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Table of Contents    
BRIEF REPORT
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1368-1370

Innovative Microscope Drape to Mitigate Particulate Dispersion During High-Speed Drilling


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Date of Submission28-Sep-2020
Date of Decision13-Feb-2021
Date of Acceptance30-Mar-2021
Date of Web Publication30-Oct-2021

Correspondence Address:
Vivek Tandon
Department of Neurosurgery, Room No 608, CNC, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329552

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 » Abstract 


Background: High-speed drilling during neurosurgical procedures lead to aerosol generation. Contaminated particles when dispersed can lead to transmission of disease in healthcare workers via air-borne route. We designed and validated the utility of an innovative microscope drape, in mitigating the dispersion of aerosol, while drilling on an ex-vivo model.
Methods: Two consecutive high-speed drilling operative simulations were performed using a dry-model under operative-microscope with and without drape, respectively, to demonstrate the degree of particulate dispersion while high-speed drilling using a 10% Povidone-Iodine solution for irrigation.
Results: There was significantly lower particulate dispersion and soiling of surgeon's gown, mask, and surrounding drapes outside the immediate operative field using the customized microscope mounted drape.
Conclusions: Customized microscope mounted drape is effective in containing the widespread particulate dispersion associated with high-speed drilling under a microscope. The benefits of this specialized drape can translate into a safer micro-environment for operating surgeons during drilling procedures.


Keywords: High-speed drilling, microscope drape, neurosurgery, particulate dispersion
Key Message: We conceptualized and innovated a microscope mounted drape for reducing intraoperative particulate dispersion during high-speed drilling in neurosurgical procedures, and validated the same using operative simulation on an ex-vivo model.


How to cite this article:
Tandon V, Raheja A, Garg K, Kale SS. Innovative Microscope Drape to Mitigate Particulate Dispersion During High-Speed Drilling. Neurol India 2021;69:1368-70

How to cite this URL:
Tandon V, Raheja A, Garg K, Kale SS. Innovative Microscope Drape to Mitigate Particulate Dispersion During High-Speed Drilling. Neurol India [serial online] 2021 [cited 2021 Dec 2];69:1368-70. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1368/329552




COVID 19 pandemic has had an adverse effect on neurosurgical practice.[1] Most neurosurgical procedures require the use of a microscope and with the existing guidelines on the use of personal protective equipment, one cannot utilize microscope optimally. The recommended use of goggles and face screen increases the distance between eyepiece and surgeons' eye leading to a tunnel vision and after a certain period fogging of protective gear also obscures the vision. Considering all these facts we decided to develop a drape that can sufficiently cover the operative field and prevent the spread of aerosols, thus allowing surgeons to use microscope freely. The objective of the study was to validate the effectiveness of customized microscope mounted drape for containing intraoperative particulate dispersion while high-speed drilling.


 » Methods – Operative Simulation Top


A mannequin head was utilized along with usual microneurosurgery tools like high-speed pneumatic drill (75,000 RPM) and suction (12 F) to simulate the operative field. 10% povidone-iodine solution was utilized for irrigation while drilling, as its consistency roughly matches that of blood and its color is easily visible on drapes, gowns, and masks. Two consecutive high-speed drilling operative simulations were performed using the above model under the operative microscope. The first run was conducted without customized drape (simulating standard operative condition) to demonstrate the degree of particulate dispersion. The second run was conducted with customized microscope mounted drape [Figure 1] and [Video 1] to validate its effectiveness in containing the dispersion of particulate generated during high-speed drilling under 10% Povidone-Iodine irrigation. Both the test runs included intermittent irrigation of cumulative amount 200 ml, 10% Povidone-Iodine solution, using a hand operated 10 cc syringe with brain cannula by same assistant using dominant hand. The rate of irrigation (100 ml/minute), suction power utilized, and spatial relation of suction to mannequin head and drill bit was similar between the two groups to ensure comparability. The pictographic and videographic evidence was collected to compare the degree of particulate dispersion among the two test runs.
Figure 1: Front view of customized microscope drape, with additional straps tied over microscope for optimal support (a). Fiber glass sheet (b). Central flexible yellow cap for mounting the drape (c). Side view to demonstrate the final configuration of operative field (d). Horizontal slit-like dynamic slots for operating surgeons and assistants' arms, and passage of operative instruments (e). Beading at inferior aspect of drape to prevent its collapse and maintain uniform operative field (f)

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 » Results Top


There was a remarkable difference noticed among the perceived particulate dispersion while high-speed drilling using two techniques as per the observed visual evidence. There was significantly lower particulate dispersion and soiling of the surgeon's gown, mask, and surrounding drapes outside the immediate operative field using the customized microscope mounted drape [Figure 2] and [Video 1].
Figure 2: Comparison of two operative simulations on high-speed drilling dry model under a microscope. Exaggerated soiling of surrounding drapes (a) and operating surgeon's gown and face mask (b) with 10% povidone-iodine solution was noticed when drilling was performed without drape. On the contrary, minimal soiling outside operative field (surrounding drapes, (c) and operating surgeon's gown and mask, (d)) was noticed when drilling with microscope drape. Demonstration of contained particulate dispersion within customized drape after completing simulation in test arm (e)

