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1.
Pediatr Surg Int ; 38(5): 769-775, 2022 May.
Article in English | MEDLINE | ID: covidwho-1763343

ABSTRACT

PURPOSE: The safety of minimally invasive surgery (MIS) was questioned in the COVID-19 pandemic due to concern regarding disease spread. We continued MIS during the pandemic with appropriate protective measures. This study aims to assess the safety of MIS compared to Open Surgery (OS) in this setting. METHODS: Operations performed during 2020 lockdown were compared with operations from the same time-period in 2019 and 2021. Outcomes reviewed included all complications, respiratory complications, length of stay (LOS) and operating surgeon COVID-19 infections (OSI). RESULTS: In 2020, MIS comprised 52% of procedures. 29% of MIS 2020 had complications (2019: 24%, 2021: 15%; p = 0.08) vs 47% in OS 2020 (p = 0.04 vs MIS). 8.5% of MIS 2020 had respiratory complications (2019: 7.7%, 2021: 6.9%; p = 0.9) vs 10.5% in OS 2020 (p = 0.8 vs MIS). Median LOS[IQR] for MIS 2020 was 2.5[6] days vs 5[23] days in OS 2020 (p = 0.06). In 2020, 2 patients (1.2%) were COVID-19 positive (MIS: 1, OS: 1) and there were no OSI. CONCLUSION: Despite extensive use of MIS during the pandemic, there was no associated increase in respiratory or other complications, and no OSI. Our study suggests that, with appropriate protective measures, MIS can be performed safely despite high levels of COVID-19 in the population.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Communicable Disease Control , Humans , Length of Stay , Minimally Invasive Surgical Procedures/methods , Retrospective Studies
2.
Asian Pac J Cancer Prev ; 23(2): 573-581, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1716438

ABSTRACT

BACKGROUND: To evaluate gynecologic oncologists' trends and attitudes towards the use of Minimally invasive surgery (MIS) in active period of the COVID-19 pandemic in Turkey. METHODS: Online national survey sent to members of Turkish Endoscopy Platform consisting of six sections and 45 questions between the dates 1-15 June 2020 in Turkey to explore their surgical practice during the pandemic in three hospital types: Education and research hospital/university hospital, state hospital and private Hospital. Participants were gynecologic oncologists who are members of Turkish Endoscopy Platform. RESULTS: Fifty-eight percent of participants canceled all operations except for cancer surgeries and emergent operations. About a quarter of participants (28%) continued to operate laparoscopically and/or robotically. For the evaluation of the suspected adnexial mass (SAM) 64% used laparotomy and only 13 % operated by laparoscopy (L/S). For the management of low-risk early-stage endometrial cancer only fifth of the participants preferred to perform L/S. For endometrial cancer with high-intermediate risk factors more than half of participants preferred complete staging with laparotomy. For advanced stage ovarian cancer, one-fifth of the participants preferred to perform an explorative laparotomy, whilst 15 % preferred diagnostic laparoscopy to triage the patients for either NACT or cytoreductive surgery. On the contrary 41 % of participants chose to have cytology by paracentesis for neo-adjuvant chemotherapy (NACT). Gynecologic oncologists with >10 years L/S experience used MIS more for SAM. Furthermore, experienced surgeons used L/S more for endometrial cancer patients. In busy COVID hospitals, more participants preferred laparotomy over L/S. CONCLUSION: Use of MIS decreased during the pandemic in Turkey. More experienced surgeons continued to perform MIS. Surgical treatment was the preferred approach for SAM, early-stage endometrial cancer.  However, NACT was more popular compared to radical surgery.


