Ventilated Upper Airway Endoscopic Endonasal Procedure Mask: Surgical Safety in the COVID-19 Era

• Type of Material: Article
• Authors: Samuel N. Helman, Emory University; Roberto M. Soriano, Emory University; Martin L. Tomov, Emory University; Vahid Serpooshan, Emory University; Joshua Levy, Emory University; Gustavo Pradilla Andrade, Emory University; Clementino Solares Rivera, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the Congress of Neurological Surgeons.
• Final Published Version (URL): http://dx.doi.org/10.1093/ons/opaa168
• Title of Journal or Parent Work: Operative Neurosurgery
• Volume: 19
• Issue: 3
• Start Page: 271
• End Page: 280
• Grant/Funding Information: None declared
• Keywords: Endoscopic skull base surgery; Life Sciences & Biomedicine; Ventilated mask; Neurosciences & Neurology; COVID-19 infection prevention; Surgery; Aerosolization reduction; Endonasal surgery; Science & Technology; Clinical Neurology; COVID-19
• Research Categories: Engineering, Biomedical; Health Sciences, Epidemiology; Health Sciences, Health Care Management; Biology, Neuroscience; Health Sciences, Public Health

Abstract

BACKGROUND COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have been employed, including the use of personal protective equipment, preoperative COVID-19 testing, and recently the use of a modified surgical mask barrier. OBJECTIVE To reduce the risks of pathogen transmission during endoscopic skull base surgery. METHODS This study was exempt from Institutional Review Board approval. Our study utilizes a 3-dimensional (3D)-printed mask with an anterior aperture fitted with a surgical glove with ports designed to allow for surgical instrumentation and side ports to accommodate suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic surgery trocar served as a port for instruments, and, on the contralateral side, rubber tubing was used over the endoscrub endosheath to create an airtight seal. Surgical freedom and aerosolization were tested in both modalities. RESULTS The ventilated mask allowed for excellent surgical maneuverability and freedom. The trocar system was effective for posterior surgical procedures, allowing access to critical paramedian structures, and afforded a superior surgical seal, but was limited in terms of visualization and maneuverability during anterior approaches. Aerosolization was reduced using both the mask and nasal trocar. CONCLUSION The ventilated upper airway endoscopic procedure mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a critical role in advancing skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in instances where 3D printing is not available. Additional studies are needed to validate these preliminary findings.