LAUSR

Objective In the COVID-19 crisis, laparoscopic surgery is in the focus as a relevant source of bioaerosol release. The efficacy of electrostatic aerosol precipitation (EAP) and continuous aerosol evacuation (CAE) to eliminate bioaerosols during laparoscopic surgery was verified. Methods Ex-vivo laparoscopic cholecystectomies (LCs) were simulated +/- EAP or CAE in a pelvitrainer equipped with swine gallbladders. Release of bioaerosols was initiated by performing high-frequency electrosurgery with a monopolar electro hook (MP-HOOK) force at 40 W (MP-HOOK40) and 60 W (MP-HOOK60), as well as by ultrasonic cutting (USC). Particle number concentrations (PNC) of arising aerosols were analyzed with a condensation particle counter (CPC). Aerosol samples were taken i) within the pelvitrainer near to the source, ii) outside the pelvitrainer at the working trocar and iii) in the breathing zone of the surgeon. Results Within the pelvitrainer, MP-HOOK40 (6.4 x 105 cm-3) and MP-HOOK60 (7.3 x 105 cm-3) showed significant higher median PNCs compared to USC (4.4 x 105 cm-3) (p = 0.001). EAP lead to a significant decrease of the median PNCs in all three groups. A high linear correlation with Pearson correlation coefficients of 0.852, 0.825 and 0.759 were observed by comparing MP-HOOK40 (+/- EAP), MP-HOOK60 (+/- EAP) and USC (+/- EAP), respectively. During ex-vivo LC and CAE, significant bioaerosol contaminations of the operating room occurred. Ex-vivo LC with EAP lead to a considerable reduction of the bioaerosol concentration. Conclusion EAP was found to be efficient for intraoperative bioaerosol elimination and reducing the risk of bioaerosol exposure for surgical staff.