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1.
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
2.
J Minim Invasive Gynecol ; 27(6): 1256-1257, 2020.
Article in English | MEDLINE | ID: covidwho-1454310

ABSTRACT

STUDY OBJECTIVE: To demonstrate a surgical video wherein a robot-assisted colostomy takedown was performed with anastomosis of the descending colon to the rectum after reduction of ventral hernias and extensive lysis of adhesions. DESIGN: Case report and a step-by-step video demonstration of a robot-assisted colostomy takedown and end-to-side anastomosis. SETTING: Tertiary referral center in New Haven, Connecticut. A 64-year-old female was diagnosed with stage IIIA endometrioid endometrial adenocarcinoma in 2015 when she underwent an optimal cytoreductive surgery. In addition, she required resection of the sigmoid colon and a descending end colostomy with Hartmann's pouch, mainly secondary to extensive diverticulitis. After adjuvant chemoradiation, she remained disease free and desired colostomy reversal. Body mass index at the time was 32 kg/m2. Computed tomography of her abdomen and pelvis did not show any evidence of recurrence but was notable for a large ventral hernia and a parastomal hernia. She then underwent a colonoscopy, which was negative for any pathologic condition, except for some narrowing of the distal rectum above the level of the levator ani. INTERVENTIONS: Enterolysis was extensive and took approximately 2 hours. The splenic flexure of the colon had to be mobilized to provide an adequate proximal limb to the anastomosis site. An anvil was then introduced into the distal descending colon through the colostomy site. A robotic stapler was used to seal the colostomy site and detach it from the anterior abdominal wall. Unfortunately, the 28-mm EEA sizer (Covidien, Dublin, Ireland) perforated through the distal rectum, caudal to the stricture site. A substantial length of the distal rectum had to be sacrificed secondary to the perforation, which mandated further mobilization of the splenic flexure. The rectum was then reapproximated with a 3-0 barbed suture in 2 layers. This provided us with approximately 6- to 8-cm distal rectum. An end-to-side anastomosis of the descending colon to the distal rectum was performed. Anastomotic integrity was confirmed using the bubble test. Because of the lower colorectal anastomosis, a protective diverting loop ileostomy was performed. The patient had an uneventful postoperative course. A hypaque enema performed 3 months after the colostomy takedown showed no evidence of anastomotic leak or stricture. The ileostomy was then reversed without any complications. CONCLUSION: Robot-assisted colostomy takedown and anastomosis of the descending colon to rectum were successfully performed. Although there is a paucity of literature examining this technique within gynecologic surgery, the literature on general surgery has supported laparoscopic Hartmann's reversal and has demonstrated improved rates of postoperative complications and incisional hernia and reduced duration of hospitalization [1]. Minimally invasive technique is a feasible alternative to laparotomy for gynecologic oncology patients who undergo colostomy, as long as the patients are recurrence free.


Subject(s)
Colostomy/adverse effects , Hernia, Ventral/etiology , Hernia, Ventral/surgery , Robotic Surgical Procedures/methods , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Abdominal Wall/surgery , Anastomosis, Surgical/methods , Anastomotic Leak/surgery , Colon, Sigmoid/pathology , Colon, Sigmoid/surgery , Colonic Pouches/adverse effects , Colostomy/methods , Female , Humans , Laparoscopy/methods , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/surgery , Reconstructive Surgical Procedures/methods , Reoperation/methods , Severity of Illness Index
3.
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
4.
Semin Cardiothorac Vasc Anesth ; 25(2): 138-150, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1181063

ABSTRACT

In 2020, we identified and screened over 490 peer-reviewed publications on pancreatic transplantation, over 500 on intestinal transplantation, and over 5000 on kidney transplantation. The liver transplantation section specially focused on clinical trials and systematic reviews published in 2020 and featured selected articles. This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a wide range of topics, including COVID-19 and organ transplantation, risk factors and outcomes, pain management, artificial intelligence, robotic donor surgery, and machine perfusion.


Subject(s)
Abdomen/surgery , COVID-19 , Organ Transplantation/methods , Anesthesiology , Artificial Intelligence , Critical Care/methods , Humans , Risk Factors , Robotic Surgical Procedures/methods
5.
J Robot Surg ; 16(1): 59-64, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1077657

ABSTRACT

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a "COVID protected" robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. "COVID protected" robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in "COVID protected" units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.


