Results
Surgical Cases
Four patients underwent endoscopic endonasal surgery for osteomyelitis, sinonasal malignancies, nasopharyngeal malignancy, and a pituitary adenoma threatening vision. Two patients required concurrent endoscopic sinus surgery as well. Power instruments with aerosol generating potential were used in these surgeries and are summarized in Table 1. These instruments include a microdebrider (used in 3 cases), electrocautery (used in 3 cases), and a high-speed drill (used in 2 cases).
Black Light Examination
Our cases demonstrated there is minimal spread of fluorescein beyond the immediate surgical field. We examined the surgical field and adjacent area prior to and after the case with a UV emitting black light (Figure 2). We marked the areas of contamination. In general, we found very little contamination of droplets on the patient. In all cases, we found fluorescent dye at sites round the nares, on the wipe placed on the patient’s chest, and on the surgical instrument table.  In the first NOVID design, without the Lone Star ring retractor, we found one single droplet on the vertical drape “wall” placed by the anesthesiologist at the foot of the patient. This was about 4 feet from the surgeon. In the two functional endoscopic sinus surgery cases, we did not find droplets under the barrier beyond the nares or near the smoke evacuator. In the transsphenoidal pituitary case, we did identify fluid under the barrier several centimeters away from the nares. In both skull base cases, we identified dye on the gauze placed over the tip of the smoke evacuator (Figure 1D).
Examination of the surgeon revealed a few droplets along the abdomen region and in one case (Table 1, Case 3) a single droplet on the surgeon’s arm. Also, during this case, the scrub nurse had large droplets >5mm on the abdomen region. However, the nurse was also handling fluorescein stained epinephrine cottonoids and caused self-contamination had self-contaminated. It is noted that instruments from the case are used to pick up cottonoids, such as Bayonet forceps, should be considered contaminated as well.