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首页> 外文期刊>Surgical Endoscopy >Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery
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Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

机译：停止泄漏!:在腹腔镜手术期间减轻雾化Covid-19的潜在暴露

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Background Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. Methods A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure. Results For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. Conclusions Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.
机译：背景：在腹腔镜手术中，病毒颗粒被证明会雾化成吸入气体。在手术室，这可能会使人员接触到气溶胶病毒和致癌物。鉴于2019冠状病毒疾病的情况，以及对医疗专家的安全关注，我们的研究试图量化从腹腔镜器械和套管针端口之间动态相互作用泄漏的气体量，以更好地了解手术雾化颗粒的潜在暴露。方法构建一个定制的装置来模拟一个充气的腹腔镜手术腔。检查了两种手术器械的使用情况，以观察和量化吸入气体泄漏的机会。这两种情况都考虑了器械和套管针端口尺寸/尺寸的多种配置：（1）腹腔镜器械从端口完全插入和完全移除；（2）镜在端口内的移动，被认为是“动态交互”，在任何手术过程中几乎100%的时间都会发生。结果对于5mm套管针中的5mm器械，在动态相互作用和完全插入/取出情况下的平均气体泄漏量分别为43.67和25.97 mL。在12 mm端口中，5 mm仪器的气体泄漏量平均为41.32 mL，动态交互作用与仪器插入和移除的气体泄漏量平均为29.47 mL。在12mm端口的10mm仪器上显示了类似的模式，动态交互作用为55.68ml，插入/移除仪器为58.59 mL。结论腹腔镜手术器械和手术口之间的动态相互作用和插入/取出事件似乎有助于持续将吸入的气体泄漏到手术室。根据目前的2019冠状病毒疾病流行情况，应考虑采取任何减少或气体泄漏的措施。减少腹腔镜和器械的移除和更换将是减少腹腔镜手术中气体泄漏的一种策略。

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