Subject(s)
COVID-19 , Laparoscopy , Rectal Neoplasms , Robotic Surgical Procedures , Urologic Neoplasms , Humans , Pandemics , Rectal Neoplasms/surgery , Robotic Surgical Procedures/methods , SARS-CoV-2 , Urologic Neoplasms/surgery
6.
J Robot Surg ; 15(6): 963-970, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1064593

ABSTRACT

This study describes a novel approach in the reduction of SARS-CoV-2 transmission during trans-oral robotic surgery (TORS). Eight patients underwent TORS between 01 February 2020 and 07 September 2020. A sterile plastic sheet draped over sterile supports with water-tight seal around each cannula was used to create a sterile working space within which the robotic arms could freely move during operation. This set-up acts as an additional physical barrier against droplet and aerosol transmission. Operative diagnosis; droplet count and distribution on plastic sheet and face shields of console and assistant surgeons, and scrub nurse were documented. TORS tumour excision was performed for patients with suspected tonsillar tumour (n = 3) and tongue base tumour (n = 2). TORS tonsillectomy and tongue base mucosectomy was performed for cervical nodal metastatic carcinoma of unknown origin (n = 3). Droplet contamination was noted on all plastic drapes (n = 8). Droplet contamination was most severe over the central surface at 97.2% (91.7-100.0%), with the highest droplet count along the centre-most column where it overlies the site of operation in the oral cavity 33.3% (n = 31). Droplet count decreased towards the periphery. Contamination rate was 2.8% (0.0-8.3%) over the right lateral surface. There was no droplet contamination over the vertex and left lateral surface of plastic drapes. No droplet contamination was noted on face shields of all parties. The use of sterile plastic drapes with water-tight seal around each robotic cannula can help reduce viral transmission to healthcare providers during TORS.


Subject(s)
COVID-19 , Robotic Surgical Procedures , Tongue Neoplasms , Humans , Robotic Surgical Procedures/methods , SARS-CoV-2
7.
J Robot Surg ; 15(6): 937-944, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1053073

ABSTRACT

The COVID-19 pandemic led to a decrease in surgical activity to avoid nosocomial contamination. Robotic-assisted surgery safety is uncertain, since viral dissemination could be facilitated by gas environment. We assessed the impact and safety of the COVID-19 pandemic on robotic-assisted surgery. Data were collected prospectively during lockdown (March 16th-April 30th 2020) in 10 academic centres with robotic surgical activity and was compared to a reference period of similar length. After surgery, patients with suspected COVID-19 were tested by RT-PCR. During the COVID-19 lockdown we evidenced a 60% decrease in activity and a 49% decrease in oncological procedures. However, the overall proportion of oncological surgeries was significantly higher during the pandemic (p < 0.001). Thirteen (7.2%) patients had suspected COVID-19 contamination, but only three (1.6%) were confirmed by RT-PCR. The COVID-19 pandemic resulted in a significant decrease in robotic-assisted surgery. Robotic approach was safe with a low rate of postoperative COVID-19 contamination.


Subject(s)
COVID-19 , Robotic Surgical Procedures , Communicable Disease Control , Humans , Pandemics , Robotic Surgical Procedures/methods , SARS-CoV-2
9.
Int Braz J Urol ; 46(suppl.1): 215-221, 2020 07.
Article in English | MEDLINE | ID: covidwho-818693

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 , COVID-19 , 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 , SARS-CoV-2 , Urologic Surgical Procedures/trends , Urology/standards , Urology/trends , Workflow
10.
Urol Oncol ; 39(5): 298.e7-298.e11, 2021 05.
Article in English | MEDLINE | ID: covidwho-779731