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 » Discussion Top


Many diseases like COVID-19, Hepatitis B, Hepatitis C, and Human immunodeficiency virus (HIV) are known to cause viremia.[2] High-speed drilling, an integral part of neurosurgical and skull base procedures, can lead to the formation of contaminated aerosols and particles carrying viral particles, which can potentially cause intraoperative transmission of diseases among healthcare workers through the exposed mucous membranes.[3] COVID-19 has particularly exposed the vulnerability of healthcare workers working in a potentially highly contagious environment of the operation room. A systematic review has recommended use of Level III PPE for staff scrubbed for surgery while other paramedical staff working in operating room can use level II PPE.[4] These recommendations are for orthopedic surgeons. As neurosurgeons, our level of exposure because of high-speed drilling is nearly equal but our surgeries have been impacted more. We cannot use a microscope while wearing level II or level III PPEs because of the reasons described above. It is imperative for present-day neurosurgeons to transform their practice in the COVID-19 era by adopting newer innovative techniques to ensure safe working conditions.

We conceptualized and developed a customized microscope mounted drape [Figure 1] and [Video 1] and assessed its effectiveness for containing intraoperative particulate dispersion while high-speed drilling under a microscope. The drape developed by us is a cost-effective and useful innovation, which can potentially mitigate contaminated particulate dispersion during high-speed intraoperative drilling. This drape can be mounted on the objective lens of any microscope (can be customized). There are multiple slit-like dynamic slots for the passage of operating and assisting surgeons' arms, operative instruments, suction, etc., [Figure 1] The drape provides a contained microenvironment for the generated aerosols and droplets, and a negative pressure created inside operative field using vacuum suction device ensures appropriate mitigation of particulate dispersion [Video 1]. The drape is made up of thin transparent plastic and fiberglass sheet, which helps in easy visualization inside the field [Figure 1]. This prototype drape has certain advantages and limitations in comparison to other innovative drapes customized for skull base surgery.[5],[6],[7],[8] The proposed microscope mounted drape has transparent plastic and fiberglass sheet in comparison to opaque drapes utilized by Das et al.[6] which can ensure clear panoramic view of surgical field, especially for the assistant and scrub nurse. The experimental model used in this study simulates operative high-speed drilling procedure in comparison to smoke generation and detection model used by Ioannidis et al.[7] However lack of airtight microenvironment provided by our drape is its inherent limitation when compared to the proposed innovation by Ioannidis et al.[7] The presence of multiple slit-like dynamic slots for the passage of operative instruments may provide an optimal degree of freedom and favorable surgical ergonomics in comparison to previously described drapes.[5],[6],[7],[8]

The use of this low-cost drape can allay fear among healthcare workers, allow the use of a microscope, and potentially prevent the spread of aerosolized infection during high-speed drilling. Limitations of this drape are – it mildly decreases dexterity as freedom of movement of the arm is lost. Surgeon and assistants need to learn and adapt to its usage. It is not an airtight compartment and hence other precautions must be taken. Besides this drape is currently a prototype and its clinical use for routine neurosurgical procedures is still pending.


 » Conclusions Top


Customized microscope mounted drape is effective in containing the widespread particulate dispersion associated with high-speed drilling under a microscope. The benefits of this specialized drape can translate into a safer micro-environment for operating surgeons during drilling procedures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

We thank Dr. G.D. Agrawal (Proprietor Surgiwear Company) for his contribution in materializing this innovative concept. We also thank our operating room staff including nursing and technical staff for their assistance in performing operative simulation on dry model.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Venkataram T, Goyal N, Dash C, Chandra PP, Chaturvedi J, Raheja A, et al. Impact of COVID-19 pandemic on neurosurgical practice in India: Results of an anonymized national survey. Neurol India 2020;68:595-602.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Chang L, Yan Y, Wang L. “Coronavirus disease 2019: Coronaviruses and blood safety.” Transfus Med Rev 2020;34:75-80.  Back to cited text no. 2
    
3.
Chen JX, Workman AD, Chari DA, Jung DH, Kozin E, Lee DJ, et al. Demonstration and mitigation of aerosol and particle dispersion during mastoidectomy relevant to the COVID-19 era. Otol Neurotol 2020;41:1230-9.  Back to cited text no. 3
    
4.
Wang Y, Zeng L, Yao S, Zhu F, Liu C, Laura AD, et al. Recommendations of protective measures for orthopedic surgeons during COVID-19 pandemic. Knee Surg Sports Traumatol Arthrosc 2020;28:2027-35.  Back to cited text no. 4
    
5.
Chari DA, Workman AD, Chen JX, Jung DH, Abdul-Aziz D, Kozin ED, et al. Aerosol dispersion during mastoidectomy and custom mitigation strategies for otologic surgery in the COVID-19 era. Otolaryngol Head Neck Surg 2021;164:67-73.  Back to cited text no. 5
    
6.
Das A, Mitra S, Kumar S, Sengupta A. Two-drape closed pocket technique: Minimizing aerosolization in mastoid exploration during COVID-19 pandemic. Euro Arch Otorhinolaryngol 2020;277:3529-32.  Back to cited text no. 6
    
7.
Ioannidis D, Tsagkovits A, Rokade A. Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method. J Laryngol Otol 2020;134:804-10.  Back to cited text no. 7
    
8.
Cottrell J, Lui J, Le T, Chen J. An operative barrier system for skull base and mastoid surgery: Creating a safe operative theatre in the era of COVID-19. J Otolaryngol Head Neck Surg 2020;49:71.  Back to cited text no. 8
    


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