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.