Convert to open: the new paradigm for surgery during COVID-19?

Saverio, Salomone Di; Pata, Francesco; Khan, Mansoor A.; Ietto, Giuseppe; Zani, Elia; Carcano, Giulio

doi:10.1002/bjs.11662

Cited by 45 publications

(49 citation statements)

References 4 publications

(4 reference statements)

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“…Open surgeries, if needed, might be recommended and should be performed safely in most patients especially in acute care surgery, avoiding the creation of pneumoperitoneum and other smoke-generating and time-consuming maneuvers, which might increase the risk of aerosolization during laparoscopy. Establishing local institutional treatment algorithms or protocols based on international guidelines is essential to manage these patients properly [ 7 , 8 ]. In our case scenario, if we would have been faced with an uncontrollable bleeding with renal origin, we had also been challenged whether to treat it conservatively or with selective embolization or open surgery, as the last resort, depending mainly on the stability of the patient and the degree of bleeding.…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Renal Papillary Necrosis in a COVID-19-Positive Patient

Tallai

Gulistan

Alrayashi

et al. 2021

Case Reports in Urology

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In this case report we describe an unusual presentation of severe acute papillary necrosis in a COVID-19-positive patient. An emergency flexible ureteroscopy greatly helped in the establishment of the diagnosis. In the international literature, there is a paucity of intraoperative endoscopic images representing severe renal papillary necrosis. We present a case of severe acute renal papillary necrosis in a 49-year-old south-Asian, COVID-19-positive male patient who needed emergency urological intervention for macroscopic hematuria and urinary retention due to clot formation in the urinary bladder. The patient underwent emergency cystoscopy, clot evacuation, and by rigid and flexible ureteroscopy. The diagnosis was only confirmed in the postoperative period, retrospectively. Finally, the patient fully recovered due to the multidisciplinary management. Diagnosis of rare clinical entities can be sometimes challenging in the everyday routine practice. Having atypical clinical course, the surgeon should be prepared and sometimes must take responsible decisions promptly, even if needed intraoperatively, to manage unexpected findings in order to get the right diagnosis without compromising the patient’s safety.

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Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Renal Papillary Necrosis in a COVID-19-Positive Patient

Tallai

Gulistan

Alrayashi

et al. 2021

Case Reports in Urology

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“…However, this favors the aerosolization of the particles in the surgical smoke. For this reason, the recommendations during the COVID-19 pandemic are to use negative pressure or if not possible, at least to stop the positive pressure [6][7][8][9][10][11]54,55]. Spacing interventions with a 30 min to 1-h interval, depending on the ventilation possibilities, is also necessary to limit the possibility of contamination.…”

Section: Regulations For Increasing Safety In Laparoscopic Surgerymentioning

confidence: 99%

Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues

et al. 2020

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(1) Background:The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery.(2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until July 10th. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future.

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“…A tailored strategy to protect health workers and patients, avoiding unnecessary risks, is a priority. 4 , 5…”

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confidence: 99%