Closed circuit system in laparoscopy: SARS-CoV-2 pandemic

Abstract

Background: There is a big concern regarding transmission of Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) during laparoscopy and using energy devices through the carbon dioxide (CO2) pneumoperitoneum. So, we decided to use a novel indigenous innovative closed-circuit system (CCS) to avoid this contamination in operation theatre.Methods: We set out to do a prospective study in the safety of this innovative closed-circuit system in elective surgeries over 3 consecutive months of May to July 2020, during the peak of SARS-CoV-2 pandemic in a tertiary teaching hospital. We recruited 52 patients undergoing elective laparoscopic surgery in a single laparoscopy unit. The Coronavirus disease 2019 (COVID-19) status was unknown, so we presumed all patients to be potential carriers of SARS-CoV-2. However, we followed the Indian council for medical research (ICMR) and Government of Karnataka (GOK) guidelines of clinical screening before surgery. We observed the postoperative outcome regarding COVID-19 symptoms in Health care workers (HCW) involved in the operation theatre. If required, we do a real time reverse transcription polymerase chain reaction (RT-PCR) to find the true positives.Results: Of the total 52 (basic and advanced) laparoscopic surgeries performed during this period, only 2 (3.84%) patients turned positive in the postoperative period. They developed COVID-19 symptoms and were tested positive by RT-PCR. None (100%) of the HCW developed any symptoms of COVID-19.Conclusion: Closed circuit system is a safe and promising technique during laparoscopy.

Balance between maternal antiviral response and placental transfer of protection in gestational SARS-CoV-2 infection

“…IL-6, IL-10 and IL-23 could affect NAb transfer efficiency by altering NAb glycosylation and or FcRn-NAb binding avidity (9,52). In contrast to our and others (49)(50)(51) findings, effective NAbs have been found in the cord blood after maternal SARS-CoV-2 infection (30). As the transfer efficiency of anti-RBD IgG relied on infection symptomatology, it is possible that the differences observed were due to distinct clinical profiles in the recruited cohorts.…”

“…Distinctively from vaccination, SARS-CoV-2 maternal infection led to an almost absence of NAbs in cord blood, independently of gestational age at time of infection. Reduced transplacental transfer NAbs upon maternal SARS-CoV-2 infection had been previously noted (49)(50)(51) but the factors that govern it were yet to be identified. We advanced on this by identifying how both maternal inflammation and the nature of the neutralizing antibody response impinges on NAbs placental transfer.…”