Laparoscopic surgery during the COVID-19 pandemic: detection of SARS-COV-2 in abdominal tissues, fluids, and surgical smoke

Abstract

Background There are still concerns over the safety of laparoscopic surgery in coronavirus disease 2019 (COVID-19) patients due to the potential risk of viral transmission through surgical smoke/laparoscopic pneumoperitoneum. Methods We performed a systematic review of currently available literature to determine the presence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in abdominal tissues or fluids and in surgical smoke. Results A total of 19 studies (15 case reports and 4 case series) comprising 29 COVID-19 patients were included. The viral RNA was positively identified in 11 patients (37.9%). The samples that tested positive include the peritoneal fluid, bile, ascitic fluid, peritoneal dialysate, duodenal wall, and appendix. Similar samples, together with the omentum and abdominal subcutaneous fat, tested negative in the other patients. Only one study investigated SARS-COV-2 RNA in surgical smoke generated during laparoscopy, reporting negative findings. Conclusions There are conflicting results regarding the presence of SARS-COV-2 in abdominal tissues and fluids. No currently available evidence supports the hypothesis that SARS-COV-2 can be aerosolized and transmitted through surgical smoke. Larger studies are urgently needed to corroborate these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02142-8.

Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy

“…But there has been a constant debate among the surgeons primarily due to the lack of a definitive evidence regarding the spread of the virus. 17 18 …”

Impact of COVID-19 on the outcomes of gastrointestinal surgery

“…Hence, many surgical societies recommended restricted use of laparoscopy and diathermy during the pandemic [16]. However, with accumulation of experience and clinical data analysis, it was found that there was no significant perioperative SARS-CoV-2 infection transmission among the patients and healthcare workers with laparoscopy [15,17,18]. Hence, the new recommendation was to perform laparoscopic surgeries using appropriate precautions such as personal protective equipments, smoke evacuation devices, if it was clearly beneficial to the patients and reduced their hospital stay [19,20].…”

“…Surgical smoke is considered to be one of the means of perioperative viral transmission based on the previous reports [21]. The SARS-CoV-2 virus has been found in the peritoneal fluid, bile, ascitic fluid and surgically resected specimens suggesting that the viruses are present in the operative field during the surgery [18,68]. But, the evidence to support that SARS-CoV-2 infection is transmitted by surgical smoke is lacking [15,17,18].…”

“…The SARS-CoV-2 virus has been found in the peritoneal fluid, bile, ascitic fluid and surgically resected specimens suggesting that the viruses are present in the operative field during the surgery [18,68]. But, the evidence to support that SARS-CoV-2 infection is transmitted by surgical smoke is lacking [15,17,18]. However, due to the theoretical concerns, it is recommended to use personal protective equipments and smoke evacuation devices, minimize aerosol generation, and avoid gas leaks to prevent perioperative SARS-CoV-2 transmission (Table 2) [16,19,20].…”

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

“…Im Verlauf der Pandemie hat sich zwar die Evidenzlage etwas gebessert, was jedoch aufgrund gegensätzlicher Ergebnisse zu keiner vermehrten Sicherheit geführt hat [ 3 ]. Es bleibt somit ein potenzielles Risiko der intraoperativen SARS-CoV-2-Transmission im Rahmen kolorektaler Eingriffe bestehen und somit sind die eingangs erwähnten Sicherheitsmaßnahmen weiterhin zu empfehlen.…”