The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.

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The debate regarding the safety of smoke evacuation and aerosol diffusion during laparoscopy has resurfaced with the COVID 19 outbreak. We suggest using a simple, readily available low-cost filtration system for immediate implementation. We solicit the responsibility of surgeons to take the necessary precautions to reduce the risk of viral diffusion in the operating room and ensure that our patients continue to benefit from the advantages of laparoscopic surgery.

Background Surgical smoke is a well-recognized hazard in the operating room. At the beginning of the COVID-19 pandemic, surgical societies quickly published guidelines recommending avoiding laparoscopy or to consider open surgery because of the fear of transmission of SARS-CoV-2 through surgical smoke or aerosol. This narrative review of the literature aimed to determine whether there are any differences in the creation of surgical smoke/aerosol between laparoscopy and laparotomy and if laparoscopy may be safer than laparotomy. Methods A literature search was performed using the Pubmed, Embase and Google scholar search engines, as well as manual search of the major journals with specific COVID-19 sections for ahead-of-print publications. Results Of 1098 identified articles, we critically appraised 50. Surgical smoke created by electrosurgical and ultrasonic devices has the same composition both in laparoscopy and laparotomy. SARS-CoV-2 has never been found in surgical smoke and there is currently no data to support its virulence if ever it could be transmitted through surgical smoke/aerosol. Conclusion If laparoscopy is performed in a closed cavity enabling containment of surgical smoke/aerosol, and proper evacuation of smoke with simple measures is respected, and as long as laparoscopy is not contraindicated, we believe that this surgical approach may be safer for the operating team while the patient has the benefits of minimally invasive surgery. Evidence-based research in this field is needed for definitive determination of safety. Keywords COVID-19 • SARS-CoV-2 • Laparoscopy • Risk • Viral transmission • Safety Surgical smoke may harbor particulates of blood fragments, viable cellular material, bacteria and viruses, as well as toxic gas vapors, all of which can negatively affect surgical staff [1]. Consequently, it was feared that surgical smoke may contain viable SARS-CoV-2 [2-4] and all too quickly, major surgical learned societies published guidelines, statements and recommendations, not only to stop elective surgery but favoring laparotomy over laparoscopy [5-7]. In turn, societies [8] and surgeons [9, 10] dedicated to Minimally Invasive Surgery challenged these statements, underscoring that these risks were largely overestimated and unjustified because of the low quality of evidence [9, 10]. Even if other societies [11] progressively nuanced their initial recommendations and statements, they no longer take any clear stand for or against, only to generate more confusion among surgeons on whether laparotomy or laparoscopy was more appropriate during the pandemic. In this narrative review, we aimed to critically appraise the literature with regard to the quandary of surgical smoke

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