Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era

Kameyama, Hitoshi; Otani, Tetsuya; Yamazaki, Toshiyuki; Iwaya, Akira; Uehara, Hiroaki; Harada, Rina; Hirai, Makoto; Komatsu, Masaru; Kubota, Akira; Katada, Tomohiro; Kobayashi, Kazuo; Sato, Daisuke; Yokoyama, Naoyuki; Kuwabara, Shirou; Tanaka, Yuki; Sawakami, Kimihiko

doi:10.1007/s00464-021-08394-1

Cited by 20 publications

(10 citation statements)

References 30 publications

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“…In this study, the open approach generated more surgical smoke. This finding is in agreement with a recent study conducted by Kameyama et al They concluded that open approach produced more surgical smoke than laparoscopic approach in colorectal surgery [ 21 ]. However, to perform laparoscopic surgery during this era, the surgical teams must follow the recommendations strictly, included smallest incision to prevent gas leak, avoidance of hand-assisted surgery, low flow and pressure of pneumoperitoneum, use of closed-suction system, preferred sharp dissection, total removal of gas closely, etc.…”

Section: Discussionsupporting

confidence: 93%

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

et al. 2021

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Background The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers. Methods Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared. Results Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001. Conclusions Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.

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Section: Discussionsupporting

confidence: 93%

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

et al. 2021

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“…A Japanese group quantified the particulate matter counts in surgical smoke from both laparoscopic and open surgery in colorectal disease. The results showed lower exposure to surgical smoke during laparoscopic surgery compared to open surgery [ 70 ]. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) summarized studies on MIS during the pandemic era and reported its results recently.…”

Section: Resultsmentioning

confidence: 99%

Surgical safety in the COVID-19 era: present and future considerations

Kim

Park

2022

Ann Surg Treat Res

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The impacts of coronavirus disease 2019 (COVID-19) have been globally paradigm shifting in all aspects. Surgeons have experienced unprecedented changes regarding operation schedules, preparations before surgery, and the precautions needed both during and after surgery. Many medical centers simultaneously reported a decrease in their numbers of surgeries, whether they were elective or emergent, or for cancerous or benign resections. However, accumulated surgical outcomes from the last 2 years of experience presented postoperative morbidity and mortality data that were comparable to the pre-pandemic era, whether in elective or urgent settings. Although COVID-19 showed a significant association with postoperative morbidity and mortality, the majority of noninfected patients could be treated successfully with stringent mitigation protocols. Initially recommended to be avoided at the start of the pandemic, minimally invasive surgery seems to be safe and feasible according to reported surgical outcomes. Numerous sets of guidelines have now been produced from medical societies and adhering to the basic precautions has been found to be practicable. It is crucial that health care systems and surgical staff remain vigilant and attentive to the ever-changing situation in this pandemic in order to provide optimal medical support to their patients.

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“…Li et al [ 14 ] reported that after using electrical or ultrasonic equipment for 10 min, the particle concentration in the smoke during laparoscopic surgery was significantly higher than that during open surgery. Kameyama et al [ 15 ] quantitated particulate matter counts as part of surgical smoke in 31 consecutive patients who underwent colectomy. However, they found that exposure to surgical smoke was lower during laparoscopic surgery than during open surgery for colorectal diseases.…”

Section: Discussionmentioning

confidence: 99%

Patient with gastric cancer who underwent distal gastrectomy after treatment of COVID-19 infection diagnosed by preoperative PCR screening

Kimura¹,

Morinaga²,

Wada³

et al. 2022

surg case rep

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Background Because of the coronavirus disease 2019 (COVID-19) pandemic, preoperative screenings for COVID-19 infection are often performed in many institutions. Some patients are diagnosed with COVID-19 infection by antigen tests or polymerase chain reaction (PCR) testing for COVID-19, even if they have no symptoms, such as fever or respiratory symptoms. We herein describe a patient with gastric cancer who underwent distal gastrectomy 6 weeks after recovering from COVID-19 infection diagnosed by preoperative PCR. Case presentation An 86-year-old man was transferred to our hospital because of hematemesis and melena. A hemorrhagic gastric ulcer was found in the lesser curvature of the antrum by emergency endoscopy. Endoscopic hemostasis was performed, and he was discharged after recovery. A tumor-like lesion in the lesser curvature of the antrum was found on repeat endoscopy and was diagnosed as well-differentiated adenocarcinoma by biopsy. There was no evidence of lymph node metastasis or distant metastasis; therefore, we planned radical surgery. However, he was diagnosed with COVID-19 infection by preoperative PCR screening. Although he had no symptoms, such as fever or respiratory symptoms, he was hospitalized because of his advanced age. He was discharged 10 days after admission, and repeat COVID-19 PCR was negative. We planned radical surgery for the stomach tumor 6 weeks after recovery from the COVID-19 infection. A PCR-negative COVID-19 status was confirmed again before hospitalization. Open distal gastrectomy with Billroth I reconstruction was performed. We avoided ultrasonic scalpels and used a Crystal Vision 450D surgical smoke evacuator (I.C. Medical, Inc., Phoenix, AZ, USA) to reduce intraoperative surgical smoke. The postoperative course was uneventful. Conclusion Because of the COVID-19 pandemic, some patients are diagnosed with COVID-19 infection by preoperative antigen tests or PCR, even if they have no symptoms. If possible, elective surgery should be performed 4 to 6 weeks after recovery from COVID-19 infection to maximize safety. Moreover, surgeons must consider intraoperative surgical smoke.

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Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era

Cited by 20 publications

References 30 publications

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

Surgical safety in the COVID-19 era: present and future considerations

Patient with gastric cancer who underwent distal gastrectomy after treatment of COVID-19 infection diagnosed by preoperative PCR screening

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