EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic

Abstract

Background COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. Methods Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. Results A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. Conclusion The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

“…COVID-19 patients may potentially expose healthcare providers to the risk of contamination during surgical and anesthetic procedures [ 4 ], and positivity cases and some deaths are already occurring among health workers [ 5 , 6 ]. In this scenario, the surgical community had been pushed to rapidly understand how to deal with the virus's presence and organize the gradual resumption of surgical activity [ 7 ].…”

Re-Operative Laparoscopic Colorectal Surgery: A Systematic Review

“…Thirty (30) full-text articles were assessed for eligibility, and twenty-seven (27) articles were included for full-text reading. Seventeen (17) articles dated from 2007 to 2020 were included in the systematic review [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Five articles were conducted in South Korea, three in Italy, two in the Netherlands, two in Japan, two in the United States of America, one in Spain, one in Denmark, and one in Argentina.…”

“…This was by far the largest and most well-designed cohort study that offers quality data establishing the low mortality rate of laparoscopic management of complications in colorectal surgery. As one could expect, studies that did not investigate immediate complications [ 14 , 17 , 25 , 26 ] had zero mortality in the laparoscopic arm. This can be explained from the physiological status of the patients who underwent redo surgery, as it was mainly in an elective or semi-elective setting.…”

“…Conversion to open surgery was reported from 0% in various studies to 36.8%. Not surprisingly, the biggest conversion ratio (7/19) was in the laparoscopic redo IPAA arm of the Yellinek et al study [ 26 ]. As most studies addressed re-operative laparoscopic surgery on the basis of complications/recurrence, Akiyoshi et al [ 17 ], who looked at laparoscopic lateral pelvic lymph dissection for local recurrence, did not report any conversions to open surgery.…”

Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones

“…A recent multi-center study revealed that, in 28 patients, the effectiveness of percutaneous single-operator cholangioscopy using the SpyGlass for diagnostic and therapeutic indications may be considered as an alternative approach in clinical cases where gastrointestinal anatomy is altered or when ERCP has failed [ 13 ]. This system allows a direct visualization of the stones, reducing fluoroscopy time and permitting a less invasive and less traumatic method of the interventional radiology management of difficult bile stones that are not removable with other techniques.…”