- 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 ultra-filtration system should be used.
- Set electrocautery as low as possible.
- Laparoscopic ports should be adequately sealed prior to utilization and reassessed frequently during the procedure for leak.
- If ports develop leak, seals/ports should be changed as soon as safe to do so.
- Pneumoperitoneum should be safely evacuated before closure, trocar removal, specimen extraction or conversion to open:
- All ports should remain in situ and closed during the deflation procedure.
- Evacuator tubing should be placed to the least dependant port and the patient be repositioned to allow CO2 removal.
- All escaping CO2 gas and smoke should be captured with an ultra-filtration system and desufflation mode should be used if available.
- Extraction of surgical specimens should occur after the desufflation technique is completed.
- Hand-assisted surgery and suture closure devices should be avoided as it can lead to leakage.
These statements come from guidelines produced by the CAGS, SAGES and MSSS (Québec) on laparoscopic procedure in regard of the potential of aerosolization as a mode of transmission during minimally invasive surgery. From the current knowledge, SARS-CoV-2 has been found in the nasopharynx, upper and lower respiratory tracts, entire gastrointestinal tract, blood, bile and feces. Morris et al say that previous viral epidemics showed no viral transmission during laparoscopy procedure. They consider that, while smoke evacuation and filtration systems can be used in both laparoscopy and laparotomy, laparoscopy has the advantage of almost entirely contain the surgical plume in the abdominal cavity.
- Canadian Association of General Surgeons (CAGS). (March 24, 2020) Laparoscopy and the risk of aerosolization. Retrieved from https://cags-accg.ca/covid-19-update/resources/
- Ministère de la santé et services sociaux (MSSS). (April 7, 2020) Directives cliniques aux professionnels et au réseau pour la COVID-19 – Bloc opératoire. Retrieved from https://msss.gouv.qc.ca/professionnels/covid-19/directives-cliniques-aux-professionnels-et-au-reseau/bloc-operatoire/
- Morris S., Frader A., Milad M., et al (April 3, 2020) Understanding the “Scope” of the Problem: Why Laparoscopy is Considered Safe During the COVID-19 Pandemic, Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2020.04.002
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). (March 29, 2020) Resources for smoke & gas evacuation during open, laparoscopic, and endoscopic procedures. Retrieved from https://www.sages.org/resources-smoke-gas-evacuation-during-open-laparoscopic-endoscopic-procedures/