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.