Difficulties Encountered using Optical Magnification in Microsurgery with Personal Protection Equipments Amidst the COVID-19 Era. Is there a Possible Solution?

Introduction: COVID-19 pandemic has posed great difficulties in managing surgical patients. The use of standard Personal Protection Equipments (PPEs) alongwith devices for optical magnification in operative microsurgery is difficult. Aims: To categorize the specific problems faced during repair and reconstruction using optical magnification devices and to offer and propose some technical solutions for the same. Methodology: This is a retrospective descriptive institutional study over 10 patients warranted for urgent microsurgical procedures over 1 month in 2 tertiary care hospitals. As per guidelines for executing surgical procedures in this scenario, 10 patients were operated for acute trauma or malignancy using surgical loupes or operating microscopes in addition to using the standard available PPE like the Visor masks, N-95 respirators etc. The operative techniques using different devices were analyzed and the difficulties encountered were categorized with temporary ways of dealing with them and possible solutions (if any) are offered. Results: Out of the 10 patients operated (3 onco-reconstruction and 7 trauma reconstruction with mean age 50.6 years with male female ratio of 7: 3, N-95 respirators were used in 60 % cases, Visor mask face shields in 40 % cases, Loupes in 70 % cases and operating microscope in 30 % cases. Vessel wall repair or anastomosis was done in 50 % cases and nerve repair or coaptation in 30 % cases. Minimum use of electrocautery (Monopolar diathermy in 40 % and Bipolar in 90 % cases) was advocated for haemostasis. In majority of the cases, blurring of magnified fields, fogging of the optical devices was encountered alongwith breathing difficulties. Conclusion: Executing microsurgery with optical magnification using the standard PPEs amidst the COVID-19 era causes immense problems of vision. There should be a rational approach to modify designs of the protective face and neck equipments specifically for the microsurgeons.