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1.
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
2.
Medicine (Baltimore) ; 99(30): e20652, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-683721

ABSTRACT

The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation.We retrospectively reviewed 18 patients (aged 25-62, 34.2 ±â€Š7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ±â€Š3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed.The operation time ranged from 30 to 65 minutes (42.8 ±â€Š18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ±â€Š22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ±â€Š4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ±â€Š2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation.Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.


Subject(s)
Fracture Fixation, Internal/statistics & numerical data , Fractures, Bone/surgery , Pelvic Bones/injuries , Adult , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Pelvic Bones/surgery , Retrospective Studies
3.
J Neurointerv Surg ; 12(8): 726-730, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-629793

ABSTRACT

BACKGROUND: This survey was focused on the provision of neurointerventional services, the current practices of managing patients under COVID-19 conditions, and the expectations for the future. METHODS: Invitations for this survey were sent out as a collaborative effort of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y Terapeutica (SILAN), the Society of Vascular and Interventional Neurology (SVIN), and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN). RESULTS: Overall, 475 participants from 61 countries responded (six from Africa (1%), 81 from Asia (17%), 156 from Europe (33%), 53 from Latin America (11%), and 172 from North America (11%)). The majority of participants (96%) reported being able to provide emergency services, though 26% of these reported limited resources. A decrease in emergency procedures was reported by 69% of participants (52% in ischemic and hemorrhagic stroke, 11% ischemic, and 6% hemorrhagic stroke alone). Only 4% reported an increase in emergency cases. The emerging need for social distancing and the rapid adoption of remote communication was reflected in the interest in establishing case discussion forums (43%), general online forums (37%), and access to angio video streaming for live mentoring and support (33%). CONCLUSION: Neurointerventional emergency services are available in almost all centers, while the number of emergency patients is markedly decreased. Half of the participants have abandoned neurointerventions in non-emergent situations. There are considerable variations in the management of neurointerventions and in the expectations for the future.


Subject(s)
Betacoronavirus , Coronavirus Infections , Minimally Invasive Surgical Procedures , Pandemics , Pneumonia, Viral , Coronavirus Infections/epidemiology , Humans , Neurosurgical Procedures , Pneumonia, Viral/epidemiology , Surveys and Questionnaires
4.
Eur Arch Otorhinolaryngol ; 277(7): 2133-2135, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-628611

ABSTRACT

PURPOSE: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. METHODS: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. RESULTS: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. CONCLUSION: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Intubation, Intratracheal , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome, Adult/therapy , Tracheostomy/methods , Adult , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Intensive Care Units , Male , Middle Aged , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
5.
J Neurointerv Surg ; 12(8): 726-730, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-602527

ABSTRACT

BACKGROUND: This survey was focused on the provision of neurointerventional services, the current practices of managing patients under COVID-19 conditions, and the expectations for the future. METHODS: Invitations for this survey were sent out as a collaborative effort of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y Terapeutica (SILAN), the Society of Vascular and Interventional Neurology (SVIN), and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN). RESULTS: Overall, 475 participants from 61 countries responded (six from Africa (1%), 81 from Asia (17%), 156 from Europe (33%), 53 from Latin America (11%), and 172 from North America (11%)). The majority of participants (96%) reported being able to provide emergency services, though 26% of these reported limited resources. A decrease in emergency procedures was reported by 69% of participants (52% in ischemic and hemorrhagic stroke, 11% ischemic, and 6% hemorrhagic stroke alone). Only 4% reported an increase in emergency cases. The emerging need for social distancing and the rapid adoption of remote communication was reflected in the interest in establishing case discussion forums (43%), general online forums (37%), and access to angio video streaming for live mentoring and support (33%). CONCLUSION: Neurointerventional emergency services are available in almost all centers, while the number of emergency patients is markedly decreased. Half of the participants have abandoned neurointerventions in non-emergent situations. There are considerable variations in the management of neurointerventions and in the expectations for the future.


