Hostname: page-component-6766d58669-rxg44 Total loading time: 0 Render date: 2026-05-16T21:53:09.522Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of aerosol generation between electrocautery and cold dissection tonsillectomy

Published online by Cambridge University Press:  27 March 2023

E Sanmark Open the ORCID record for E Sanmark [Opens in a new window] ,
N Rantanen ,
L-M Oksanen ,
A Tuhkuri Matvejeff ,
R Möller  and
A Geneid
E Sanmark*
Affiliation:
Faculty of Medicine, University of Helsinki, Finland Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki University Hospital, Finland
N Rantanen
Affiliation:
Clinical Research Institute HUCH, Helsinki University Hospital, Finland
L-M Oksanen
Affiliation:
Faculty of Medicine, University of Helsinki, Finland Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki University Hospital, Finland
A Tuhkuri Matvejeff
Affiliation:
Faculty of Medicine, University of Helsinki, Finland Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki University Hospital, Finland
R Möller
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
A Geneid
Affiliation:
Faculty of Medicine, University of Helsinki, Finland Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki University Hospital, Finland
*
Author for correspondence: Dr E Sanmark, Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki University Hospital, Kasarmikatu 11-13, Helsinki 00100, Finland E-mail: enni@sanmark.fi
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Coronavirus disease 2019 can spread through aerosols produced by surgical procedures, but knowledge of the extent of aerosol production and the risk posed by many common procedures does not exist. This study analysed aerosol generation during tonsillectomy and how it differs between distinct surgical techniques and instruments. The results can be used in risk assessment during current and future pandemics and epidemics.

Method

An optical particle sizer was used to measure particle concentrations generated during tonsillectomy from the perspectives of the surgeon and other staff. Coughing is commonly used as a reference for high-risk aerosol generation; therefore, coughing and the operating theatre's background concentration were chosen as reference values. Different instruments were also compared to find the safest way to perform the tonsillectomy from the perspective of airborne transmission.

Results

Eighteen tonsillectomies were evaluated; all techniques mostly generated less than 1 μm particles. For the surgeon, bipolar electrocautery significantly exceeded the particle generation of coughing in both total and less than 1 μm particles and was found to produce significantly higher total and less than 1 μm aerosol concentrations than cold dissection and BiZact. No technique exposed other staff to a greater aerosol concentration than is generated by a cough.

Conclusion

Bipolar electrocautery generated high aerosol concentrations during tonsillectomy; cold dissection generated significantly less. The results support cold dissection as the primary tonsillectomy technique, particularly during the epidemics of airborne diseases.

Keywords

Covid-19Airborne TransmissionTonsillectomyElectrocauteryCold Dissection Technique

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 7 , July 2023 , pp. 732 - 740
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Dr E Sanmark takes responsibility for the integrity of the content of the paper

