrumentation, the use of CO 2 laser was associated with a 1.80-fold and 2.02-fold average rise in particles <1 μm and 1-5 μm in size, respectively (p <0.0001).…”

Aerosol concentrations and size distributions during clinical dental procedures

“…The minimum number of procedures in each class was 6. A similar design has also been used in previous studies [ 26 , 27 ].…”