Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 51
Filter
Add filters

Year range
2.
Ann Surg ; 272(2): e118-e124, 2020 08.
Article in English | MEDLINE | ID: covidwho-704742

ABSTRACT

OBJECTIVE: Our objective was to review the literature surrounding the risks of viral transmission during laparoscopic surgery and propose mitigation measures to address these risks. SUMMARY BACKGROUND DATA: The SARS-CoV-2 pandemic has caused surgeons the world over to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. International society guidelines advise against the use of laparoscopy; however, the evidence on this topic is scant and recommendations are based on the perceived most cautious course of action. METHODS: We conducted a narrative review of the existing literature surrounding the risks of viral transmission during laparoscopic surgery and balance these risks against the benefits of minimally invasive approaches. We also propose mitigation measures to address these risks that we have adopted in our institution. RESULTS AND CONCLUSION: While it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy , Minimally Invasive Surgical Procedures , Operating Rooms , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Betacoronavirus , Decision Making , Humans , Pandemics , Patient Selection , Personal Protective Equipment
5.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-646934

ABSTRACT

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Subject(s)
Coronavirus Infections/epidemiology , Digestive System Surgical Procedures , Emergencies , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Respiratory Insufficiency/epidemiology , Respiratory Tract Infections/epidemiology , Abscess/surgery , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy , Betacoronavirus , Cholecystectomy, Laparoscopic , Comorbidity , Coronavirus Infections/therapy , Disease Outbreaks , Drainage , Female , Herniorrhaphy , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Embolism/drug therapy , Pulmonary Embolism/epidemiology , Respiratory Insufficiency/therapy , Respiratory Tract Infections/therapy , Retrospective Studies , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , United Kingdom/epidemiology , Young Adult
6.
Int J Surg ; 80: 157-161, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644648

ABSTRACT

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Subject(s)
Abscess/surgery , Appendicitis/surgery , Cholecystitis, Acute/surgery , Coronavirus Infections/epidemiology , Intestinal Obstruction/surgery , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Rectal Diseases/surgery , Abdominal Wall , Abscess/epidemiology , Acute Disease , Appendectomy/statistics & numerical data , Appendicitis/epidemiology , Betacoronavirus , Cholecystitis, Acute/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Emergencies , Female , Hernia, Abdominal/epidemiology , Hernia, Abdominal/surgery , Herniorrhaphy/statistics & numerical data , Humans , Hypertension/epidemiology , Intestinal Obstruction/epidemiology , Laparoscopy/statistics & numerical data , Logistic Models , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pandemics , Rectal Diseases/epidemiology , Reoperation/statistics & numerical data , Retrospective Studies , Spain/epidemiology , Time-to-Treatment/statistics & numerical data
7.
Int J Surg ; 80: 21-25, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-638076

ABSTRACT

The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reserves worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of the COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients' selection and management plans with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up sheds lights on the impact of the COVID-19, big data analytics of response of medical personnel in understanding and curtailing the disease process and the consensus guidelines for carrying out laparoscoendoscopic procedures.


Subject(s)
Coronavirus Infections/prevention & control , Disposable Equipment , Endoscopy/methods , Health Care Rationing , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Neoplasms/surgery , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Betacoronavirus , Big Data , Clinical Protocols , Coronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Data Science , Elective Surgical Procedures/methods , Electrocoagulation/methods , Equipment Contamination/prevention & control , Health Personnel , Humans , Operating Rooms , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Ultrasonic Surgical Procedures/methods
8.
World J Emerg Surg ; 15(1): 43, 2020 07 02.
Article in English | MEDLINE | ID: covidwho-621542

ABSTRACT

BACKGROUND: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. CASE PRESENTATION: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4) against gallbladder vessels. All these findings define a histological diagnosis of vasculitis of the gallbladder. CONCLUSIONS: Ischemic gangrenous cholecystitis can be a tardive complication of COVID-19, and it is characterized by a dysregulated host inflammatory response and thrombosis of medium-size vessels.


