Assessing the risk of viral infection from gases and plumes during intra‐abdominal surgery: a systematic scoping review

Gavin, Dominic J.; Wilkie, Bruce; Tay, Jia Ying Isaac; Loveday, Benjamin; Furlong, Timothy J.; Thomson, Benjamin

doi:10.1111/ans.16242

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…31,32 In 2020, a review of 24 studies found no evidence of SARS-2-CoV2 in surgical smoke associated with minimally invasive surgery. 33 An Australia and New Zealand group reviewed the evidence to June 2020 34 and found no reports of respiratory viruses or COVID-19 in peritoneal fluid.…”

Section: Is It Dangerous?mentioning

confidence: 99%

Clearing the air on surgical plume

Watters

Foran

McKinley³

et al. 2021

ANZ Journal of Surgery

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Background Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. Method This paper is a narrative review of potential risks, including any associated with COVID‐19, and options for mitigation. Results Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID‐19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID‐19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. Conclusion The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.

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Section: Is It Dangerous?mentioning

confidence: 99%

Clearing the air on surgical plume

Watters

Foran

McKinley³

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

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COVID-19 infection risk by open and laparoscopic surgical smoke: A systematic review of the literature

et al. 2021

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Background The current COVID-19 pandemic has greatly changed the way surgery is delivered. In particular, current guidelines and policies have highlighted the need to use high level Personal Protective Equipment to reduce the risk of viral infection during open and laparoscopic surgical procedures. In particular, it was felt that the laparoscopic approach was at higher risk of viral transmission due to the chimney effect of the smoke escape from the trocars during and after the procedure. However, with this being a new and largely unknown viral agent, guidelines have been based on speculation and extrapolation from previous studies conducted in completely different situations, and led to anxiety amongst surgeons and theatre staff. We decided to conduct a systematic review of the Literature to try to clarify whether inhalation of surgical smoke can increase the risk of COVID-19 infection. Methods A thorough search of the relevant Literature was performed following the PRISMA guidelines and the most relevant papers on this topic were selected for qualitative analysis. Duplicates, review, personal opinions and guidelines have been excluded. Quantitative analysis has not been performed due to the lack of homogeneous high-quality studies. Results Literature search identified 740 papers but only 34 of them were suitable for qualitative analysis. The quality of those studies is generally quite low. We were not able to find any evidence directly linking surgical smoke with viral transmission, other than in patients with active HPV infection. Discussion Inhalation of surgical smoke can be generally hazardous, and therefore the use of PPE during surgical operations must be recommended in any case. However, the present systematic review of the existent Literature did not identify any significant evidence of the risk of viral transmission with the surgical smoke, therefore the current guidelines restricting the use of laparoscopy and/or diathermy during the current Covid-19 pandemic may be considered excessive and non-evidence based.

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Assessing the risk of viral infection from gases and plumes during intra‐abdominal surgery: a systematic scoping review

Cited by 2 publications

References 25 publications

Clearing the air on surgical plume

Clearing the air on surgical plume

COVID-19 infection risk by open and laparoscopic surgical smoke: A systematic review of the literature

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