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Hayashi Y, Ishii Y, Ishida T, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Takahashi T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study. MINIM INVASIV THER 2023; 32:183-189. [PMID: 37288765 DOI: 10.1080/13645706.2023.2211661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 06/09/2023]
Abstract
Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.
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Affiliation(s)
- Yoshinori Hayashi
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Tomo Ishida
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Chan KS, Lo HY, Shelat VG. Carbon footprints in minimally invasive surgery: Good patient outcomes, but costly for the environment. World J Gastrointest Surg 2023; 15:1277-1285. [PMID: 37555111 PMCID: PMC10405111 DOI: 10.4240/wjgs.v15.i7.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 07/21/2023] Open
Abstract
Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery (MIS). Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and mortality. MIS has become the first-line surgical intervention for some types of gastrointestinal surgery, such as laparoscopic cholecystectomy and appendicectomy. Carbon dioxide (CO2) is the main gas used for insufflation in MIS. CO2 contributes 9%-26% of the greenhouse effect, resulting in global warming. The rise in global CO2 concentration since 2000 is about 20 ppm per decade, up to 10 times faster than any sustained rise in CO2 during the past 800000 years. Since 1970, there has been a steady yet worrying increase in average global temperature by 1.7 °C per century. A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO2 emission per surgery, with higher CO2 emission following robotic compared to laparoscopic surgery. However, with superior benefits of MIS over open surgery, this poses an ethical dilemma to surgeons. A recent survey in the United Kingdom of 130 surgeons showed that the majority (94%) were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental sustainability. Given the deleterious environmental effects of MIS, this study aims to summarize the trends of MIS and its carbon footprint, awareness and attitudes towards this issue, and efforts and challenges to ensuring environmental sustainability.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Hong Yee Lo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Ruhi-Williams P, Manasa M, Fazl Alizadeh R, Sullivan B, Kirby KA, Amin A, Nguyen NT. Impact of COVID-19 Pandemic on Management and Outcomes of Acute Cholecystitis at US Academic Centers. J Am Coll Surg 2023; 237:87-93. [PMID: 37318137 DOI: 10.1097/xcs.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had wide-ranging effects on management of medical conditions. Many hospitals encountered staffing shortages, limited operating room availability, and shortage of hospital beds. There was increased psychological stress and fear of contracting COVID-19 infection, leading to delay in medical care for various disease processes. The objective of this study was to examine changes in management and outcomes attributed to the COVID-19 pandemic in patients presenting with acute calculus cholecystitis at US academic centers. STUDY DESIGN Using the Vizient database, patients with the diagnosis of acute calculus cholecystitis who underwent intervention during the 15 months before the pandemic (prepandemic, October 2018 to December 2019) were compared with 15 months during the pandemic (pandemic, March 2020 to May 2021). Outcomes measures included demographics, characteristics, type of intervention, length of stay, in-hospital mortality, and direct cost. RESULTS There were 146,459 patients with acute calculus cholecystitis identified (prepandemic: 74,605 vs pandemic: 71,854). Patients in the pandemic group were more likely to undergo medical management (29.4% vs 31.8%; p < 0.001) or percutaneous cholecystostomy tube placement (21.5% vs 18%; p < 0.001) and less likely to undergo laparoscopic cholecystectomy (69.8% vs 73.0%; p < 0.001). Patients in the pandemic group who underwent procedural intervention had longer length of stay (6.5 days vs 5.9 days; p < 0.001), higher in-hospital death (3.1% vs 2.3%; p < 0.001), and higher cost ($14,609 vs $12,570; p < 0.001). CONCLUSIONS In this analysis of patients with acute calculus cholecystitis, there were distinct changes in the management and outcomes of patients due to the COVID-19 pandemic. Changes in the type of intervention and outcomes are likely related to delayed presentation with increases in the severity and complexity of the disease.
