Laparoscopic versus open surgery: aerosols and their implications for surgery during the COVID-19 pandemic

Joseph, Janso Padickakudi; Joseph, Anokha Oomman; Oomman, Susmita; Jayanthi, Naga Venkatesh

doi:10.1007/s10353-020-00644-1

Cited by 4 publications

(11 citation statements)

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“…Infection modalities confirmed by clinical trials are through droplets, aerosols, direct and indirect contact (6,7). To prevent in-hospital contamination of medical personnel, the new protocol guidelines recommend avoiding all medical-surgical procedures with the potential to generate aerosols in suspected infected individuals or whose COVID-19 status has not yet been evaluated, including endoscopy and laparoscopy, and performing them with appropriate protective equipment, only when the benefit to the patient outweighs the risk (8)(9)(10)(11)(12)(13)(14)(15)(16). This has a significant impact on the management of acute abdomen, a clinical entity of special severity, whose Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges investigation and surgical approach does not allow a time delay until obtaining the result of RT-PCR testing for SARS-Cov-2.…”

Section: Introductionmentioning

confidence: 99%

Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

et al. 2021

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The present study investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of acute surgical abdomen. A retrospective study of emergency hospitalizations with a diagnosis of acute surgical abdomen between April and July 2020 vs. a similar period in 2019 was performed. The observation sheets and the operating protocols were analyzed. Between April and July 2020, 50 cases of acute surgical abdomen were hospitalized and treated, compared to 43 cases in the same period last year. The main types of pathology in both groups included: Occlusions (60%, respectively 44.2% in 2019) and peritonitis (32%, respectively 41.8% in 2019). There was an increased rate of patients with colorectal cancers neglected therapeutically or uninvestigated, who presented during the pandemic period with emergencies for complications such as occlusion or tumor perforation (32 vs. 6.97%, P=0.0039). One case, with gastric perforation, was COVID-positive, with no pulmonary symptoms at admission. The number of postoperative infectious complications was lower during the pandemic (2 vs. 13.95%, P=0.0461). As the COVID-19 pandemic appears to be still far from ending, we should learn to adapt our surgical protocols to the new evidence.Oncological patients are a vulnerable group, who were neglected in the first months of the pandemic. SARS-Cov-2 infection may be a cause of abdominal pain and should be taken into account in different diagnoses of acute abdomen in surgical wards. Correct wearing of adequate personal protective equipment (PPE) and respecting strict rules of asepsis and antisepsis are required for preventing in-hospital transmission of infection.

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Section: Introductionmentioning

confidence: 99%

Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

et al. 2021

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Section: Resultsmentioning

confidence: 99%

“…Preoperative testing of surgical patients with RT-PCR for SARS-CoV-2 2 is strongly recommended but it does not guarantee lack of infectivity due to a demonstrated false-negative rate of up to 10-30%, including the patients in early incubation period or post-infection, with a minimal viral load at the level of nasopharynx [51]. For this reason, wearing complete PPE, limiting elective hospitalizations, spacing surgeries with keeping 30 min-1 h between them is recommended [51][52][53][54]. Regarding the laparoscopic approach in patients suspected or infected with SARS-CoV-2, the International Endoscopic Surgery Societies have warned since the beginning of the pandemic of the risk of aerosolization of particles, which may have a viral load, given the 19-nCov tropism for the digestive mucosa.…”

Section: Regulations For Increasing Safety In Laparoscopic Surgerymentioning

confidence: 99%

“…If initially these interventions were mostly contraindicated, later, as the medical society learns to coexist with the new virus, the preventive methods necessary to mitigate the infectious risk, were defined more and more coherently. These include appropriate PPE (FFP2 respirator or higher, wrap around goggles or face shield), smoke evacuation devices connected to a filtration system and proper room filtration and ventilation [52,53].…”

Section: Regulations For Increasing Safety In Laparoscopic Surgerymentioning

confidence: 99%

“…Any deviation from best practice or mistakes while using these precautions may represent a higher risk of pollution and dangerous exposure for the entire operation room (OR) staff and subsequent personnel in the OR, which represents additional psychological stress for the operating team. For this reason, an additional precaution is to limit the personnel in the OR, to avoid complicated maneuvers and to involve the experienced personnel [52][53][54].…”

Section: Regulations For Increasing Safety In Laparoscopic Surgerymentioning

confidence: 99%

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

et al. 2020

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(1) Background:The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery.(2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until July 10th. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future.

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Directives of general surgical practice during the COVID-19 pandemic

Omer

2021

Journal of Education and Health Promotion

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The coronavirus disease 2019 (COVID-19) is a serious global pandemic that has extremely affected health-care systems. This article aimed to review the perspectives of general surgical practice during the COVID-19 pandemic. A systematic review of the literature addressing modification to general surgical practice during the COVID-19 pandemic indexed in PubMed, Scopus, Google, and Google scholar was carried out on June 19–20, 2020. The literature review yielded 577 articles. The exclusion of duplication, articles not in English, and specialized ones in various surgical disciplines precluded 398 articles. Finally, following checking for relevance and publication status, 114 papers were included. Recommendations for surgical practice during the COVID-19 pandemic revolved around mitigation of the risk of virus transmission to patients and health-care workers. The emerging themes of safety precautions were related to patient prioritization and testing, mindful consideration of the operative strategy, optimum use of personal protective equipment, operative room setup, and departmental organization. However, those recommendations were often diverging and bore on a dearth of evidence and personal opinions. Multidisciplinary work and cooperation among surgical specialties are required to establish and validate the protocols for safe surgical practice during the pandemic and perhaps similar crises in future. The COVID-19 pandemic has brought several challenges to the field of medicine, including the surgical specialty. The centrality of safety precautions emerging in this crisis requires surgeons to adopt the new roles and work standards and translate them into practice during the pandemic and perhaps longer.

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Laparoscopic versus open surgery: aerosols and their implications for surgery during the COVID-19 pandemic

Abstract: oncology, domains which surgeons around the world are attempting to preserve despite the COVID-19 pandemic. In the authors' centres in the United Kingdom, there has been anecdotal avoidance of laparoscopy surgery based on the above guidelines.

Cited by 4 publications

References 5 publications

Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

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

Directives of general surgical practice during the COVID-19 pandemic

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