Risks of viral contamination in healthcare professionals during laparoscopy in the Covid-19 pandemic

Véziant, Julie; Bourdel, Nicolas; Slim, K.

doi:10.1016/j.jviscsurg.2020.04.010

Cited by 53 publications

(68 citation statements)

References 17 publications

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“…The size of particles differs according to the energy source: electrosurgery (ES) (monopolar and bipolar energy devices) dissection releases 0.07 µm size particles [16], while laser tissue coagulation produces larger particles [17]. Ultrasonic (US) energy devices release the largest (0.35-6.5 µm), but also cooler particles (due to the vibration mechanism involved rather than heat only in the tissue desiccation process of ES energy) [4,14]. Substantial differences were also found regarding smoke particulate size depending on the type of tissue dissected.…”

Section: Is There Any Difference In the Surgical Smoke Created Betweementioning

confidence: 99%

The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review

et al. 2020

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Background Surgical smoke is a well-recognized hazard in the operating room. At the beginning of the COVID-19 pandemic, surgical societies quickly published guidelines recommending avoiding laparoscopy or to consider open surgery because of the fear of transmission of SARS-CoV-2 through surgical smoke or aerosol. This narrative review of the literature aimed to determine whether there are any differences in the creation of surgical smoke/aerosol between laparoscopy and laparotomy and if laparoscopy may be safer than laparotomy. Methods A literature search was performed using the Pubmed, Embase and Google scholar search engines, as well as manual search of the major journals with specific COVID-19 sections for ahead-of-print publications. Results Of 1098 identified articles, we critically appraised 50. Surgical smoke created by electrosurgical and ultrasonic devices has the same composition both in laparoscopy and laparotomy. SARS-CoV-2 has never been found in surgical smoke and there is currently no data to support its virulence if ever it could be transmitted through surgical smoke/aerosol. Conclusion If laparoscopy is performed in a closed cavity enabling containment of surgical smoke/aerosol, and proper evacuation of smoke with simple measures is respected, and as long as laparoscopy is not contraindicated, we believe that this surgical approach may be safer for the operating team while the patient has the benefits of minimally invasive surgery. Evidence-based research in this field is needed for definitive determination of safety. Keywords COVID-19 • SARS-CoV-2 • Laparoscopy • Risk • Viral transmission • Safety Surgical smoke may harbor particulates of blood fragments, viable cellular material, bacteria and viruses, as well as toxic gas vapors, all of which can negatively affect surgical staff [1]. Consequently, it was feared that surgical smoke may contain viable SARS-CoV-2 [2-4] and all too quickly, major surgical learned societies published guidelines, statements and recommendations, not only to stop elective surgery but favoring laparotomy over laparoscopy [5-7]. In turn, societies [8] and surgeons [9, 10] dedicated to Minimally Invasive Surgery challenged these statements, underscoring that these risks were largely overestimated and unjustified because of the low quality of evidence [9, 10]. Even if other societies [11] progressively nuanced their initial recommendations and statements, they no longer take any clear stand for or against, only to generate more confusion among surgeons on whether laparotomy or laparoscopy was more appropriate during the pandemic. In this narrative review, we aimed to critically appraise the literature with regard to the quandary of surgical smoke

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Section: Is There Any Difference In the Surgical Smoke Created Betweementioning

confidence: 99%

The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review

et al. 2020

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“…This is symbolized by all laparoscopy procedures being labelled as high risk because an allpervading grave fear of infection to HCPs via surgical smoke and laparoscopy gas prompted the guidelines to err on the "side of safety" [26]. Studies have isolated bacterial/viral fragments in surgical smoke, but presently pathogen transmission via smoke and laparoscopic gas to HCPs has not been shown [27,28].…”

Section: Discussionmentioning

confidence: 99%

Rapid Scoping Review of Laparoscopic Surgery Guidelines During the COVID-19 Pandemic and Appraisal Using a Simple Quality Appraisal Tool “EMERGE”

et al. 2020

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The theoretical danger of virus transmission during laparoscopic surgery (LS) via surgical smoke and laparoscopy gas has led to the formulation of many guidelines during the COVID-19 pandemic. This rapid scoping review of these guidelines was done to assess the quality of their evidence and appraise them for their impact on surgical services from the global south. A simple quality appraisal tool was constructed which can be used to evaluate rapidly emerging guidelines for evidence as well as for the needs of the global south. This rapid scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Electronic databases were searched with predefined strategy and retrieved papers were screened according to relevant criteria. A simple objective tool to assess the quality of rapidly emerging guidelines including evidence, methodology, ease, resource optimization, geography, and the economy was constructed. Twenty studies met the inclusion criteria. None of the guidelines qualified to be evidence-based clinical practice guidelines as the level of evidence was uniformly rated "low". A newly constructed tool showed good validation, reliability, and internal consistency. This rapid scoping review found two major research gaps: lack of systematic review of evidence during their development and insufficient weightage of their impact on surgical services from the global south. These significant issues were addressed by constructing a simple and more representative tool for evaluating rapidly emerging guidelines which also gives the rightful importance of their impact on surgical services from the global south.

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“…After a rigorous analysis of the literature on surgical smoke, we conclude that there is no high level of evidence that laparoscopic surgery is routinely prohibited simply because of the risk of aerosol contamination. In particular, there is no evidence that COVID-19 is transmitted via surgical smoke generated by ultrasonic surgical instruments [20][21][22][23]. By the way, during the COVID-19 pandemic, we also use smoke evacuator which is designed with a vacuum motor.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on Gastric Cancer Surgery: A Single-Center Retrospective Study

Liu

et al. 2020

Preprint

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Background：The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients.Methods：The ‘COVID-19’ period was defined as occurring between 2020-01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study.Results： The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p=0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p=0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p<0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p=0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p<0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p=0.006).Conclusion：This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.

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Risks of viral contamination in healthcare professionals during laparoscopy in the Covid-19 pandemic

Cited by 53 publications

References 17 publications

The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review

The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review

Rapid Scoping Review of Laparoscopic Surgery Guidelines During the COVID-19 Pandemic and Appraisal Using a Simple Quality Appraisal Tool “EMERGE”

The Impact of COVID-19 on Gastric Cancer Surgery: A Single-Center Retrospective Study

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