Dynamic near-infrared carbon dioxide leak visualization detection during surgery using the FLIR GF343 optical imaging sy
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and Other Interventional Techniques
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Dynamic near‑infrared carbon dioxide leak visualization detection during surgery using the FLIR GF343 optical imaging system Mohammad Faraz Khan1 · Jeffrey Dalli1 · Ronan A. Cahill1 Received: 3 June 2020 / Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
There is ongoing concern regarding the aerosolization hazard of laparoscopy since the outbreak of the COVID19 pandemic [1–4]. As a global crisis without precedent in the modern surgical era, expert opinion and theoretical extrapolations dominated initial considerations and directions regarding operative care processes. As elective surgical care restarts again, it’s imperative that we advance in a systemic, scientific way to fortify minimally invasive surgical practice against further waves of this or other airborne pathogens and pollutants [5]. The fundamental driver of any higher risk of intraabdominal pathogen aerosolization by laparoscopy versus laparotomy is the use and leakage of surgical gas, specifically carbon dioxide (CO2) [6]. We set out to develop a reliable model to determine intraoperative unfiltered CO2 leak into the operating room from out of the patient to enable comprehensive understanding and address of this substantial issue. A practical and clinically deployable methodology for leak ascertainment would allow immediate feedback for surgeons intraoperatively regarding factors within their control (e.g., leaks related to skin incision or instrument usage including leaky port seals and uncapped irrigation channels) that otherwise often go unnoticed. It also would allow surgeons share best practice with evidential support and provide reassurance to centers who do not have a significant problem with CO2 leaks. Finally, it would enable rapid testing and iterative development of the many potential adjunctive mechanical solutions (e.g., improved trocar seals and valves, gas leak traps, etc.) including reproducibility in assessment and trialing. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08071-9) contains supplementary material, which is available to authorized users. * Ronan A. Cahill [email protected] 1
UCD Centre for Precision Surgery, University College Dublin and Department of Surgery, Mater Misericordiae University Hospital, 47 Eccles Street, Dublin 7, Ireland
To do this, we have examined optical gas imaging in both the experimental and clinical settings. As carbon dioxide (CO2) is both constitutively different to room air and becomes humidified and warmed after abdominal insufflation, it can be visually exploited in a manner similar to industrial gas leak-testing either via density- or via spectral-based imaging. Visual assessment enables a “seeing is believing” approach while also enabling computational analytics and modeling of particle trajectory benchmarking against established fluid mechanical models to demonstrate droplet behavior within the gas vortex. As the operating
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