SAGES and EAES recommendations for minimally invasive surgery during COVID-19 pandemic

Abstract

The unprecedented pandemic of COVID-19 has impacted many lives and affects the whole healthcare systems globally. In addition to the considerable workload challenges, surgeons are faced with a number of uncertainties regarding their own safety, practice, and overall patient care. This guide has been drafted at short notice to advise on specific issues related to surgical service provision and the safety of minimally invasive surgery during the COVID-19 pandemic. Although laparoscopy can theoretically lead to aerosolization of blood borne viruses, there is no evidence available to confirm this is the case with COVID-19. The ultimate decision on the approach should be made after considering the proven benefits of laparoscopic techniques versus the potential theoretical risks of aerosolization. Nevertheless, erring on the side of safety would warrant treating the coronavirus as exhibiting similar aerosolization properties and all members of the OR staff should use personal protective equipment (PPE) in all surgical procedures during the pandemic regardless of known or suspected COVID status. Pneumoperitoneum should be safely evacuated via a filtration system before closure, trocar removal, specimen extraction, or conversion to open. All emergent endoscopic procedures performed during the pandemic should be considered as high risk and PPE must be used by all endoscopy staff.

Surgery for non-Covid-19 patients during the pandemic

“…At the same time, it is of importance to maintain equipoise for non-Covid-19 patients despite decreased resources. Adaptations of surgical guidelines are required, as recommended by various scientific societies [ 6 , 17 , 18 ]. Thus, the “ primum non nocere ” principle has to be applied not only for Covid-19, but all patients.…”

European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic

“…On the other hand, studies have shown that similar virus can be retrieved in surgical smoke (HBV, HIV, and HPV) [11], so great care should be taken to reduce aerosolisation and direct contamination. The risk of contagion is unlikely when general prevention strategies have been applied as recommended by the other societies (SAGES-EAES [12], ACS):…”

“…There is no evidence for contraindication of the laparoscopic approach. In fact, the laparoscopic approach seems to allow better control of surgical smoke/plume than laparotomy [12]. 2.…”

“…The desufflation of any gas from the pneumoperitoneum through a virus filter is recommended. Consider also to fully desufflate the abdomen BEFORE extracting any tissue specimen [12], Also take care when inserting equipment such as mesh or sutures through a port, as this will temporarily disrupt the valve allowing gas escape. 5.…”

“…Trocar wounds should be kept at minimum length to avoid air leaks around the port. In the case of openaccess trocars, the use of ports with retention balloon should be considered to minimize inadvertent removal of the port [12].…”