Introduction
Tonsillectomy is a common ENT procedure commonly undertaken for
recurrent tonsillitis or sleep disordered breathing. Blood splatter
contamination occurring on the surgeon during tonsil surgery is well
recognised in the
literature11Keogh IJ, Hone
SW, Colreavey M, Walsh M. Blood splash and tonsillectomy: an
underestimated hazard to the otolaryngologist. J Laryngol Otol. 2001
Jun;115(6):455-6.,22Hanna
BC, Thompson P, Smyth C, Gallagher G. Blood splash from different
diathermy instruments during tonsillectomy. J Laryngol Otol. 2006;
120(11): 927 – 31.. In fact, tonsillectomy was the procedure most
commonly resulting in patient’s blood and secretions being detected on
the surgeon’s face33Lakhani
R, Loh Y, Zhang TT, Kothari P. A prospective study of blood splatter
in ENT. Eur Arch Otorhinolaryngol. 2015 Jul;272(7):1809-12..
The current Covid-19 pandemic has highlighted many routine ENT
operations, including tonsillectomy, as being an aerosol-generating
procedure (AGP). The issue of AGP has been at the forefront of concerns
raised by healthcare professionals and patient-focused groups alike
because the coronavirus is in the oral and nasal cavities44Kowalski
LP, Sanabria A, Ridge JA, Ng WT, de Bree R, Rinaldo A, Takes RP,
Mäkitie AA, Carvalho AL, Bradford CR, Paleri V, Hartl DM, Vander
Poorten V, Nixon IJ, Piazza C, Lacy PD, Rodrigo JP, Guntinas-Lichius
O, Mendenhall WM, D’Cruz A, Lee AWM, Ferlito A. COVID-19 pandemic:
Effects and evidence-based recommendations for otolaryngology and head
and neck surgery practice. Head Neck. 2020 Jun;42(6):1259-1267..
Procedures undertaken in these anatomical areas on patients who carry
the virus may cause aerosolisation of the virus thereby posing a
relative risk of transmission to the clinical team.
Studies focusing on bipolar cautery during tonsil surgery have
demonstrated not only aerosolisation of particles originating from the
oral cavity but also deposition of blood droplets around the surgeon’s
eyes55Carr MM, Patel VA, Soo JC, Friend S, Lee EG. Effect of
Electrocautery Settings on Particulate Concentrations in Surgical
Plume during Tonsillectomy. Otolaryngol Head Neck Surg. 2020
Jun;162(6):867-872.,66Keogh IJ, Hone SW,
Colreavey M, Walsh M. Blood splash and tonsillectomy: an
underestimated hazard to the otolaryngologist. J Laryngol Otol. 2001
Jun;115(6):455-6.. Coblation is a popular method because it
purportedly causes less pain than other surgical methods77Pynnonen
M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus
other surgical techniques for tonsillectomy. Cochrane Database Syst
Rev. 2017 Aug 22;8(8):CD004619.,88Daskalakis
D, Tsetsos N, Karagergou S, Goudakos J, Markou K, Karkos P.
Intracapsular coblation tonsillectomy versus extracapsular coblation
tonsillectomy: a systematic review and a meta-analysis. Eur Arch
Otorhinolaryngol. 2020 Jul 4. doi: 10.1007/s00405-020-06178-2. Online
ahead of print.. However, in the light of the current pandemic it is
unknown if Coblation tonsillectomy results in detectable droplet
splatter on the surgeon. The aim of this study was to assess droplet
splatter around the surgical field and surgeon during simulated tonsil
surgery in order to better inform on mitigation strategies and evaluate
choice of personal protective equipment.