endoscopes require high-level disinfection but cannot be autoclaved, and ENT departments often require a quick turnaround time for disinfection due to frequent, often outpatient, use.
Explore this issue:August 2012
Study design: Literature review plus guideline development.
Synopsis: Flexible ENT endoscopes should be reprocessed immediately after use, and the entire endoscope must be cleaned and disinfected.
The authors examined both traditional and emerging disinfection methods and recommended specific seven-step protocols for manual disinfection by immersion, automatic disinfection, manual disinfection with wipes containing chlorine dioxide (ClO2) and immersion disinfection with ClO2 electronically controlled by a microprocessor. Reprocessing time ranged from two to 30 minutes and varied by disinfection method used. Some specific protocol recommendations were made, including rinsing with sterile water and using an enzymatic cleaning solution.
Sterile protective sheaths were also examined, although these must be used in conjunction with cleaning and medium-level disinfection methods to guarantee high-level disinfection. Microbiological tests on endoscopic surfaces were not recommended except in the case of epidemics, and tracking for disinfection protocols, equipment testing and maintenance, and action/intervention logs were recommended for all sites.
Bottom line: ENT endoscopes can be safely and quickly reprocessed if high-level disinfection protocols are maintained. Thorough tracking of reprocessing methods and equipment use and maintenance are recommended, but routine culture tests on endoscopic surfaces are not.
Citation: Cavaliere M, Iemma M. Guidelines for reprocessing nonlumened heat-sensitive ear/nose/throat endoscopes. Laryngoscope. 2012;22(8):1708-1718
—Reviewed by Amy E. Hamaker
Multicenter Study Shows Feasibility and Safety of Transoral Robotic Surgery
Is transoral robotic surgery (TORS) a safe, feasible method for head and neck cancer surgery?
Background: The role of TORS as a multidisciplinary treatment for head and neck cancer is expanding. Although several single-institution studies on TORS have been conducted, multicenter data on its effectiveness and safety are limited.
Study design: Review of pooled early data from independent institutional review board-approved prospective clinical trials.
Setting: University of Pennsylvania, Philadelphia; University of Alabama at Birmingham; and Mayo Clinic, Rochester, Minn.
Synopsis: For this study, 179 patients who presented with benign and malignant lesions of the oropharynx, supraglottic larynx, hypopharynx and oral cavity between May 2005 and December 2008 were evaluated. Centers followed similar protocols for data collection. Feasibility was measured by the ability to utilize TORS without reverting to traditional surgery, while safety was measured by the incidence of peri-operative complications and functional outcomes. Surgical margin adequacy was measured by the presence of any positive margin after the procedure.