Subject(s)
Attitude of Health Personnel , COVID-19 , Genital Neoplasms, Female/surgery , Gynecologic Surgical Procedures/methods , Minimally Invasive Surgical Procedures/methods , Practice Patterns, Physicians'/trends , Adult , Aged , Female , Gynecologic Surgical Procedures/trends , Gynecology , Humans , Laparoscopy/methods , Laparoscopy/trends , Laparotomy/methods , Laparotomy/trends , Male , Middle Aged , Minimally Invasive Surgical Procedures/trends , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/trends , SARS-CoV-2 , Societies, Medical , Surgical Oncology , Surveys and Questionnaires , Turkey
4.
J Surg Oncol ; 124(8): 1217-1223, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1363705

ABSTRACT

PURPOSE: In order for patients with gastrointestinal cancer not to suffer the consequences of delayed treatment, they should be operated on in pandemic hospitals under adequate conditions. We aimed to discuss the outcomes of our gastrointestinal cancer surgery patients and to present our patient management recommendations to resume operative treatment during the ongoing COVID-19 pandemic while taking into account hospital facilities. MATERIALS AND METHODS: This study included 129 gastrointestinal cancer patients who underwent surgery between March 2020 and May 2021 in the gastrointestinal surgery clinic of our hospital, which was assigned as a pandemic hospital in March 2020. Patients' demographic characteristics and preoperative and postoperative findings were recorded. RESULTS: Among the patients, 42.6% (n = 55) were female and 57.3% (n = 74) were male. The mean age was 61.89 ± 3.4 years. The primary tumor organs were the stomach 37.2% (n = 48), pancreas 36.4% (n = 47), rectum 11.6% (n = 15), colon 8.5% (n = 11), and esophagus 6.2% (n = 8). The patients were treated with open (75.2%, n = 97) or minimally invasive surgery (24.8%, n = 32; laparoscopic 11.6%, n = 15; robotic 13.2%, n = 17). Eight patients tested positive for COVID-19 before surgery. No patients developed COVID-19 during postoperative intensive care or after being moved to the floor unit. There was no COVID-19-related morbidity or mortality. CONCLUSION: Failure to treat gastrointestinal cancer patients during the pandemic may result in undesirable consequences, such as stage shift and mortality. Cancer patients can be treated safely with conventional and minimally invasive surgery guided by current recommendations and experience.


Subject(s)
COVID-19/epidemiology , Digestive System Surgical Procedures/methods , Gastrointestinal Neoplasms/surgery , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Robotic Surgical Procedures/methods , COVID-19/virology , Female , Follow-Up Studies , Gastrointestinal Neoplasms/pathology , Humans , Length of Stay , Male , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , SARS-CoV-2/isolation & purification , Turkey/epidemiology
5.
PLoS One ; 16(7): e0254958, 2021.
Article in English | MEDLINE | ID: covidwho-1331994

ABSTRACT

BACKGROUND: The COVID-19 pandemic forced a reconsideration of surgical patient management in the setting of scarce resources and risk of viral transmission. Herein we assess the impact of implementing a protocol of more rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication for patients undergoing brain tumor surgery. METHODS: A case-control retrospective review was undertaken at a community hospital with a dedicated neurosurgery and otolaryngology team using minimally invasive surgical techniques, total intravenous anesthesia (TIVA) and early post-operative imaging protocols. All patients undergoing craniotomy or endoscopic endonasal removal of a brain, skull base or pituitary tumor were included during two non-overlapping periods: March 2019-January 2020 (pre-pandemic epoch) versus March 2020-January 2021 (pandemic epoch with streamlined care protocol implemented). Data collection included demographics, preoperative American Society of Anesthesiologists (ASA) status, tumor pathology, and tumor resection and remission rates. Primary outcomes were ICU utilization and hospital length of stay (LOS). Secondary outcomes were complications, readmissions and reoperations. FINDINGS: Of 295 patients, 163 patients were treated pre-pandemic (58% women, mean age 53.2±16 years) and 132 were treated during the pandemic (52% women, mean age 52.3±17 years). From pre-pandemic to pandemic, ICU utilization decreased from 92(54%) to 43(29%) of operations (p<0.001) and hospital LOS≤1 day increased from 21(12.2%) to 60(41.4%), p<0.001, respectively. For craniotomy cohort, median LOS was 2 days for both epochs; median ICU LOS decreased from 1 to 0 days (p<0.001), ICU use decreased from 73(80%) to 29(33%),(p<0.001). For endonasal cohort, median LOS decreased from 2 to 1 days; median ICU LOS was 0 days for both epochs; (p<0.001). There were no differences pre-pandemic versus pandemic in ASA scores, resection/remission rates, readmissions or reoperations. CONCLUSION: This experience suggests the COVID-19 pandemic provided an opportunity for implementing a brain tumor care protocol to facilitate safely decreasing ICU utilization and accelerating discharge home without an increase in complications, readmission or reoperations. More rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication, layered upon a foundation of minimally invasive surgery, TIVA anesthesia and early post-operative imaging are possible contributors to these favorable trends.


