Reduced field of view under the surgical microscope due to personal protective equipment: lessons learned during the COVID-19 pandemic

Abstract

OBJECTIVEDuring 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.METHODSFifteen 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.RESULTSFOV 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).CONCLUSIONSWhile 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.

Personal protection equipment for orthopaedic and trauma surgery during the COVID-19 pandemic: The results of an EFORT survey initiative

“…This might negatively affect the quality of care and reduce PPE compliance if the surgeon perceives discomfort to be hampering surgical performance. The above data also clearly show that existing PPE is not adequately designed for orthopaedic and trauma surgery; this is an open field for further improvement ( 13 , 14 , 15 , 16 , 17 ). The limitations of PPE use have already been recognised in various surgical specialties ( 16 , 17 , 23 , 24 , 27 , 29 ) and may explain the relatively low level (60%) of compliance with their use found in our study for both orthopaedic surgeons and staff.…”

“…The above data also clearly show that existing PPE is not adequately designed for orthopaedic and trauma surgery; this is an open field for further improvement ( 13 , 14 , 15 , 16 , 17 ). The limitations of PPE use have already been recognised in various surgical specialties ( 16 , 17 , 23 , 24 , 27 , 29 ) and may explain the relatively low level (60%) of compliance with their use found in our study for both orthopaedic surgeons and staff. A small number (15%) of respondents confirmed that they had used modified PPE due to either PPE shortages or in an attempt to reduce virus transmission during aerosol-generating orthopaedic procedures.…”

“…Soon, various problems with a substantial impact on the working environment and staff safety appeared related to the availability, use, rationing, modification, compliance and recycling of PPE ( 7 , 10 , 11 , 12 ). Later, it was also observed that PPE might cause problems to surgeons of certain specialties and adversely affect their surgical performance, for example, due to a negative impact on vision and communication ( 13 , 14 , 15 , 16 , 17 ). Moreover, evidence-based literature has not given detailed comparative recommendations for the use of different kinds of PPE in the operating theatre and even the WHO has failed to address this issue in the operating theatre environment ( 18 ).…”

The Influence of Face Shields on the Quality of Colonoscopy in the Era of the COVID-19 Pandemic

“…A Turkish study investigated the effect of face shields on the field-of-view of neurosurgeons when using a surgical microscope. 27 The field-of-view significantly decreased from that of the naked eye (9,305.33±406.1 mm 2 ) to that with a face shield (92.33±6.4 mm 2 ). Another study in the United Kingdom evaluated the effect of face shields on the field-of-vision of otolaryngologists using a microscope.…”

Implementation of Specific Neurosurgical Protocol for Urgent Elective and Emergency Patients during the COVID-19 Pandemic in Croatia

“…The employment of protective measures appears to be crucial for the disease dissemination containment. However, such measures required for the personnel may decrease an acceptable field of view under the surgical microscope, which is the essential ingredient of a safe surgery 18 .…”