ABSTRACT

OBJECTIVES: To assess potential nosocomial coronavirus disease-2019 (COVID-19) transmission in patients who underwent robot-assisted laparoscopic procedures during the pandemic. MATERIAL AND METHODS: Prospective study in patients undergoing robot-assisted laparoscopy in urology or gynaecology within 2 academic hospitals. Patients underwent local preoperative COVID-19 screening using a symptoms questionnaire. Patients with suspicious screening underwent coronavirus real time-polymerase chain reaction (RT-PCR) and were excluded from robotic surgery if positive. Patients with symptoms postsurgery were systematically tested for coronavirus by RT-PCR. One-month postsurgery, all patients had a telephone consultation to evaluate COVID-19 symptoms. RESULTS: Sixty-eight patients underwent robotic surgery during the study period (median age: 63-years [IQR: 53-70], 1.8 male: female ratio). Oncology was the main indication for robotic surgery (n = 62, 91.2%) and 26 patients (38.2%) received a chest CT-scan prior to surgery. Eleven patients (16.2%) were symptomatic after surgery of whom only 1 tested positive for coronavirus by RT-PCR (1.5%) and was transferred to COVID-19 unit with no life-threatening condition. No attending surgeon was diagnosed with COVID-19 during the study. CONCLUSIONS: Robot-assisted laparoscopic surgery seemed safe in the era of COVID-19 as long as all recommended precautions are followed. The rate of nosocomial COVID-19 transmission was extremely low despite the fact that we only used RT-PCR testing in symptomatic patients during the preoperative work-up. Larger cohort is needed to validate these results.


Subject(s)
COVID-19/transmission , Cross Infection/diagnosis , Robotic Surgical Procedures/methods , SARS-CoV-2/isolation & purification , Surveys and Questionnaires/statistics & numerical data , Academic Medical Centers , Aged , COVID-19/epidemiology , COVID-19/virology , Female , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/statistics & numerical data , Humans , Laparoscopy/methods , Male , Middle Aged , Pandemics/prevention & control , Postoperative Period , Prospective Studies , Robotic Surgical Procedures/statistics & numerical data , SARS-CoV-2/physiology , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data
12.
J Robot Surg ; 14(6): 917-920, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-657356

ABSTRACT

Health care has changed in unprecedented ways since the first reported cases of COVID-19. With global case rates continuing to rise and government restrictions beginning to loosen, many worry that a second wave in our future. In many hospitals around the world, non-emergent surgeries were put on hold as hospitals were transformed into COVID centers. As surgeons and administrators do their best to reinstate non-emergent procedures, guidance is sought from any and all reliable sources. Robotic surgery has many known and demonstrated benefits over open surgery and often over conventional laparoscopy. In this commentary, we aim to highlight some of the advantages robotic surgery may offer during this uniquely challenging time in health care.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/trends , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Health Care Rationing/trends , Health Services Accessibility/trends , Humans , Infection Control/trends , Perioperative Care/methods , Perioperative Care/trends , Pneumonia, Viral/transmission , Robotic Surgical Procedures/methods , SARS-CoV-2
14.
Rev. Col. Bras. Cir ; 47: e20202558, 2020. graf
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-613684

ABSTRACT

RESUMO A infecção pelo coronavírus determinante da doença COVID-19, também conhecida como SARS-COV2 foi classificada nos últimos meses como pandemia. Essa é potencialmente fatal, representando enorme problema de saúde mundial. A disseminação, após provável origem zoonótica na cidade de Wuhan, China, resultou em colapso do sistema de saúde de diversos países, alguns com enorme impacto social e número grande de mortes descritas na Itália e Espanha. Medidas extremas intra e extra-hospitalares têm sido implementadas a fim de conter a transmissão e disseminação da COVID-19. No âmbito cirúrgico, enorme quantidade de procedimentos considerados não essenciais ou eletivos foram prorrogados ou suspensos até resolução da pandemia. No entanto, cirurgias de urgência e oncológicas não permitem que o paciente espere. Nesta publicação, sugerimos e ensinamos adaptação a ser feita com materiais de uso corriqueiro em laparoscopias para evitar a contaminação ou a disseminação entre as equipes assistenciais e os pacientes.


