Recommendations for Gynecological Endoscopic Surgery during COVID-19 Pandemic

Abstract

The presence of coronavirus disease 2019 (COVID-19) continues to overwhelm health-care systems with numerous concerns around the safety of patients as well as health-care professionals. It is essential to allow for judicious use of resources and emphasize allotting maximum staff and resources to care for the affected. To this end, most centers are choosing to defer elective procedures and perform only emergency surgeries. The safety of all theater staff is of utmost importance, and the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral transmission should be curbed when operating. In particular, there are concerns relating to the transmission of COVID-19 during gynecological laparoscopic surgery, arising from the possible generation of contaminated aerosols from gas leakage and the creation of smoke from the use of electrosurgical devices. The aim of this paper is to review the evidence available as of today for recommendations to follow while performing gynecological procedures.

Control of airborne particles in surgical procedures during the Covid-19 pandemic: scoping review

“…Of the 22 documents/studies included, 19 were published in English ( 12 , 17 – 29 , 32 – 35 , 37 ) , two in Spanish ( 30 , 31 ) and one in Portuguese ( 36 ) . As for the origin, nine were produced in the American continent ( 17 , 19 , 21 , 27 , 28 , 30 , 35 – 37 ) , seven in the Asian continent ( 18 , 23 – 26 , 29 , 32 ) , five on the European or Eurasian continent ( 12 , 22 , 31 , 33 , 34 ) , and one in Oceania ( 20 ) .…”

“…Of the 22 documents/studies included, 19 were published in English ( 12 , 17 – 29 , 32 – 35 , 37 ) , two in Spanish ( 30 , 31 ) and one in Portuguese ( 36 ) . As for the origin, nine were produced in the American continent ( 17 , 19 , 21 , 27 , 28 , 30 , 35 – 37 ) , seven in the Asian continent ( 18 , 23 – 26 , 29 , 32 ) , five on the European or Eurasian continent ( 12 , 22 , 31 , 33 , 34 ) , and one in Oceania ( 20 ) . Among the studies, 14 were reviews ( 12 , 17 – 19 , 22 , 25 , 26 , 28 – 34 ) , four were expert consensus statements ( 20 , 21 , 24 , 27 ) , three were protocol recommendations ( 35 – 37 ) , and one was related to the development of a technique for aerosol reduction ( 23 ) .…”

“…As for surgical procedures, the highest frequency in the guidelines was focused on videolaparoscopic surgery ( 12 , 17 – 19 , 27 , 29 – 32 ) . It is a minimally invasive surgical approach that uses high-resolution cameras and appropriate instruments inserted through trocars in small incisions ( 12 , 19 ) .…”

“…If these resources cannot be used, the maintenance of a stable pressure should be encouraged. Therefore, it is recommended to turn off the air conditioning equipment during aerosol generating procedures ( 32 ) . Care with filtration and pressure shall be maintained during the process of operating rooms final cleaning ( 12 , 22 , 32 ) .…”

“…Another recommendation identified in the studies concerns the size and number of surgical incisions, with the risk of producing surgical smoke being proportional to the size and number of incisions ( 17 , 18 ) . In addition, all energy-generating equipment, such as electrocautery or ultrasonics, shall be set to low power to reduce the production of aerosolized particulate matter ( 18 , 30 , 32 ) .…”