Novel approach reduces SARS-CoV-2 transmission in transoral robotic surgery

The creation of a water-tight, sterile and closed environment with sterile plastic drapes may help in preventing droplet and aerosol spillage in transoral robotic surgery (TORS), which may lower the likelihood of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to healthcare workers (HCWs), a recent study by the University of Hong Kong has shown.

“Our study’s findings suggest that the proposed set-up [with the use of sterile plastic drapes and water-tight seal around each robotic cannula] is effective in preventing droplet and aerosol contamination during TORS,” noted the authors. [J Robot Surg 2021, doi: 10.1007/s11701-021-01200-z]

“Such set-up is functional and readily available, and the approach should be considered in supporting safe clinical practice and efficient use of resources at such time of global shortage of personal protective equipment [PPE] during the coronavirus disease 2019 [COVID-19] pandemic,” they suggested. “Our proposed set-up can also be advocated for other aerosol-generating procedures [AGPs] and endoscopic head and neck [H&N] surgical procedures, to reduce potential SARS-CoV-2 transmission to HCWs.”

In the study, droplet contamination (size range, 0.2–3.2 mm) was noted in all sterile plastic drapes (n=8) set up for the TORS procedure. Droplet contamination was most severe over the central surface of drapes (average, 97.2 percent), followed by the right lateral surface (average, 2.8 percent), with the highest droplet count (n=31) noted along the centre-most column (ie, column E) of the plastic drape overlying the site of operation in the oral cavity.

There was a decrease in droplet count towards the periphery on both sides of drapes, from 25 to 6 and 3 at columns D, C and B, respectively, towards the right side and from 21 to 7 at columns F and G, respectively, towards the left side.

No droplet contamination was noted over the vertex and left lateral surfaces or drapes, or on the face shields of all HCWs (ie, H&N consultant surgeon, surgical assistant, scrub nurse and consultant anaesthetist).

The study included eight patients with no clinical evidence of COVID-19 who underwent TORS at the University of Hong Kong between 1 February 2020 and 7 September 2020. Five TORS procedures for tumour excision were performed for three patients with suspected tonsillar tumour and two patients with tongue base tumour. Three patients had TORS tonsillectomy and tongue base mucosectomy for cervical nodal metastatic carcinoma of unknown origin.

Full barrier protection, including goggle, N95 respirator, face shield covering full face length from forehead to neck with outer edges reaching bilateral ears, gowns and gloves, was adopted by all HCWs.