References

Greenhalgh, T, Jimenez, JL, Prather, KA, Tufekci, Z, Fisman, D, Schooley, R. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. Lancet 2021;397:1603–510.1016/S0140-6736(21)00869-2CrossRefGoogle ScholarPubMed
Chacon, AM, Nguyen, DD, McCabe, P, Madill, C. Aerosol-generating behaviours in speech pathology clinical practice: a systematic literature review. PLoS One 2021;16:e025030810.1371/journal.pone.0250308CrossRefGoogle ScholarPubMed
Sanmark, E, Oksanen, LAH, Rantanen, N, Lahelma, M, Anttila, VJ, Atanasova, N et al. Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy. Eur Arch Otorhinolaryngol 2021;279:825–3410.1007/s00405-021-07105-9CrossRefGoogle ScholarPubMed
Dadgarnia, MH, Aghaei, MA, Atighechi, S, Behniafard, N, Vahidi, MR, Meybodian, M et al. The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection. Int J Pediatr Otorhinolaryngol 2016;89:38–4110.1016/j.ijporl.2016.07.022CrossRefGoogle ScholarPubMed
Bogrul, MF, Unal, A, Yilmaz, F, Sancaktar, ME, Bakirtas, M. Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage. Eur Arch Otorhinolaryngol 2019;276:2061–710.1007/s00405-019-05464-yCrossRefGoogle ScholarPubMed
Younis, RT, Lazar, RH. History and current practice of tonsillectomy. Laryngoscope 2002;112:3–510.1002/lary.5541121403CrossRefGoogle ScholarPubMed
Lowe, D, van der Meulen, J, Cromwell, D, Lewsey, J, Copley, L, Browne, J et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–2410.1097/mlg.0b013e318031f0b0CrossRefGoogle ScholarPubMed
Silveira, H, Soares, JS, Lima, HA. Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 2003;67:345–5110.1016/S0165-5876(02)00399-3CrossRefGoogle ScholarPubMed
Kujawski, O, Dulguerov, P, Gysin, C, Lehmann, W. Microscopic tonsillectomy: a double-blind randomized trial. Otolaryngol Head Neck Surg 1997;117:641–7Google ScholarPubMed
Jérémie Bettoni, MO, Duisit, J, Caula, A, Bitar, G, Lengele, B, Testelin, S et al. Tonsillectomy using the BiZact: a pilot study in 186 children and adult. Clin Otolaryngol 2019;44:392–6Google Scholar
Lachanas, VA, Prokopakis, EP, Bourolias, CA, Karatzanis, AD, Malandrakis, SG, Helidonis, ES et al. Ligasure versus cold knife tonsillectomy. Laryngoscope 2005;115:1591–410.1097/01.mlg.0000172044.57285.b6CrossRefGoogle ScholarPubMed
Fernstrom, A, Goldblatt, M. Aerobiology and its role in the transmission of infectious diseases. J Pathog 2013;2013:49396010.1155/2013/493960CrossRefGoogle ScholarPubMed
NHS England and NHS Improvement. Health Technical Memorandum 03-01: Specialised ventilation for healthcare premises. Part A 2021. https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM0301-PartA-accessible-F6.pdf [20 March 2023]Google Scholar
Oksanen, LM, Sanmark, E, Sofieva, S, Rantanen, N, Lahelma, M, Anttila, VJ et al. Aerosol generation during general anesthesia is comparable to coughing: an observational clinical study. Acta Anaesthesiol Scand 2022;66:463–7210.1111/aas.14022CrossRefGoogle ScholarPubMed
Jackson, T, Deibert, D, Wyatt, G, Durand-Moreau, Q, Adisesh, A, Khunti, K et al. Classification of aerosol-generating procedures: a rapid systematic review. BMJ Open Respir Res 2020;7:e00073010.1136/bmjresp-2020-000730CrossRefGoogle ScholarPubMed
Yang, S, Lee, GW, Chen, CM, Wu, CC, Yu, KP. The size and concentration of droplets generated by coughing in human subjects. J Aerosol Med 2007;20:484–9410.1089/jam.2007.0610CrossRefGoogle ScholarPubMed
Brown, J, Gregson, FKA, Shrimpton, A, Cook, TM, Bzdek, BR, Reid, JP et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia 2021;76:174–8110.1111/anae.15292CrossRefGoogle ScholarPubMed
WHO. Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed. In: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-2021.1 [29 June 2020]Google Scholar
Sanmark, E, Oksanen, L-M, Rantanen, N, Lahelma, M, Anttila, V-J, Lehtonen, L, Hyvärinen, A-P, Geneid, A. Aerosol generation during coughing - quantitative definition for aerosol generating procedures: observational study. J Laryngol Otol 2022;35543098. Epub 2022 May 11Google Scholar
Workman, AD, Jafari, A, Welling, DB, Varvares, MA, Gray, ST, Holbrook, EH et al. Airborne aerosol generation during endonasal procedures in the era of COVID-19: risks and recommendations. Otolaryngol Head Neck Surg 2020;163:465–7010.1177/0194599820931805CrossRefGoogle ScholarPubMed
Sharma, D, Ye, MJ, Campiti, VJ, Rubel, KE, Higgins, TS, Wu, AW et al. Mitigation of aerosols generated during rhinologic surgery: a pandemic-era cadaveric simulation. Otolaryngol Head Neck Surg 2021;164:433–4210.1177/0194599820951169CrossRefGoogle ScholarPubMed
