Coronavirus disease 2019 and laparoscopic surgery in resource‐limited settings

Abstract

Introduction During the coronavirus disease 2019 (COVID‐19) pandemic, the use of laparoscopy has been discouraged by the Intercollegiate General Surgery because of its potential for aerosol generation and infection. In contrast, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association of Endoscopic Surgery recommend continuing to use laparoscopy but with devices to filter released CO2 aerosol particles. However, commercially available systems are costly and may not be readily available. Herein, we describe a custom‐made system to safely remove surgical smoke and CO2, as well as a case of laparoscopic cholecystectomy in which we used it. Materials and Surgical Technique The patient had had multiple episodes of biliary pancreatitis and required urgent cholecystectomy during the COVID‐19 pandemic. Although India was in complete lockdown, it was decided to operate with precaution. A system was designed using underwater seal chest tube drainage and an electrostatic membrane filter with a viral retention function greater than 99.99%. The system was connected to an extra port for continuous controlled egression of CO2 pneumoperitoneum. A regular four‐port cholecystectomy was performed at an intra‐abdominal pressure of 12 mm Hg. The gas flow rate was 10 L/min. CO2 for pneumoperitoneum, surgical aerosol, and effluents passed through the system before collecting in the suction apparatus. The exchange of operating instruments through the ports was kept to a minimum. It was done after the abdomen was temporarily desufflated using this system. Discussion The system we designed appears safe and is cost‐effective. In resource‐limited settings, it will be handy in patients requiring laparoscopic surgery both during and after the COVID‐19 pandemic.

Local adaptation of laparoscopic smoke evacuator in COVID‐19 pandemic situation

“…Recent reports by Bhattcharjee et al showed the utility of a cost‐effective, innovative system to achieve a slow egression of smoke and aerosols in a laparoscopic cholecystectomy procedure 10 . Similarly, we reported the use of our local adaptation of a smoke evacuator apparatus in various laparoscopic digestive procedures during the peak of the pandemic (May ‐ June 2020) in our country.…”

Minimally invasive surgery in India during the COVID-19 pandemic

“…Indigenous low-cost customised smoke evacuation systems are being employed worldwide. [ 24 25 ] The ability of the smoke evacuation device to eliminate the virus is based on the filters used – HEPA/ Ultra-low particulate air (ULPA). ULPA filters can retain 99.9% of the particles >0.1 <Symbol>μ</Symbol>m, whereas HEPA filters retain particles >0.3 <Symbol>μ</Symbol>m.[ 26 ] Customised smoke evacuators, also using similar filters, theoretically have similar efficiency in eliminating the virus from surgical smoke.…”

Safety of Three-Dimensional versus Two-Dimensional Laparoscopic Hysterectomy during the COVID-19 Pandemic

“…Laparoscopy can be safe with precautionary measures and shorten the patient’s hospital stay [ 31 ]. To ensure greater safety during laparoscopic procedures, it is worth using filters and avoiding the sudden and frequent insertion and removal of surgical instruments through the ports [ 32 , 33 ]. However, more research is needed on the infectivity of surgical aerosol and virus transmission [ 34 ].…”