Richard K Englehardt, MD, Brent Nowak, Michael V Seger, MD, Frank D Duperier, MD. University of Texas Medical Center at Houston, Bariatric Medical Institute of Texas
Laparoscopic surgery is known to provide many advantages to patients by reducing post-operative pain, shortening hospital stays, and reducing incision related co-morbidities. Surgeon and staff exposure to blood and body fluids has generally been reduced without the need to “open” the abdominal cavity. There is however a potential increase in risk for aerosolized droplets or tissue traveling considerable distances upon release of intra-abdominal pressure as can commonly occur with specimen extraction in laparoscopic surgery. This creates an environmental hazard for members of the surgical team. To date there are no studies which have sought to quantify or describe this common occurrence. This study aims to describe and provide a method of measurement of aerosolized blood and tissue contamination during evacuation of the pneumoperitoneum in laparoscopic surgery.
Methods and Procedures
Patients were selected at random from a cohort of patients undergoing either laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. During these procedures a 15 mm trocar is placed in the left mid abdomen, and is typically removed for extraction of the gastric specimen or passage of an EEA surgical stapler. At the time of extraction of the 15 mm trocar, the abdomen was insufflated to a pressure of 15 mm Hg, and a white board was placed horizontally 18 inches above the patient’s abdomen. The test was repeated at 24 inches. The pneumoperitoneum was allowed to completely evacuate and the board was examined for particulate splatter. Using machine vision and computerized spatial analysis the boards were recorded, analyzed, and scored based on the distance, type, and quantity of particulate contamination. Histograms were developed to demonstrate the height and radius of aerosolization.
A total of five initial tests were performed which demonstrated that at 18 inches from the level of the incision an average of 36 (16-62) particles visible to the naked eye were observed. When conducted from a height of 24 inches the average number of particles observed decreased to 12. Only blood and serous fluid was found as a contaminant on the boards at both 18 and 24 inches. Average radius of aerosolized contamination was 7 inches.
Evacuation of the pneumoperitoneum during laparoscopic surgery results in consistent visible contamination at distances of both 18 and 24 inches from the patient’s incision. If methods are not undertaken to control the aerosolized spread of particles during release of the pneumoperitoneum, significant contamination to the surgical team can occur. These droplets are of variable size and may not be noticed making contact with one’s skin. Pressurized droplets could also contact the eyes of surgical personnel, even those wearing eye protection. The results of this study suggest that not only should all members of the surgical team during a laparoscopic case wear appropriate protective barriers to prevent body fluid contact, but conscious measures should be undertaken to prevent environmental contamination during pneumoperitoneal evacuation. Simple steps such as reducing the intrabdominal pressure during extraction can dramatically reduce the amount of airborne fluid and tissue making the operating room safer for all.
Session Number: SS04 – Quality Outcomes
Program Number: S022