Surgery

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Surgery

Resources for managing surgery patients

10  articles in this collection
Written by Mathias Castonguay, Noémie Desgagnés, Audrey Mathieu, Philippe Mercier, 

Considerations for Gynecological Surgery

Limitation of surgical services Surgical services need to be limited in this setting. The decision to maintain or cancel a procedure depends on many factors: level of urgency, morbidity/mortality risks of contracting COVID-19 for the patient, impact on hospital bed capacity, risk of community transmission and access to PPE.  Urgent procedures cannot be cancelled: ruptured […]

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04/13/2020

Dermatological Surgery

Clinics should be triaged to review only urgent patients in person, and using telemedicine where possible. Consider cancelling all elective surgeries.  To minimize COVID-19 spread during office-based excisional surgery:  All surgical patients should be considered as potentially COVID-19 positive.  Smoke extractor systems are the most effective way to minimise risk. Using bipolar diathermy rather than […]

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04/16/2020

Colorectal Cancer: Management Suggestions

Regarding surveillance and follow-up: Telephone and telemedicine visits should replace routine in-clinic visits for nearly all patients. Minimize blood tests, scans and prescriptions. Strongly consider delaying routine surveillance scans and colonoscopies, as well as carcinoembryonic antigen (CEA) monitoring. In patients with metastatic disease and abnormal CEA, controlling CEA at intervals that scans would otherwise be […]

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04/19/2020

Urology Practice during the Outbreak

Urgent procedures that can be performed under local anesthesia are preferable considering the limited availability of anesthesiologists.  Gross hematuria should be treated to limit the use of blood derivatives. Non-deferrable oncological procedures should be planned while taking in consideration the patient comorbidity profile and the availability of intensive care beds. All procedures for benign diseases […]

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04/05/2020

Perioperative Management of Infected Patient

Management of the dedicated operating room(OR):  The OR should be adequately ventilated, ideally with negative pressure.  The same OR and the same anesthesia machine should be used for COVID-19 positive patients.  The anesthetic drug trolley should be kept in the induction room and all the drugs and equipment required for the procedure should be placed […]

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04/03/2020

Laparoscopy Procedure

Laparotomy should not be considered safer than laparoscopy in COVID-19 cases. Furthermore, laparotomy increase likelihood of prolonged hospital stays, intensive care stays and surgical complications. Although not well established, SAGES and CAGS recommend to assume that COVID-19 virus could be released in surgical smoke CO2 insufflation pressure should be kept to a minimum and an […]

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04/16/2020

Guidelines: Tracheotomy

Canadian Society of Otolaryngology-Head and Neck Surgery strongly advise against performing a tracheotomy in still infectious COVID-19 patients. In positive patients, requests for tracheotomy should generally not be considered regardless of duration of endotracheal intubation.  In emergency tracheotomy with unknown COVID-19 status:  Manage patient as if COVID-19 positive.  Intubation rather than tracheotomy is highly preferable. […]

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04/03/2020

Cancer Surgery in the Time of Pandemic

Cancer surgery patients should be considered “essential” and they should be among the last group of to be delayed.  In case a hospital cannot carry out non-emergency surgeries, a jurisdictional coordination should facilitate transfer care of cancer patients to less overwhelmed institutions, rather than delaying surgery.  In spite of that, triage of cancer surgery cases […]

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04/10/2020

Localized Breast Cancer: Management Suggestions

Telemedicine should be prioritized for most encounters.1,2 Timing of surgery is mostly dictated by available resources and risk of infection specific to each center, as evidence demonstrates that preoperative delays may overall impact on BC (breast cancer) outcomes if no neoadjuvant therapies are used.1 About neoadjuvant and adjuvant systemic therapies: All BC subtypes ongoing neoadjuvant […]

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04/16/2020

Endoscopy During COVID-19 Outbreak

Upper gastrointestinal (GI) endoscopy is a high-risk procedure.  All patients scheduled for endoscopy should be classified according to their risk of COVID-19 based on the presence of respiratory symptoms, risk contacts and recent travel.  AGA recommends wearing N95 instead of the surgical mask for upper and lower endoscopy. AGA recommends wearing double gloves for all endoscopies. Endoscopies should […]

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03/29/2020