JMIR Publications

ABSTRACT

Background:

The current COVID19 pandemic is holding the world in its grip. Epidemiologist has shown that the mortality risks are higher when the health care system falls under the COVID19 pressure. It is, therefore, of great importance to keep health care providers (HCP) healthy and prevent contamination. An important group who will be confronted with the treatment of COVID19 positive patients are HCP during (semi) acute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery, therefore balancing the safety of HCP with the benefit of laparoscopic surgery for the patient.

Objective:

To provide an overview of potential contamination routes, possible risks for HCP, and propose research questions based on current literature and expert opinions about laparoscopic surgery on a COVID19 positive patient.

Methods:

We performed a scoping review adding five additional questions concerning possible contaminating routes. A systematic search was performed on Pubmed, CINAHL, and Embase databases adding results from gray literature as well. The search was not only for COVID-19 but extended with virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights into the available literature.

Results:

The initial search provide 2.007 records, after which 267 full-text papers were considered. Finally, we used 84 papers of which 14 were discussing SARS-CoV-2. Eight papers discuss the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience from 2003. Thirteen papers elaborate on the risks of intubation for the HCP and SARS-CoV-2 and 19 papers discuss this situation with other viruses. They conclude that there is significant evidence that in- and extubation is a high-risk aerosol producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of HPV, hepatitis B, polio, and rabies. There were no papers found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery.

Conclusions:

There seems to be consensus in the literature that in- and extubation is a high-risk procedure for the HCP and that maximum protective equipment is needed. On the other hand, minimal evidence is available discussing the actual risk of contamination of the HCP during laparoscopy itself. Neither on operating room pressure, surgical smoke, tissue extraction, nor CO2 deflation. But there are new studies published daily from current experiences and society statements are continuously updated. There seems no reason to abandon laparoscopic surgery over open surgery. But do not underestimate the risks, perform surgery on COVID-19 positive patients only when necessary, and keep using logical and common sense to protect yourself and others by performing surgery in a safe and protected environment.