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Affiliation(s)
- Perisa Ruhi-Williams
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Morgan Manasa
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Reza Fazl Alizadeh
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Brittany Sullivan
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Katharine A Kirby
- University of California Irvine, Center for Statistical Consulting, Department of Statistics, Irvine, CA (Kirby)
| | - Alpesh Amin
- University of California Irvine Medical Center, Department of Medicine, Orange, CA (Amin)
| | - Ninh T Nguyen
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
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Chaves CER, Girón F, Núñez-Rocha RE, Benítez E, Ruiz S, Rodríguez L, Ayala D, Villamil CJ, Galvis V, Vanegas M, Gómez M, Nassar R, Hernández JD, Conde D, Zuleta MG. Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study. BMC Surg 2023; 23:56. [PMID: 36918843 PMCID: PMC10011775 DOI: 10.1186/s12893-023-01933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. STUDY DESIGN A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. RESULTS 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado's score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02-0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54-0.86). CONCLUSION Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia.
| | - Felipe Girón
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Elkin Benítez
- School of Medicine, Fundación Universitaria Juan N. Corpas, Bogotá D.C, Colombia
| | - Saralia Ruiz
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Lina Rodríguez
- School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia
| | - Daniela Ayala
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Valentina Galvis
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Marco Vanegas
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Mónica Gómez
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | - Ricardo Nassar
- Department of Surgery, Fundación Santa Fé de Bogotá, Bogotá D.C, Colombia.,School of Medicine, Universidad de los Andes, Bogotá D.C, Colombia.,School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia
| | | | - Danny Conde
- School of Medicine, Universidad del Rosario, Bogotá D.C, Colombia.,Hospital Universitario Mayor, Méderi, Universidad El Rosario, Bogotá D.C, Colombia
| | - María Gómez Zuleta
- Department of Surgery and Specialties, Pontificia Universidad Javeriana, Cra 6A #51A-48, 110100, Bogotá D.C, Colombia
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Laguardia GCDA, Püschel VADA, Oliveira PPD, Faria LRD, Cavalcante RB, Coelho ADCO, Santos KBD, Carbogim FDC. Control of airborne particles in surgical procedures during the Covid-19 pandemic: scoping review. Rev Esc Enferm USP 2022; 56:e20210579. [PMID: 35899926 PMCID: PMC10111397 DOI: 10.1590/1980-220x-reeusp-2021-0579en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the technical and managerial strategies for the management and reduction of airborne particles production in surgical procedures settings during the Covid-19 pandemic. METHOD Scoping review, according to the Joana Briggs Institute methodology, based on documents indexed in MEDLINE, VHL, CINAHL Cochrane, Embase, Scopus, Web of Science, and gray literature, published in Portuguese, English, or Spanish. All studies from indexed scientific journals and recommendations published by international agencies or academic associations from 2019 to January 2022 were considered. Findings were summarized and analyzed using descriptive statistics and narrative synthesis. RESULTS Twenty-two studies were selected, 19 of which were published in English, two in Spanish, one in Portuguese, with a predominance of literature reviews. Findings were categorized into recommendations for the environment, the team, and the surgical technique. CONCLUSION The review mapped the technical and managerial strategies for the management and reduction of the airborne particles production in surgical procedures settings. They involve from the use of personal protective equipment, training, anesthetic modality, airway manipulation, to the execution of the surgical technique.
