Enhancing safety of laparoscopic surgery in COVID-19 era: clinical experience with low-cost filtration devices

Abstract

Background Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol. Methods The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described. Results Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization. ConclusionThe proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra-and postoperative release of CO 2.

Waiting for the Second (Non)-Covid-19 Wave: Variations in Volume of Emergency Surgeries and of Emergency Department Accesses in a Third Level Hospital in Milan, Lombardy, During the Outbreak

“…Although there is scarce evidence of airborne and particulate transmission in laparoscopy [16,18], these possibilities cannot certainly be ruled out. This is the reason why many advise against the laparoscopic approach or, more adherent to current surgical practice, suggest to use devices to remove surgical smoke [19,20], claiming that "the advantages of minimally invasive surgery may not need to be sacri ced in the current crisis" [16].…”

Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues

“…Adapting laparoscopic protocols to the pandemic era, by the use of filtration devices, smoke evacuation devices connected to trocars, the use of self-sealing trocars connected to negative pressure suction may add significant financial burden to a health care system which is already under maximal pressure [40]. Several authors developed different cost-effective filtration systems, both having as the central piece an HME (Heat and Moisture Exchangers) filter, which somehow is connected to a trocar to allow save dessuflation of CO 2 and surgical smoke [56][57][58][59][60]. HME filters have high resistance to flow and, most important, bacterial and viral filtration efficiency of ≥ 99.999%.…”

Tratamiento quirúrgico de la apendicitis aguda en paciente COVID-19 positivo en hospital de tercer nivel

“…realizar un estudio de imagen en el contexto de estos pacientes, siendo la TC toracoabdominal el estudio de elección, ya que permite orientarnos hacia un diagnóstico diferencial entre ambas patologías 3. No existe evidencia en la bibliografía que compare o soporte el tratamiento conservador vs el quirúrgico, por lo que, en nuestro centro, consideramos realizar tratamiento quirúrgico con el equipo de protección necesario y abordaje de cirugía abierta sin el uso de electrocauterio, ya que no contamos con equipo necesario para el uso seguro de cirugía laparoscópica; sin embargo, no se descarta su uso seguro a futuro 15,16. No se encontró relación en el estudio patológico entre la enfermedad por coronavirus y la apendicitis aguda.…”