ABSTRACT The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Surgical Procedures, Operative/standards , Laparoscopy/methods , Coronavirus Infections/prevention & control , Aerosols/adverse effects , Pandemics/prevention & control , Robotic Surgical Procedures/methods , Operating Rooms/methods , Pneumoperitoneum, Artificial/standards , Protective Devices/standards , Surgical Instruments/standards , Punctures/methods , Disease Transmission, Infectious/prevention & control , Betacoronavirus , SARS-CoV-2 , COVID-19 , Intraoperative Period
15.
J Robot Surg ; 14(6): 909-911, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-598631

ABSTRACT

Potential risks of COVID-19 spread during minimally invasive procedures caused several concerns among surgeons, despite the lack of high-level evidence. Urological robotic and laparoscopic surgery is performed in elective setting in almost all occasions, thus allowing adequate planning and stratification. Two high-volume urological centers in Italy performed 77 robotic and laparoscopic surgeries during the "lockdown" period and adopted various strategies to prevent contamination. First of all, all patients were tested negative with nasopharyngeal swab before the surgical intervention. Patients and personnel were provided adequate personal protective equipment and intraoperative strategies to prevent smoke formation and pneumoperitoneum spread were adopted. No patients nor staff members tested positive for COVID-19 during a 15-day follow-up period. In conclusion, minimally invasive urologic surgery can be safely performed during the pandemic period with adequate planning. We believe that renouncing the benefits of it would be counterproductive, especially in a scenario of long-lasting cohabitation with the virus.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Laparoscopy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Female , Follow-Up Studies , Hospitals, High-Volume , Humans , Italy , Male , Middle Aged , Outcome Assessment, Health Care , Pneumonia, Viral/transmission , SARS-CoV-2
17.
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 , COVID-19 , Clinical Decision-Making , Endoscopy/methods , Humans , Laparoscopy/methods , Neoplasm Grading , Neoplasm Staging , Pandemics , Robotic Surgical Procedures/methods , SARS-CoV-2 , Urologic Diseases/surgery , Urologic Neoplasms/pathology , Urologic Surgical Procedures/methods
18.
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
19.
Surg Laparosc Endosc Percutan Tech ; 30(5): e28-e29, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-518295

ABSTRACT

The wide and fast spread of COVID-19 around the world has led to a dramatic increase in the need for protection products both for carers and for populations. Surgical team protection includes a systematic screening of patients, wearing protection devices by all the operating staff, and adequate management of aerosols. The risk of aerosol dispersal is particularly high during laparoscopic and robotic surgeries due to the interaction between circulating CO2 and surgical smoke that may contain small viral particles. To decrease the risk of virus transmission, many recommendations have been implemented including the use of integrated insufflation devices comprising smoke evacuation and filtration mode. Such devices are lacking in many centers around the world and to overcome this urgent unmet need, we designed a cost-effective filtrating suction as a more readily available alternative.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Laparoscopy/methods , Pneumonia, Viral/epidemiology , Robotic Surgical Procedures/methods , Smoke , Aerosols , COVID-19 , Cost-Benefit Analysis , Disease Transmission, Infectious , Equipment Design , Humans , Hydroxyethylrutoside , Laparoscopy/economics , Pandemics , Robotic Surgical Procedures/economics , SARS-CoV-2 , Suction/economics , Suction/methods
20.
J Robot Surg ; 14(5): 795-797, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-209449

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic poses an immense threat to healthcare systems worldwide. At a time when elective surgeries are being suspended and questions are being raised about how the remaining procedures on COVID-19 positive patients can be performed safely, it is important to consider the potential role of robotic assisted surgery within the current pandemic. Recently, several robotic assisted surgery societies have issued their recommendations. To date, however, no specific recommendations are available for cardiothoracic robotic assisted surgery in COVID-19 positive patients. Here, we discuss the potential risks, benefits, and preventive measures that need to be taken into account when considering robotic assisted surgery for cardiothoracic indications in patients with confirmed COVID-19. It is suggested that robotic assisted surgery might have various advantages such as early recovery after surgery, shorter hospital stay, and reduced loss of blood and fluids as well as smaller incisions. However, electrosurgical and ultrasonic devices, as well as CO2 insufflation should be managed with caution to prevent the risk of aerosolization of viral particles.


Subject(s)
Cardiac Surgical Procedures/methods , Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/methods , COVID-19 , Cardiac Surgical Procedures/statistics & numerical data , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Elective Surgical Procedures/statistics & numerical data , Female , Humans , Infection Control/organization & administration , Length of Stay , Male , Occupational Health/statistics & numerical data , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Robotic Surgical Procedures/statistics & numerical data
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