Subject(s)
Betacoronavirus , Coronavirus Infections , Minimally Invasive Surgical Procedures , Pandemics , Pneumonia, Viral , Coronavirus Infections/epidemiology , Humans , Neurosurgical Procedures , Pneumonia, Viral/epidemiology , Surveys and Questionnaires
6.
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
7.
J Neurosurg Anesthesiol ; 32(3): 193-201, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-548377

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.


Subject(s)
Anesthesiology/methods , Brain Ischemia/surgery , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/surgery , Betacoronavirus , Brain Ischemia/complications , Consensus , Critical Care , Europe , Humans , Minimally Invasive Surgical Procedures , Neurosciences , Neurosurgery , Societies, Medical , Stroke/complications , United States
8.
J Laparoendosc Adv Surg Tech A ; 30(8): 915-918, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-528227

ABSTRACT

The COVID-19 outbreak has dramatically impacted our activities of pediatric surgeons and urologists over the past 3 months, especially in the field of minimally invasive surgery (MIS) and robotics. Analyzing the available literature, there is very scarce evidence regarding the use of MIS and robotics for treatment of pediatric surgical and urological pathologies during this pandemic. However, we found some useful information that we would like to share with other pediatric surgeons and urologists through this journal. Based upon the available data, we believe that surgery should only be performed in pediatric patients with emergent/urgent and oncological indications until resolution of the COVID-19 outbreak. Robotics and MIS may be safely performed in such selected children by adopting specific technical precautions such as prevention of aerosol dispersion using filters/suction or adapted systems and appropriate use of electrocautery and other sealing devices for reduction of surgical smoke, as reported in our recent experience. Another key point to manage this pandemic emergency is that all hospitals should provide health care professionals with adequate individual protections and perform universal screening in all patients undergoing surgery. Considering that this pandemic is a rapidly evolving situation with new information available daily, these data resulting from the analysis of literature focused on pediatric robotics and MIS may be further revised and updated.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Infection Control/methods , Minimally Invasive Surgical Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , Child , Humans , Pediatrics
11.
Eur Urol Focus ; 6(5): 1032-1048, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-437422

ABSTRACT

CONTEXT: The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. OBJECTIVE: To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. EVIDENCE ACQUISITION: Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming "adaptive" and the future "chronic" phase of the COVID-19 pandemic. EVIDENCE SYNTHESIS: Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. CONCLUSIONS: The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. PATIENT SUMMARY: Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Urologic Neoplasms/diagnosis , Urologic Neoplasms/therapy , Urology/trends , Ambulatory Care/trends , Betacoronavirus , Europe/epidemiology , Forecasting , Hospitalization/trends , Humans , Minimally Invasive Surgical Procedures/trends , Pandemics , Societies, Medical , Telemedicine/trends , Urologic Diseases/diagnosis , Urologic Diseases/therapy , Urologic Surgical Procedures/trends , Urology/organization & administration , Urology/standards
12.
Updates Surg ; 72(2): 241-247, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-418919

ABSTRACT

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.


Subject(s)
Biliary Tract Diseases/surgery , Coronavirus Infections , Liver Diseases/surgery , Minimally Invasive Surgical Procedures , Pancreatic Diseases/surgery , Pandemics , Pneumonia, Viral , Health Care Surveys , Humans , Italy
13.
Eur Arch Otorhinolaryngol ; 277(8): 2403-2404, 2020 08.
Article in English | MEDLINE | ID: covidwho-378190

ABSTRACT

BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Critical Care/methods , Intubation, Intratracheal/adverse effects , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Tracheostomy/methods , Betacoronavirus , Coronavirus Infections/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Insufficiency , Severe Acute Respiratory Syndrome , Time Factors , Treatment Outcome
14.
Head Neck ; 42(7): 1363-1366, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-326903

ABSTRACT

BACKGROUND: Percutaneous tracheostomy (PT) in patients with coronavirus disease (COVID-19) included several critical steps associated with increased risk of aerosol generation. We reported a modified PT technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients. METHODS: PT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure. RESULTS: The modified technique we proposed was successfully performed in three critically ill patients with COVID-19. CONCLUSIONS: In COVID-19 critically ill patients, a modified PT technique, including the use of a smaller ETT cuffed at the carina and fiber-optic bronchoscope inserted between the tube and the inner surface of the trachea, may ensure a better airway management, respiratory function, patient comfort, and great safety for the staff.


