What Is the Appropriate Use of Laparoscopy over Open Procedures in the Current COVID-19 Climate?

Abstract

Introduction Among surgeons worldwide, a concern with the use of minimally invasive techniques has been raised due to a proposed risk of viral transmission of the coronavirus disease of 2019 (COVID-19) with the creation of pneumoperitoneum. Due to this proposed concern, we sought to collect the available data and evaluate the use of laparoscopy and the risk of COVID-19 transmission.Methods A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Results Few studies have been performed on viral transmission during surgery, but to date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open or laparoscopic. There is no societal consensus on limiting or restricting laparoscopic or robotic surgery; however, there is expert consensus on the modification of standard practices to minimize any risk of transmission. Conclusions Despite very little evidence to support viral transmission through laparoscopic or open approaches, we recommend making modifications to surgical practice such as the use of smoke evacuation and minimizing energy device use among other measures to minimize operative staff exposure to aerosolized particles.

Caring for Patients with Rectal Cancer During the COVID-19 Pandemic

“…5 The virus has also been isolated from gastrointestinal secretions; although the transmissibility of viral products in stool is not well understood, there is at least theoretical risk of aerosolization of such particles by electrocautery during abdominal surgery. [6][7][8] Postoperative Care at the Hospital Even when enhanced recovery protocols that limit in-hospital resource utilization are used, patients will usually require a minimum of a 2 to 3-day admission. 9 While most patients will have an uncomplicated hospital course, a subset of patients will have an extended stay; may require admission to the intensive care unit; and may require critical hospital resources such as blood transfusion, interventional radiology, or even reoperation.…”

“…If surgery is essential, either open or laparoscopic or robotic surgery may be considered based upon surgeon comfort and expertise. 6 Providers should take all possible precautions to prevent inadvertently exposing caregivers. These include minimizing the use of energy devices; using closed-circuit smoke evacuation devices; wearing enhanced PPE; and, during laparoscopy, insufflating to lower pressures and desufflating the abdomen with a closed smoke evacuation system.…”

Gynecological laparoscopic surgery in the shade of COVID-19 pandemic

“…COVID-19 virus (SARS-CoV-2) is a respiratory agent transmitted via respiratory droplets [7]. The mechanisms are thought to be in three ways: (a) directly by droplets from human to human via someone's nose, mouth, or eyes or (b) smaller but much more numerous particles called "aerosol particles" or (c) from contaminated surfaces with larger droplets that spread onto the surfaces from an infected person's secretions [16]. Sites of deposition in the recipient differ between inhaled droplets and aerosol particles; while the bigger ones localize in upper regions of the respiratory tract, the inhaled aerosol particles penetrate deeper into the lungs [17].…”

“…In contrast, particles with the smallest mean size (<0.1 µm) were formed by electrocautery; the largest ones sized 0.35-6.5 µm were shown to be generated by use of the ultrasonic scalpels [18]. The role of CO 2 in aerosol formation remains unclear [16]. Based on our previous information about the presence of Hepatitis B [19], human immunodeficiency viruses (HIV) [20], and similar respiratory viruses as influenza or coronaviruses [Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS)] in surgical plume during laparoscopy, to date, no study presents the ability of viral transmission by laparoscopy [16,21].…”

“…The role of CO 2 in aerosol formation remains unclear [16]. Based on our previous information about the presence of Hepatitis B [19], human immunodeficiency viruses (HIV) [20], and similar respiratory viruses as influenza or coronaviruses [Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS)] in surgical plume during laparoscopy, to date, no study presents the ability of viral transmission by laparoscopy [16,21]. Besides, SARS-CoV-2 has not been detected in AGPs yet, but the virus has been detected in blood in 1% of cases and stool specimens in 29% of cases [21,22].…”