Minimally Invasive Surgery and Surgical Smoke, Decoding Fear and Ensuring Safety: Adaptations and Safety Modifications During COVID Pandemic

Abstract

The most fearful word starting from C, Cancer has now been replaced with COVID-19 owing to its associated physical, emotional and financial hardships as well as its social stigma. Never before we as medical fraternity been challenged to take care of patients and at the same time consider the safety of ourselves, family members and our fellow healthcare workers. Emotions and fear-driven treatments that are otherwise inefficacious may contribute to a false sense of security, unwarranted side-effects, divert resources and delay research into treatments that may actually work. Decoding fear with available evidence i.e. practicing evidence-based medicine will guide us in better handling of situations in this pandemic. The objective of this review is to discuss the modifications required in the operating theatre during COVID-19 times for minimal access, laparoscopy and robotic surgery, especially with regard to the handling of surgical smoke, minimally invasive surgical instruments, trocars with smoke evacuator and special personal protection equipment. Although there is no evidence of viral transmission through laparoscopic or open approaches, we recommend modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device use. We have come up with Rule of 20 for 2020 pandemic in operation theatres and modification of trocar for safe handling of surgical smoke in MIS which can be used in resource-limited settings. Hospitals must follow specific protocols and arrange suitable training of the healthcare workers. We believe that ''Fears are educated into us, and can, if we wish, be educated out''.

The effect of Covid-19 phobia on work stress and psychological resilience of nurses exposed to surgical smoke in the operating room

“…In fact, in the Somashekhar et al ( 2020) study, it is reported that one of the main concerns about surgical intervention during the pandemic is the fear of surgical smoke (for reasons such as the risk of viral contamination and exposure to smoke) [29]. According to results of this study, operating room nurses experienced fear at the level of phobia due to Covid-19, since the Covid-19 phobia score was high (Table 3).…”

Laparoscopic Surgery in COVID-19 Era in a Tertiary Hospital in Nepal

“…20 Similar to our study, Somashekhar et al demonstrated safe laparoscopic surgery using an extra port trocar for smoke evacuation during laparoscopy, which was connected with tubing to a water seal container containing 4% sodium hypochlorite solution. 25 Pawar et al performed 12 colorectal cancer surgeries by laparoscopic methods by using HEPA filter in all COVID positive patients using full PPE. He reported that laparoscopic surgery can be safely performed.…”

“…23,24 Instead of Heated water, an underwater seal container containing 4% sodium hypochlorite solution has also been recommended for the evacuation of smoke during laparoscopic surgery. 25,26 So this study was aimed to observe the effects of the use of filtration System (Heat and Moisture exchanger (HME) filter along with desufflation in underwater seal bag containing 5% sodium hypochlorite solution) in laparoscopic surgery on surgery staffs to reduce the cross-contamination and transmission of covid-19.…”

The Impact of Electrocautery Smoke on Surgical Staff and the Efficacy of Normal Surgical Masks Versus N95 Masks

“…N95 respirators are a type of personal protective equipment (PPE) designed specifically to provide a higher level of respiratory protection [ 48 ]. These respirators provide a tight seal to the face and can filter out at least 95 percent of airborne particles, including smaller particles and aerosols [ 49 ].…”