Subject(s)
Bronchoscopy/instrumentation , Coronavirus Infections/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intubation, Intratracheal/methods , Pneumonia, Viral/surgery , Tracheostomy/methods , Airway Management , Cohort Studies , Coronavirus Infections/diagnosis , Critical Illness , Female , Fiber Optic Technology , Humans , Intensive Care Units , Intubation, Intratracheal/instrumentation , Male , Minimally Invasive Surgical Procedures/methods , Occupational Health , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Treatment Outcome
15.
Head Neck ; 42(7): 1374-1381, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-305887

ABSTRACT

BACKGROUND: An increasing number of COVID-19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID-19. We explored the safe and effective management of tracheostomy in COVID-19 patients, to benefit patients and protect health care workers at the same time. METHODS: We retrospectively analyzed 11 hospitalized COVID-19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications, and nosocomial infection of the health care workers associated with the tracheostomy were analyzed. RESULTS: The tracheostomy of all the 11 cases (100%) was performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no health care workers associated with the tracheostomy are confirmed to be infected by SARS-CoV-2. CONCLUSION: Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID-19 patients.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Tracheostomy/methods , Adult , Aged , Aged, 80 and over , China , Cohort Studies , Female , Humans , Intubation, Intratracheal , Male , Middle Aged , Minimally Invasive Surgical Procedures , Pandemics/statistics & numerical data , Retrospective Studies , Risk Assessment , Tertiary Care Centers
16.
Ann Thorac Surg ; 110(2): 718-724, 2020 08.
Article in English | MEDLINE | ID: covidwho-276989

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented disruption in health care delivery around the world. In an effort to prevent hospital-acquired COVID-19 infections, most hospitals have severely curtailed elective surgery, performing only surgeries if the patient's survival or permanent function would be compromised by a delay in surgery. As hospitals emerge from the pandemic, it will be necessary to progressively increase surgical activity at a time when hospitals continue to care for COVID-19 patients. In an attempt to mitigate the risk of nosocomial infection, we have created a patient care pathway designed to minimize risk of exposure of patients coming into the hospital for scheduled procedures. The COVID-minimal surgery pathway is a predetermined patient flow, which dictates the locations, personnel, and materials that come in contact with our cancer surgery population, designed to minimize risk for virus transmission. We outline the approach that allowed a large academic medical center to create a COVID-minimal cancer surgery pathway within 7 days of initiating discussions. Although the pathway represents a combination of recommended practices, there are no data to support its efficacy. We share the pathway concept and our experience so that others wishing to similarly align staff and resources toward the protection of patients may have an easier time navigating the process.


Subject(s)
Coronavirus Infections/epidemiology , Critical Pathways/organization & administration , Minimally Invasive Surgical Procedures , Neoplasms/surgery , Pneumonia, Viral/epidemiology , Surgical Oncology/organization & administration , Betacoronavirus , Elective Surgical Procedures , Humans , Pandemics
17.
Int J Surg ; 79: 233-248, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-274246