Guderian, DB, Loth, AG, Weiss, R, Diensthuber, M, Stover, T, Leinung, M. In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling. Eur Arch Otorhinolaryngol 2021;278:1237–4510.1007/s00405-020-06330-yCrossRefGoogle ScholarPubMed
Heintzenberg, J. Properties of the log-normal particle size distribution. Aerosol Sci Tech 1994;21:46–810.1080/02786829408959695CrossRefGoogle Scholar
Coleman, KK, Tay, DJW, Sen Tan, K, Ong, SWX, Son, TT, Koh, MH et al. Viral load of SARS-CoV-2 in respiratory aerosols emitted by COVID-19 patients while breathing, talking, and singing. Clin Infect Dis 2021;ciab691. Epub 2021 Aug 6Google Scholar
Jones, RM, Brosseau, LM. Aerosol transmission of infectious disease. J Occup Environ Med 2015;57:501–810.1097/JOM.0000000000000448CrossRefGoogle ScholarPubMed
Murr, AT, Lenze, NR, Gelpi, MW, Brown, WC, Ebert, CS Jr, Senior, BA et al. Quantification of aerosol concentrations during endonasal instrumentation in the clinic setting. Laryngoscope 2020;131:1415–21Google ScholarPubMed
Guderian, DB, Loth, AG, Weiß, R, Diensthuber, M, Stöver, T, Leinung, M. In vitro comparison of surgical techniques in times of the SARS-CoV-2 pandemic: electrocautery generates more droplets and aerosol than laser surgery or drilling. Eur Arch Otorhinolaryngol 2020:1–9Google ScholarPubMed
Kowalski, LP, Sanabria, A, Ridge, JA, Ng, WT, de Bree, R, Rinaldo, A et al. COVID-19 pandemic: effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck 2020;42:1259–6710.1002/hed.26164CrossRefGoogle ScholarPubMed
Gendy, S, O'Leary, M, Colreavy, M, Rowley, H, O'Dwyer, T, Blayney, A. Tonsillectomy--cold dissection vs. hot dissection: a prospective study. Ir Med J 2005;98:243–4Google ScholarPubMed
Schijven, J, Vermeulen, LC, Swart, A, Meijer, A, Duizer, E, de Roda Husman, AM. Erratum: quantitative microbial risk assessment for airborne transmission of SARS-CoV-2 via breathing, speaking, singing, coughing, and sneezing. Environ Health Perspect 2021;129:9900110.1289/EHP10105CrossRefGoogle ScholarPubMed
Vuorinen, V, Aarnio, M, Alava, M, Alopaeus, V, Atanasova, N, Auvinen, M et al. Modelling aerosol transport and virus exposure with numerical simulations in relation to SARS-CoV-2 transmission by inhalation indoors. Saf Sci 2020;130:10486610.1016/j.ssci.2020.104866CrossRefGoogle ScholarPubMed
Buonanno, G, Stabile, L, Morawska, L. Estimation of airborne viral emission: Quanta emission rate of SARS-CoV-2 for infection risk assessment. Environ Int 2020;141:10579410.1016/j.envint.2020.105794CrossRefGoogle ScholarPubMed
Chin, AWH, Chu, JTS, Perera, MRA, Hui, KPY, Yen, HL, Chan, MCW et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020;1:e1010.1016/S2666-5247(20)30003-3CrossRefGoogle ScholarPubMed
Heinzerling, A, Stuckey, MJ, Scheuer, T, Xu, K, Perkins, KM, Resseger, H et al. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient - Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:472–610.15585/mmwr.mm6915e5CrossRefGoogle ScholarPubMed
Rickman, HM, Rampling, T, Shaw, K, Martinez-Garcia, G, Hail, L, Coen, P et al. Nosocomial transmission of coronavirus disease 2019: a retrospective study of 66 hospital-acquired cases in a London teaching hospital. Clin Infect Dis 2021;72:690–310.1093/cid/ciaa816CrossRefGoogle Scholar
Zhan, M, Qin, Y, Xue, X, Zhu, S. Death from Covid-19 of 23 health care workers in China. N Engl J Med 2020;382:2267–810.1056/NEJMc2005696CrossRefGoogle ScholarPubMed
Broderick, D, Kyzas, P, Sanders, K, Sawyerr, A, Katre, C, Vassiliou, L. Surgical tracheostomies in Covid-19 patients: important considerations and the “5Ts” of safety. Br J Oral Maxillofac Surg 2020;58:585–910.1016/j.bjoms.2020.04.008CrossRefGoogle ScholarPubMed
Verma, S, Dhanak, M, Frankenfield, J. Visualizing the effectiveness of face masks in obstructing respiratory jets. Phys Fluids 2020;32:06170810.1063/5.0016018CrossRefGoogle ScholarPubMed
Asadi, S, Cappa, CD, Barreda, S, Wexler, AS, Bouvier, NM, Ristenpart, WD. Efficacy of masks and face coverings in controlling outward aerosol particle emission from expiratory activities. Sci Rep 2020;10:1–1310.1038/s41598-020-72798-7CrossRefGoogle ScholarPubMed
Walker, JEC, Wells, RE. Heat and water exchange in the respiratory tract. Am J Med 1961;30:259–6710.1016/0002-9343(61)90097-3CrossRefGoogle ScholarPubMed
Orr, C Jr, Hurd, FK, Corbett, WJ. Aerosol size and relative humidity. J Colloid Sci 1958;13:472–8210.1016/0095-8522(58)90055-2CrossRefGoogle Scholar