Novel approach to reduce SARS-CoV-2 transmission during trans-oral robotic surgery

Abstract

This study describes a novel approach in the reduction of SARS-CoV-2 transmission during trans-oral robotic surgery (TORS). Eight patients underwent TORS between 01 February 2020 and 07 September 2020. A sterile plastic sheet draped over sterile supports with water-tight seal around each cannula was used to create a sterile working space within which the robotic arms could freely move during operation. This set-up acts as an additional physical barrier against droplet and aerosol transmission. Operative diagnosis; droplet count and distribution on plastic sheet and face shields of console and assistant surgeons, and scrub nurse were documented. TORS tumour excision was performed for patients with suspected tonsillar tumour ( n = 3) and tongue base tumour ( n = 2). TORS tonsillectomy and tongue base mucosectomy was performed for cervical nodal metastatic carcinoma of unknown origin ( n = 3). Droplet contamination was noted on all plastic drapes ( n = 8). Droplet contamination was most severe over the central surface at 97.2% (91.7–100.0%), with the highest droplet count along the centre-most column where it overlies the site of operation in the oral cavity 33.3% ( n = 31). Droplet count decreased towards the periphery. Contamination rate was 2.8% (0.0–8.3%) over the right lateral surface. There was no droplet contamination over the vertex and left lateral surface of plastic drapes. No droplet contamination was noted on face shields of all parties. The use of sterile plastic drapes with water-tight seal around each robotic cannula can help reduce viral transmission to healthcare providers during TORS.

Revisiting Tonsillectomy Practices in the Light of the COVID-19 Pandemic

“…Therefore, this model can be used in the future to ensure further safety in TORS surgery. An SES may also be placed under the drapes to further the safety of TORS surgery 45 .…”

Advancing surgical setting: A paradigm for healthcare workers during the monkeypox outbreak

“…In addition to potential aerosol-generating procedures (AGPs) such as cardiopulmonary resuscitation, surgical smoke, suctioning, intubation, and extubation, the techniques and tools used, such as electric cautery, pulse washing, and laparoscopic suction devices in transoral robotic surgery (TORS), minimally invasive surgery (MIS), laparoscopic and video-assisted thoracoscopic surgery (VATS) procedures, and other surgeries also generate aerosols infected with the virus [ 17 , 18 ].…”

“…Decreasing application time, improving tissue moisture to reduce surgical smoke, limitation of the use of equipment and procedures such as harmonic scalpels, use of smoke evacuation system and filtration of CO 2 plume, creation of a water-tight, sterile and isolated environment with sterile plastic drapes help to reduce the transmission of monkeypox and the formation of aerosol particles [ 18 , 21 ]. Restriction of the operating team to the most experienced staff with the minimal number of members leads to minimization of operating time, blood loss, duration of exposure, morbidity, and length of hospital stay.…”

“…Restriction of the operating team to the most experienced staff with the minimal number of members leads to minimization of operating time, blood loss, duration of exposure, morbidity, and length of hospital stay. Altogether, these precautions will lower the chances of viral transmission, thus protecting other patients and healthcare providers [ 22 ]. In conclusion, with applying our knowledge obtained from the COVID-19 pandemic in terms of disease control and prevention to the recent outbreak of monkeypox, it is possible to overcome the future challenges encountered in healthcare facilities, particularly the setting of surgery, regarding infection control.…”