Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study

Bogani, Giorgio; Ditto, Antonino; Cecco, Loris De; Lopez, Salvatore; Guerrisi, Rocco; Piccioni, Federico; Micali, Arianna; Daidone, Maria Grazia; Raspagliesi, Francesco

doi:10.1016/j.jmig.2020.12.026

Cited by 20 publications

(22 citation statements)

References 13 publications

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“…In one patient, both swabs showed amplification of the Ngene, and in another case, only the swab test on the filter came back positive. That study suggested the presence of SARS-CoV-2 particles was within the Jakimiuk surgical smoke/aerosolized native fluid from the abdominal cavity (38). However, low the specificity of the N-gene broadens the findings of this paper to respiratory coronaviruses.…”

Section: Discussionmentioning

confidence: 61%

Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive

Jakimiuk¹,

Januszewski²,

Santor-Zaczynska³

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: COVID-19 infection poses significant risks during surgical interventions. We investigated the intraperitoneal presence of SARS-CoV-2 in COVID-19 positive patients. Design: A prospective group study. Setting: Department of Obstetrics and Gynecology designated for COVID-19 patients, Central Clinical Hospital of the Ministry of Interior, Warsaw Patients: Overall, 65 pregnant women with COVID-19 infection underwent caesarian section. The diagnosis was confirmed either by positive antigen test or by positive RT-PCR assay performed within no more than 13 days prior to the operation. Interventions: On the day of the operation, a nasopharyngeal swab was taken, and peritoneal fluid was collected at the beginning of the operation. Both the nasopharyngeal swab and peritoneal fluid samples were tested for SARS-CoV-2. Measurements and Main Results: A total of 65 pregnant women with COVID-19 infection were enrolled in the study. The SARS-CoV-2 RNA test by nasopharyngeal swab produced positive results in 34 patients. In this group as well as in 31 non-confirmed patients all peritoneal fluid samples tested negative for SARS-CoV-2 RNA. Conclusion: These results suggest a low risk of COVID-19 transmission from the peritoneal cavity at the time of laparoscopy or laparotomy

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Section: Discussionmentioning

confidence: 61%

Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive

Jakimiuk¹,

Januszewski²,

Santor-Zaczynska³

et al. 2021

Journal of Minimally Invasive Gynecology

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Section: Areas Of Training Affectedmentioning

confidence: 99%

“…Laparoscopic surgery was identified as an aerosol-generating procedure and was hence considered high risk [ 68 , 69 ]. This caused anxiety amongst theatre staff and surgeons and prompted guidelines for avoidance of laparoscopic surgery [ 68 , 69 ]. While there were some exceptions [ 70 , 71 ], a large number of hospitals discontinued or refrained from minimally invasive surgery [ 69 ].…”

Section: Areas Of Training Affectedmentioning

confidence: 99%

The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

Yiasemidou

2021

Indian J Surg

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The COVID-19 pandemic and infection control measures had an unavoidable impact on surgical services. During the first wave of the pandemic, elective surgery, endoscopy, and ‘face-to-face’ clinics were discontinued after recommendations from professional bodies. In addition, training courses, examinations, conferences, and training rotations were postponed or cancelled. Inadvertently, infection control and prevention measures, both within and outside hospitals, have caused a significant negative impact on training. At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom. While the recovery phase is well underway in some parts of the world, most surgical services are not operating at full capacity. Unfortunately, some countries are still battling a second or third wave of the pandemic with severely negative consequences on surgical services. Several studies have looked into the impact of COVID-19 on surgical training. Here, an objective overview of studies from different parts of the world is presented. Also, evidence-based solutions are suggested for future surgical training interventions.

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“…Until now, there has been no scientific evidence in this regard, and there are only recommendations that the clinical-scientific community has raised on the basis of previous experiences with other highly transmissible viruses through surgery, such as Ebola [2], as well as evidence related to the presence of hepatitis B virus in the pneumoperitoneum during laparoscopy [3]. Some authors have recently reported cases where SARS-CoV-2 has been detected in peritoneal fluids, blood, and cerebrospinal fluid [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, different specific surgical societies around the world [8][9][10] have acted quickly to establish general recommendations, especially based on expert opinions, for performing surgical interventions, such as the use of personal protective equipment and training health personnel. In the specific case of laparoscopic interventions, the protection measures of the airway and mucous membranes are extreme, and the use of filters for the evacuation of CO 2 after surgery has also been recommended.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Prevalence in Laparoscopic Surgery Filters. Analysis in Patients with Negative Oropharyngeal RT-qPCR in a Pandemic Context: A Cross-Sectional Study

Llueca

Barneo-Muñoz

Escrig-Sos

et al. 2021

JPM

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Objective: Surgical societies of different specialties have lately demonstrated a growing concern regarding the potential risk of SARS-CoV-2 transmission during surgery, mainly via aerosols carrying SARS-CoV-2 particles during laparoscopy smoke evacuation. Since there is not sufficient scientific evidence to rule out this hypothesis, our study aimed to evaluate the prevalence of the appearance of SARS-CoV-2 genetic material in the in-filter membrane of the smoke filter systems, used in laparoscopic surgery, in a tertiary referral hospital during the peak phases of the pandemic. Methods: During the highest incidence of the pandemic outbreak, 180 laparoscopic smoke evacuation systems were collected from laparoscopies performed between April 2020 and May 2021 in University General Hospital of Castellón. As part of the safety protocol established as a result of the pandemic, an oropharyngeal reverse-transcription polymerase chain reaction (RT-PCR) was performed before surgery. We performed RT-qPCR tests for the detection and quantification of SARS-CoV-2 genetic material in the in-filter membranes extracted from the smoke evacuation systems. Results: We found two RT-qPCR positive in-filters from a sample of 128 patients with SARS-CoV-2-negative results in their oropharyngeal RT-qPCR, i.e., 1.6% (95% CI: 0.5–5.5%). From this estimation, the predictive posterior probabilities of finding n cases of negative oropharyngeal COVID-19 patients with positive filters increases with the increasing number of surgeries performed. Conclusions: This cross-sectional study provides evidence suggesting that airborne transmission of SARS-CoV-2 particles from smoke evacuation of aerosols carrying viral particles during laparoscopy should not be ruled out.

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Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study

Cited by 20 publications

References 13 publications

Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive

Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive

The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

SARS-CoV-2 Prevalence in Laparoscopic Surgery Filters. Analysis in Patients with Negative Oropharyngeal RT-qPCR in a Pandemic Context: A Cross-Sectional Study

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