ABSTRACT

The Coronavirus (COVID-19) Pandemic represents a once in a century challenge to human healthcare with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. All specialties have had to triage the urgency of their daily surgical procedures and consider non-surgical management options where possible. The Pandemic has had ramifications for ways of working, surgical techniques, open vs minimally invasive, theatre workflow, patient and staff safety, training and education. With guidelines specific to each specialty being implemented and followed, surgeons should be able to continue to provide safe and effective care to their patients during the COVID-19 pandemic. In this comprehensive and up to date review we assess changes to working practices through the lens of each surgical specialty.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/organization & administration , Triage , Betacoronavirus , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/organization & administration , Humans , Medical Staff, Hospital/education , Medical Staff, Hospital/supply & distribution , Minimally Invasive Surgical Procedures , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Workflow
18.
Surg Endosc ; 34(8): 3292-3297, 2020 08.
Article in English | MEDLINE | ID: covidwho-232658

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in significant changes to surgical practice across the worlds. Some countries are seeing a tailing down of cases, while others are still having persistent and sustained community spread. These evolving disease patterns call for a customized and dynamic approach to the selection, screening, planning, and for the conduct of surgery for these patients. METHODS: The current literature and various international society guidelines were reviewed and a set of recommendations were drafted. These were circulated to the Governors of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA) for expert comments and discussion. The results of these were compiled and are presented in this paper. RESULTS: The recommendations include guidance for selection and screening of patients in times of active community spread, limited community spread, during times of sporadic cases or recovery and the transition between phases. Personal protective equipment requirements are also reviewed for each phase as minimum requirements. Capability management for the re-opening of services is also discussed. The choice between open and laparoscopic surgery is patient based, and the relative advantages of laparoscopic surgery with regard to complications, and respiratory recovery after major surgery has to be weighed against the lack of safety data for laparoscopic surgery in COVID-19 positive patients. We provide recommendations on the operating room set up and conduct of general surgery. If laparoscopic surgery is to be performed, we describe circuit modifications to assist in reducing plume generation and aerosolization. CONCLUSION: The COVID-19 pandemic requires every surgical unit to have clear guidelines to ensure both patient and staff safety. These guidelines may assist in providing guidance to units developing their own protocols. A judicious approach must be adopted as surgical units look to re-open services as the pandemic evolves.


Subject(s)
Coronavirus Infections/epidemiology , Infection Control/methods , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Pandemics , Pneumonia, Viral/epidemiology , Asia/epidemiology , Betacoronavirus , Humans , Operating Rooms , Patient Selection , Personal Protective Equipment , Surgeons
19.
Aging (Albany NY) ; 12(9): 7614-7618, 2020 05 05.
Article in English | MEDLINE | ID: covidwho-209396

ABSTRACT

During the epidemic of COVID-19, the management model of colorectal cancer has to be changed at our center due to relatively limited medical resources. Outpatient visits are reduced under well protected after appointment, and rigorous investigation of epidemiological history and clinical symptoms are needed. We prefer a simple and convenient treatment regimen, which may also be postponed appropriately. Minimally invasive CRC surgery combined with a perioperative program of enhanced recovery after surgery should be recommended. We also focus on mental health treatments and healthy lifestyle education. In addition, routine follow-up can be moderately delayed. In total, adequate doctor-patient communication is also recommended throughout the treatment.


Subject(s)
Colorectal Neoplasms/therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus/isolation & purification , Colorectal Neoplasms/psychology , Colorectal Neoplasms/surgery , Coronavirus Infections/psychology , Enhanced Recovery After Surgery , Health Resources , Humans , Medical Oncology/methods , Medical Oncology/standards , Mental Health , Minimally Invasive Surgical Procedures/methods , Pandemics , Pneumonia, Viral/psychology , Surgical Oncology/methods , Surgical Oncology/standards
20.
J Neurosurg Anesthesiol ; 32(3): 193-201, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-200354

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.


Subject(s)
Anesthesiology/methods , Brain Ischemia/surgery , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/surgery , Betacoronavirus , Brain Ischemia/complications , Consensus , Critical Care , Europe , Humans , Minimally Invasive Surgical Procedures , Neurosciences , Neurosurgery , Societies, Medical , Stroke/complications , United States
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