Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Abstract

Background Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. Methods A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure. Results For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. Conclusions Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.

Characterisation of trocar associated gas leaks during laparoscopic surgery

“…Thus far, one study has measured the flow of gas through a cannula and instrument. However, the contribution of either the cannula or instrument was not quantified [ 13 , 14 ]. The use of different combinations of trocars and instruments will likely result in varying leakage performance.…”

Aerosols, airflow, and airspace contamination during laparoscopy

“…Better empirical understanding of aerosols, airflow impact, and airspace contamination of laparoscopy would inform best practice as well as its appropriateness for classification among aerosol-generating procedures, while promoting and inspiring methods for hazard mitigation. Here, the methodology for such advancement is described, along with early findings from such evaluations including during surgery 6 , 7 .…”

Safety of Three-Dimensional versus Two-Dimensional Laparoscopic Hysterectomy during the COVID-19 Pandemic

“…Laparoscopy can be safe with precautionary measures and shorten the patient’s hospital stay [ 31 ]. To ensure greater safety during laparoscopic procedures, it is worth using filters and avoiding the sudden and frequent insertion and removal of surgical instruments through the ports [ 32 , 33 ]. However, more research is needed on the infectivity of surgical aerosol and virus transmission [ 34 ].…”