Subject(s)
Brain Neoplasms/surgery , COVID-19/prevention & control , Pandemics/prevention & control , Case-Control Studies , Craniotomy/methods , Enhanced Recovery After Surgery , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Patient Discharge , Patient Readmission , Postoperative Complications/prevention & control , Postoperative Period , Reoperation/methods , Retrospective Studies
6.
J Cardiothorac Surg ; 16(1): 182, 2021 Jun 24.
Article in English | MEDLINE | ID: covidwho-1282263

ABSTRACT

BACKGROUND: The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. CASE PRESENTATION: A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. CONCLUSION: The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.


Subject(s)
Coronary Artery Bypass/methods , Coronary Stenosis/surgery , Endocarditis/surgery , Minimally Invasive Surgical Procedures/methods , Mitral Valve/surgery , Tricuspid Valve Insufficiency/surgery , Video-Assisted Surgery/methods , Aged , COVID-19/epidemiology , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/instrumentation , Humans , Male , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/instrumentation , Pandemics , Postoperative Complications , Reoperation , SARS-CoV-2 , Thoracotomy/adverse effects , Thoracotomy/instrumentation , Thoracotomy/methods , Video-Assisted Surgery/adverse effects
8.
Eur Arch Otorhinolaryngol ; 277(7): 2133-2135, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1049646

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/therapy , Tracheostomy/methods , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Intensive Care Units , Male , Middle Aged , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , Treatment Outcome
9.
A A Pract ; 14(14): e01371, 2020 Dec 21.
Article in English | MEDLINE | ID: covidwho-992617

ABSTRACT

Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.


Subject(s)
COVID-19/complications , COVID-19/transmission , Endoscopy, Gastrointestinal/methods , Gastrostomy/methods , Minimally Invasive Surgical Procedures/methods , Tracheostomy/methods , Aerosols , Air Pressure , COVID-19/prevention & control , Enteral Nutrition , Filtration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Operating Rooms , Patient Isolation
10.
Anaesthesiol Intensive Ther ; 52(5): 366-372, 2020.
Article in English | MEDLINE | ID: covidwho-983603

ABSTRACT

INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care. MATERIAL AND METHODS: We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020. RESULTS: The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease. CONCLUSIONS: This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.


Subject(s)
COVID-19/surgery , Minimally Invasive Surgical Procedures/methods , Tracheostomy/methods , Aged , Anesthesia , Bronchoscopy , Checklist , Critical Care , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Personal Protective Equipment , Postoperative Hemorrhage/epidemiology , Postoperative Hemorrhage/therapy , Respiration, Artificial , Retrospective Studies , Surgical Instruments , Tracheostomy/instrumentation , Ventilator Weaning
11.
Surg Endosc ; 35(1): 1-17, 2021 01.
Article in English | MEDLINE | ID: covidwho-917120

ABSTRACT

BACKGROUND: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts' opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. METHODS: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. RESULTS: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. CONCLUSION: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.


Subject(s)
COVID-19 , Infection Control/standards , Minimally Invasive Surgical Procedures/standards , COVID-19/epidemiology , COVID-19/prevention & control , Delphi Technique , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Emergencies , Global Health , Health Care Rationing/standards , Health Services Accessibility/standards , Humans , Infection Control/methods , Minimally Invasive Surgical Procedures/methods , Pandemics , SARS-CoV-2
16.
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 , COVID-19 , Child , Humans , Pediatrics , SARS-CoV-2
17.
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 , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Insufficiency , SARS-CoV-2 , Severe Acute Respiratory Syndrome , Time Factors , Treatment Outcome
18.
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 , COVID-19 , 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
19.
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 , COVID-19 , Humans , Operating Rooms , Patient Selection , Personal Protective Equipment , SARS-CoV-2 , Surgeons
20.
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 , COVID-19 , 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 , SARS-CoV-2 , Surgical Oncology/methods , Surgical Oncology/standards
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