Is it possible to continue academic teaching in surgery during the COVID pandemic era?

In the era of the novel coronavirus (COVID-19) pandemic, we critically appraised the literature by means of a systematic review on surgical education and propose an educational curriculum with the aid of available technologies. We performed a literature search on 10 May 2020 of Medline/PubMed, Embase, Google Scholar and major journals with specific COVID-19 sections. Articles eligible for inclusion contained the topic of education in surgery in the context of COVID-19. Specific questions we aimed to answer were: Is there any difference in surgical education from pre-COVID-19 to now? How does technology assist us in teaching? Can we better harness technology to augment resident training? Two-hundred and twenty-six articles were identified, 21 relevant for our aim: 14 case studies, three survey analyses, three reviews and one commentary. The collapse of the traditional educational system due to social distancing caused a fragmentation of knowledge, a reduced acquisition of skills and a decreased employment of surgical trainees. These problems can be partially overcome by using new technologies and arranging 2-weeks rotation shifts, alternating clinical activities with learning. While medical care will remain largely based on the interaction with patients, students' adaptability to innovation will be a characteristic of post-COVID classes.

Nasal lavage containing Angiotensin-Converting Enzyme-2 agonist can prevent and reduce viral load in COVID-19.

COVID-19 has been the talk of the year 2020, taking many lives and leaving others in critical conditions. It has clearly and severally been reported that the SARSCoV-2 uses the Angiotensin Converting Enzyme-2 receptors to penetrate and infect cells. Reports have also stated that the nasal and olfactory mucosa are overloaded with these receptors. We emphasize that anosmia in COVID-19 is secondary to the binding of the SARSCoV-2 to Angiotensin Converting Enzyme-2 receptors on the olfactory mucosa. A hypotheses pertaining to the presentation, diagnosis, management and possible prevention of SARS-CoV-2 is proposed. Given the high false negative rates of the polymerase chain reaction (PCR) tests, we suggest that COVID-19 negative patients with anosmia without any other nasal symptom should raise a high index of suspicion and should be further evaluated. We propose the formulation and use of Angiotensin Converting Enzyme-2 receptors agonist or angiotensin receptor blockers (ARBs) as nasal lavage, to reduce the viral load of confirmed positive patients, and as a mode of prevention, especially in high risk patients, until a vaccine is developed. These medications are readily available and testing this theory involves determination of the correct dosage of angiotensin receptor blockers or ACE inhibitors (via dilution in water) that can be used as nasal lavage and performing efficacy trials. Potential side effects to be monitored for include low blood pressure or changes in heart rate. Administration of a medicated nasal lavage may be easier and rapidly disseminated on the nasal mucosa.

The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review.

BACKGROUND: Surgical smoke is a well-recognized hazard in the operating room. At the beginning of the COVID-19 pandemic, surgical societies quickly published guidelines recommending avoiding laparoscopy or to consider open surgery because of the fear of transmission of SARS-CoV-2 through surgical smoke or aerosol. This narrative review of the literature aimed to determine whether there are any differences in the creation of surgical smoke/aerosol between laparoscopy and laparotomy and if laparoscopy may be safer than laparotomy. METHODS: A literature search was performed using the Pubmed, Embase and Google scholar search engines, as well as manual search of the major journals with specific COVID-19 sections for ahead-of-print publications. RESULTS: Of 1098 identified articles, we critically appraised 50. Surgical smoke created by electrosurgical and ultrasonic devices has the same composition both in laparoscopy and laparotomy. SARS-CoV-2 has never been found in surgical smoke and there is currently no data to support its virulence if ever it could be transmitted through surgical smoke/aerosol. CONCLUSION: If laparoscopy is performed in a closed cavity enabling containment of surgical smoke/aerosol, and proper evacuation of smoke with simple measures is respected, and as long as laparoscopy is not contraindicated, we believe that this surgical approach may be safer for the operating team while the patient has the benefits of minimally invasive surgery. Evidence-based research in this field is needed for definitive determination of safety.