Subject(s)
Cholecystectomy/methods , Cholecystitis , Coronavirus Infections , Gallbladder , Gangrene , Omentum , Pandemics , Pneumonia, Viral , Spontaneous Perforation , Betacoronavirus/isolation & purification , Cholecystitis/etiology , Cholecystitis/pathology , Cholecystitis/physiopathology , Cholecystitis/surgery , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Care/methods , Gallbladder/blood supply , Gallbladder/diagnostic imaging , Gallbladder/pathology , Gangrene/etiology , Gangrene/pathology , Humans , Immunohistochemistry , Infarction/etiology , Infarction/pathology , Laparoscopy/methods , Male , Middle Aged , Omentum/blood supply , Omentum/pathology , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Spontaneous Perforation/diagnosis , Spontaneous Perforation/etiology , Spontaneous Perforation/physiopathology , Spontaneous Perforation/surgery , Thrombosis/etiology , Thrombosis/pathology , Treatment Outcome
9.
A A Pract ; 14(7): e01244, 2020 May.
Article in English | MEDLINE | ID: covidwho-601754

ABSTRACT

A novel coronavirus pandemic may be particularly hazardous to health care workers. Airway management is an aerosol-producing high-risk procedure. To minimize the production of airborne droplets, including pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the endotracheal tube during procedures requiring lung deflation, we devised a technique to mitigate the risk of infection transmission to health care personnel.


Subject(s)
Coronavirus Infections/prevention & control , Empyema, Pleural/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/instrumentation , One-Lung Ventilation/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Thoracic Surgery, Video-Assisted/methods , Aged , Betacoronavirus , Bronchoscopy/methods , Coronavirus Infections/transmission , Humans , Intubation, Intratracheal/methods , Male , Pneumonia, Viral/transmission
10.
Int Braz J Urol ; 46(suppl.1): 215-221, 2020 07.
Article in English | MEDLINE | ID: covidwho-601715

ABSTRACT

Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.


Subject(s)
Coronavirus Infections/complications , Disease Transmission, Infectious/prevention & control , Laparoscopy/methods , Pandemics , Pneumonia, Viral/complications , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , Urologists , Urology , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Robotic Surgical Procedures/trends , Urologic Surgical Procedures/trends , Urology/standards , Urology/trends , Workflow
11.
Eur Urol Focus ; 6(5): 1070-1085, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-548747

ABSTRACT

CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Standard of Care , Urologic Neoplasms/surgery , Urology/standards , Betacoronavirus , Clinical Decision-Making , Endoscopy/methods , Humans , Laparoscopy/methods , Neoplasm Grading , Neoplasm Staging , Pandemics , Robotic Surgical Procedures/methods , Urologic Diseases/surgery , Urologic Neoplasms/pathology , Urologic Surgical Procedures/methods
12.
Eur Urol Focus ; 6(5): 1058-1069, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-548746

ABSTRACT

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Although no case of SARS-CoV-2 contagion related to surgical smoke has been reported, several international surgical societies recommended caution or even discouraged the use of a laparoscopic approach. OBJECTIVE: To evaluate the risk of virus spread due to surgical smoke during surgical procedures. EVIDENCE ACQUISITION: We searched PubMed and Scopus for eligible studies, including clinical and preclinical studies assessing the presence of any virus in the surgical smoke from any surgical procedure or experimental model. EVIDENCE SYNTHESIS: We identified 24 studies. No study was found investigating SARS-CoV-2 or any other coronavirus. About other viruses, hepatitis B virus was identified in the surgical smoke collected during different laparoscopic surgeries (colorectal resections, gastrectomies, and hepatic wedge resections). Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Preclinical studies showed conflicting results, but HPV was shown to have a high risk of transmission. CONCLUSIONS: Although all the available data come from different viruses, considering that the SARS-CoV-2 virus has been shown in blood and stools, the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Specific clinical studies are needed to understand the effective presence of the virus in the surgical smoke of different surgical procedures and its concentration. Meanwhile, adoption of all the required protective strategies, including preoperative patient nasopharyngeal swab for COVID-19, seems mandatory. PATIENT SUMMARY: In this systematic review, we looked at the risk of virus spread from surgical smoke exposure during surgery. Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Hepatitis B virus , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy , Papillomaviridae , Pneumonia, Viral/transmission , Smoke , Colectomy , Condylomata Acuminata/surgery , Condylomata Acuminata/virology , Gastrectomy , Hepatectomy , Humans , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/virology , Minimally Invasive Surgical Procedures , Pandemics , Papilloma/surgery , Papilloma/virology , Papillomavirus Infections , Risk , Warts/surgery , Warts/virology
15.
Eur J Trauma Emerg Surg ; 46(4): 731-735, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-459178

ABSTRACT

BACKGROUND: Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol. METHODS: The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described. RESULTS: Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization. CONCLUSION: The proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra- and postoperative release of CO2.


