As an aerosol generating procedures, laparoscopic surgery with pneumoperitoneum has got the potential to transmit COVID-19 virus to surgeons and other health care workers during surgery. Given a choice, should open surgery be done in COVID-19 positive patients? Apart from guidelines from professional bodies like SAGES, evidences are emerging regarding laparoscopic surgeries during COVID-19 pandemic. But there is still uncertainty regarding routine use of laparoscopic surgery in COVID-19 positive patients. Like what will be the preferred approach for acute appendicitis in a COVID-19 positive patient? Laparoscopy or open appendectomy?
If it is life threatening than surgery should be done otherwise it should be avoided. Leparosocipic surgery should be done in case of emergency
The question is interesting but it starts from the assumption that there is only one possible way of contagion. In reality this has not been fully proven. Between the two techniques, the laparoscopic one is less invasive, faster and therefore should involve less exposure and less risk ...
despite the fact that there is no clear evidence, in some situations it is probably worth thinking about the preference for open operations. For example, if the operation is long.
I agree with your valuable comments..but I had some comments..first is that the study performed before covid emerge..second ...the incidence of covid transmission in open many occur also even by diathermy usage... actually we had desufflated the abdomen in controlled way that minimize covid transmission...
It's a good question.There are many recommendation for laparoscopy in covid surgery. There is no trial or study on this topic .But we are doing all elective laparoscopy surgeries only after covid test negative . 3M respirators and smoke evacuation can help.Actually some publications say it is safe in laparoscopy than open surgery.
The recommendations cautioning against laparoscopy have significant implications for the practice of modern abdominal surgery, where laparoscopy is often an established, preferred and superior modality for operating. This is particularly the case for emergency gastrointestinal (GI) surgery and surgical oncology, domains which surgeons around the world are attempting to preserve despite the COVID-19 pandemic. In the authors’ centres in the United Kingdom, there has been anecdotal avoidance of laparoscopy surgery based on some guidelines.
Zaim Gashi
Thank you for your answer. On the basis of what recommendations is this position?
In civid + patient it is warthy to posponed cold surgery, if the ooe is an emergency one, lapariscopy with adeqiut precausion can be used if indecated.
I've practiced both open and laparoscopic surgery in COVID era.
With maintaining good precaution standards, both were safe.
Dear @ Oday Al-Asad
Both are safe during COVID, but which one is safer? Both can be done and we are doing both. But which can give more infection of COVID-19 to surgeons and other HCW. That is the million dollar question! Otherwise you are very right.
Dear @ Dr Zaim Gashi
Definitely agree with the cautious way adopted in your center. You have to be careful when performing surgery - both Open and laparoscopy during this pandemic. We don't know, which one is safer at the present moment. So better to be cautious.
Dear @ Professor Nashwan Q Mahgoob
Yes that is one approach we practice, but in COVID positive emergency patients we are doing open surgery. May be evidence are still evolving.
Dear @ Dr Manuneethi Thiyagarajan
Yes you are right in doing all elective surgeries by laparoscopic approach after COVID negative reports. Only concern is the false negative rate of 20% of RT-PCR test. So we have to be careful. Because full PPE is not always available and feasible.
Dear @ Dr Tamer A.A.M. Habeeb
Yes, desufflating in a controlled manner is a good option, but using a smoke evacuator is better. May be negative pressure OR is also good.
Dear Lileswar Kaman,
Your concern about false negative rates is very justified.
It varies with the day the test is done.
The probability of a false negative result decreases from 100% on Day 1 of being infected to 67% on Day 4. (Published May 13 -'Annals of Internal Medicine').
Hence the importance of caution in the interpretation of negative results. And the need to proceed carefully.
Dear @ Trevor J D’Netto
You are absolutely right. That is the reason we surgeons should be careful. Consider all surgeries as potential risk and take appropriate precautions. Thanks!
Dear @ Dr Matteo Nioi
You may be right. Many surgeons are recommending Laparoscopy, but Laparoscopy create more aerosols due to CO2 pneumoperitoneum. That is the main concern. Otherwise you have a valid point.
I'have practiced laparoscopic appendectomy during covid - 19 pandemic with PPE. If possible swab before. I dont have smoke evacuator.
Dear @ Dr Stefano Rossi
That was in COVID- 19 positive case or negative case? If positive what were the precautions taken? How did you dealt with the smoke and pneumoperitoneum at the end of the surgery? If negative I think we are doing laparoscopy.
In covid - 19 positive patients we use a dedicated opereting room, desufflating in a controlled manner.
Dear@Dr Stefano Rossi
Does your dedicated OR has negative pressure? And how do you sterilise your OR and operating instruments after doing a positive COVID-19 patient? Any surgeon got infected during this period?
our dedicated OR has not negative pressure (administration is working for this).
Yes, we also donot have negative pressure OR. Initial period of COVID 19 pandemic, there was a concern and recommendation for Negative pressure OR. But most of the hospital doesn’t have negative pressure OR, so it may not be absolutely necessary. Thanks!
Laparoscopic Surgery And The Debate On Its Safety During Covid-19 Pandemic: A Systematic Review Of Recommendations
Literature Review
- August 2020
- The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
- 📷Michael El Boghdady
- 📷Béatrice Marianne Ewalds-Kvist