Adaptations and Safety Modifications to Perform Safe Minimal Access Surgery (Minimally Invasive Surgery: Laparoscopy and Robotic) during the COVID-19 Pandemic

Abstract

It is inevitable that some patients with suspected or confirmed COVID-19 may require urgent surgical procedures. The objective of this review was to discuss the modifications required in the operating room during COVID-19 times for minimal access, laparoscopy, and robotic surgery, especially with regard to minimally invasive surgical instruments, buffalo filter, trocars with smoke evacuator, and special personal protection equipment. We have discussed the safety measures to be followed for the suspected or confirmed COVID-19 patient. In addition to surgical patients, health care workers should also protect themselves by following the guidelines and recommendations while treating these patients. Although there is little evidence of viral transmission through laparoscopic or open approaches, we recommend modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device use to reduce the risk of exposure to aerosolized particles to the health care team. Therefore, hospitals must follow specific protocols and arrange suitable training of the health care workers. Following well-established plans to accomplish un-deferrable surgeries in COVID-19–positive patients is strongly recommended.

Removal of a Giant Cyst of the Left Ovary from a Pregnant Woman in the First Trimester by Laparoscopic Surgery under Spinal Anesthesia during the COVID-19 Pandemic

“…Indirect evidence confirms that COVID-19 may cause miscarriage [8,22]. Miscarriages are typically observed with patients having the following COVID-19-like symptoms: fever, inflammation with cytokine storm affecting early implantation and placental function, and a hypercoagulative state during placental infarction [9,23,24]. According to the research [18][19][20], miscarriages were recorded in 38% of the cases (8 of 21).…”

“…General anesthesia with intubation induces a higher risk of COVID-19 infection compared to spinal anesthesia [9,20,21] in non-specialized centers [22]. A COVID-19 infection can cause teratogenic toxicity and miscarriage [17,18].…”

“…Of these women, 39% had a miscarriage and 7% had perinatal death. Research has not yet shown vertical virus transmission across the placenta to be proven [9,10,12,13,21].…”

“…Namely, as a minimally invasive procedure, laparoscopy decreases the risk of viral contamination by blood and of aerosol transmission through the upper airways during the operation, and, thanks to its shorter hospital stay, the post-operative risk of contamination. Performing laparoscopy specifically under regional anesthesia has the added advantage of sparing the need for sedatives, hypnotics, or other intensive care material, which are more prone to shortage during this pandemic [9]. The updated guidelines from the Society of American Gastroenterology and Endoscopic Surgeons and the European Association of Endoscopic Surgery states that "Although previous research has shown that laparoscopy can lead to aerosolization of blood-borne viruses, there is no evidence to indicate that this effect is seen with COVID-19, nor would it be isolated to minimally invasive surgery (MIS) procedures" [10].…”

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic

“…RA decreases the risk of virus transmission from patient to the medical personnel [ 81 , 82 , 83 ]. Furthermore, RA enables excellent communication between patient, anesthesiologist and surgical team [ 84 , 85 , 86 ].…”