Aerosols, airflow and airspace contamination during laparoscopic surgery

Despite the numerous advantages of minimally invasive surgery (MIS) for patients, hospitals and healthcare systems, the COVID-19 pandemic revealed that gas and aerosol leakage occurring with MIS for diseases of the abdomen and pelvis remains an important and unaddressed problem. A worldwide moratorium on MIS was advocated in the early part of the pandemic in part due to a perceived riskof operating room team infection even though a formal categorisation as an aerosol generating procedure was not invoked. Following its reinstitution, misinformation regarding guidance and technologies to mitigate infection risks occurred. The lack of formal studies in this area combined with a general complacency among surgeons regarding operating room aerosol hazards has also contributed to ongoing occupational concerns with new legislation proposed regarding theatre room air quality. To better evidence the issue and management of aerosolization during MIS,initiallyfrom the perspective of in-hospital pandemic preparedness, a series of translational and clinical studies was performed with a focus on practical risk mitigation. This research required cross-disciplinary collaboration with the development and deploymentof innovative imaging technologies (Schlierenimaging, laser light-sheetsand near infraredgas thermography) including usefor the first time in operating rooms. The research encompassed a continuum of investigations from bench experiments, through to high fidelity simulation scenarios,and into real world human surgical procedures (both elective and emergency). The work presented in this thesis was performed as a comprehensive body of work and comprises four inter-connecting and indeed overlapping strands:(1) Detailing and validation of immediately available practice methods and technologies for surgical team and patient safety at the outset of the pandemic (e.g. use of previously unevaluated powered air purification respirators). (2) Mechanistic demonstrationand determination of aerosol and aerosolizationin operating room ...