Subject(s)
Coronavirus Infections , Filtration/methods , Infection Control/methods , Laparoscopy , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/methods , Equipment Design , Humans , Laparoscopy/adverse effects , Laparoscopy/instrumentation , Laparoscopy/methods , Operating Rooms/methods , Operating Rooms/trends , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumoperitoneum, Artificial/methods , Safety Management/methods
16.
J Surg Oncol ; 122(2): 122-123, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-457550

ABSTRACT

At the beginning of 2020, coronavirus disease 2019 (COVID-19) spreads worldwide. Patients with ovarian cancer should be considered at high-risk of developing severe morbidity related to COVID-19. Most of them are diagnosed in advanced stages of disease, and they are fragile. Here, we evaluated the major impact of COVID-19 on patients with ovarian cancer, discussing the effect of the outbreak on medical and surgical treatment.


Subject(s)
Coronavirus Infections/prevention & control , Ovarian Neoplasms/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Surgical Oncology/methods , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/standards , Humans , Infection Control/methods , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Laparoscopy/standards , Ovarian Neoplasms/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Surgical Oncology/standards
18.
Int J Surg ; 79: 165-167, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-437477

ABSTRACT

Coronavirus Disease 2019(COVID 19) had emerged as a global pandemic in recent times. The healthcare sector is at the epicentre of this unprecedented global pandemic challenge. Hospitals all over the world have reduced the number of non-emergency surgeries in order to utilise the staff and resources in a more efficient way. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is most transmitted via respiratory droplets, but risk of transmission is hugely increased while doing aerosol generating procedures (AGPs). Laparoscopy remains the preferred surgical approach for most surgical indications. There is theoretical possibility of generation of aerosols contaminated with COVID-19 from leaked CO2 and smoke generation after energy device use. The aim of this paper is to review available evidence evaluating the risk of spread of COVID-19 during necessary laparoscopic procedures and to compile guidelines from relevant professional organizations to minimize this risk.


Subject(s)
Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy , Pandemics , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , India/epidemiology , Infection Control , Laparoscopy/methods , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Surgeons
19.
Int J Surg ; 79: 180-188, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-397689

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases. There is a lack of evidence-based literature providing clinical and organizational guidelines for the management of a general surgery department. Aim of our study was to review the available recommendations published by general Surgery Societies and Health Institutions and evaluate the underlying Literature. MATERIALS AND METHODS: A review of the English Literature was conducted according to the AMSTAR and to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: After eligibility assessment, a total of 22 papers and statements were analyzed. Surgical societies have established criteria for triage and prioritization in order to identify procedures that can be postponed after the pandemic and those that should not. Prioritization among oncologic cases represents a difficult task: clinicians have to balance a possible delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure. There is broad agreement among guidelines that indication to proceed with surgery should be discussed in virtual Tumor Boards taking into consideration alternative therapeutic approaches. Several guidelines deal with the role of laparoscopic surgery during the pandemic: a tailored approach is currently suggested, with a case-by-case evaluation provided that appropriate personal protective equipment is available in order to minimize the potential risk of transmission. Finally, there is a considerable agreement in the published Literature concerning the management of the personnel during the peri- and intraoperative phase and on the technical advices regarding the induction, operative and recover maneuvers in COVID-19 cases. CONCLUSIONS: During COVID-19 pandemic, it is of paramount importance to face the emergency in the most effective and efficient manner, retrieving resources from non-essential settings and, at the same time, providing care to high priority non-COVID-19 related diseases.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/organization & administration , Betacoronavirus , Coronavirus Infections/transmission , Emergency Service, Hospital/organization & administration , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy , Personal Protective Equipment , Pneumonia, Viral/transmission , Surgical Procedures, Operative , Triage
20.
Surg Endosc ; 34(8): 3298-3305, 2020 08.
Article in English | MEDLINE | ID: covidwho-378322

ABSTRACT

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.


Subject(s)
Cautery , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laparoscopy/methods , Laparotomy/methods , Pneumonia, Viral/transmission , Smoke , Betacoronavirus , Humans , Infection Control/methods , Operating Rooms , Pandemics , Risk
SELECTION OF CITATIONS
SEARCH DETAIL