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Affiliation(s)
| | - Vilanice Alves de Araújo Püschel
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
| | | | | | | | | | - Kelli Borges Dos Santos
- Universidade Federal de Juiz de Fora, Faculdade de Enfermagem, Juiz de Fora, MG, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
| | - Fábio da Costa Carbogim
- Universidade Federal de Juiz de Fora, Faculdade de Enfermagem, Juiz de Fora, MG, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
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6
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Ortenzi M, Balla A, Botteri E, Lepiane P, Guerrieri M, Arezzo A, Sartori A. COVID-19 pandemic: is it time for shared surgical guidelines? A systematic review of the literature. Minerva Surg 2022; 77:171-179. [PMID: 35416005 DOI: 10.23736/s2724-5691.21.09166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The recent COrona Virus Disease 2019 (COVID-19) pandemic caused a massive disruption of surgical activity and after a year from its first outbreak surgeons still struggle to keep their regular activity coexisting with the virus exhausting requests of healthcare resources. The aim of this paper is to offer a comprehensive overview of the most important recommendations by the International Guidelines about general surgery, and possibly to invite building common shared guidelines to preserve the potential to provide surgical assistance despite the pandemic. EVIDENCE ACQUISITION This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. PubMed, Embase, Cochrane and Web of Science databases were searched. EVIDENCE SYNTHESIS The searches revealed a total of 18579 articles published up to the end of February 2021. Five articles published between March and May 2020, were included in the present study: Guidelines from The European Society of Trauma and Emergency Surgery (ESTES), The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and The European Association for Endoscopic Surgeons (EAES), The Endoscopic and Laparoscopic Surgeons of Asia (ELSA), The European Hernia Society (EHS) and The International Organization for the Study of Inflammatory Bowel Disease (IOS-IBD). CONCLUSIONS In the likely scenario that the SARS-CoV-2 pandemic will become an endemic chronic problem, we should not be forced to choose between COVID-19 or surgery in the future and find a way to make both coexisting.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy -
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili, Montichiari Hospital, Montichiari, Brescia, Italy
| | - Pasquale Lepiane
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna Hospital, Montebelluna, Treviso, Italy
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Balla A, Saraceno F, Di Saverio S, Di Lorenzo N, Lepiane P, Guerrieri M, Sileri P. Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study. Updates Surg 2022; 74:1017-1025. [PMID: 35322388 PMCID: PMC8942758 DOI: 10.1007/s13304-022-01274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
Abstract
During the corona virus disease 2019 (COVID-19) pandemic, most of the surgical procedures were performed for emergencies or oncologic reasons to the detriment of the remaining elective procedures for benign conditions. Ileostomy or colostomy creation are sequelae of oncologic or emergency colorectal surgery, but their closure does not fall within the definition of oncologic or emergency surgery. The aim of this retrospective multicentre observational study is to report the impact of COVID-19 pandemic on the ostomy closure rate in Italy. Data regarding ileostomy and colostomy creation and closure from 24 Italian centres, during the study period (March 2020–February 2021) and during the control period (March 2019–February 2020) were collected. Three hospitals (12.5%) were COVID free. The number of colostomies and ileostomies created and closed in the same period was lower ( -18.8% and -30%, respectively) in the study period in comparison to the control period (p = 0.1915 and p = 0.0001, respectively), such as the ostomies closed in the analysed periods but created before (colostomy -36.2% and ileostomy -7.4%, p = 0.2211 and p = 0.1319, respectively). Overall, a 19.5% reduction in ostomies closed occurred in the study period. Based on the present study, a reduction in ostomy closure rate occurred in Italy between March 2020 and February 2021. During the pandemic, the need to change the clinical practice probably prolonged deterioration of quality of life in patients with ostomies, increasing number of stomas that will never be closed, and related management costs, even if these issues have not been investigated in this study.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Pierpaolo Sileri
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
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Sguanci M, Mandolfino F. Standardized perioperative practice in surgery during the covid-19 pandemic: a narrative review of the evidences. Minerva Surg 2022; 77:263-271. [PMID: 35175016 DOI: 10.23736/s2724-5691.22.09417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Coronavirus (Covid-19) pandemic activated a global health crisis. The best practice in operating room is a discussed argument. This review was performed to clarify the importance and effectiveness of standardized clinical practice (procedure, organization, guidance), identifying contemporary evidence deduced from some international experience. We decided to make a narrative review that analyses the most current shared guidelines and procedures in management of Covid-19 patients in perioperative theatre. EVIDENCE ACQUISITION Medline was searched using PubMed (from 1 April 2020 to 22 December 2020) for relevant study according with Prisma Guidelines. The studies were assessed and classified for levels of evidence and recommendation. Three factors were extracted: operating room organization, personnel safety and procedures. EVIDENCE SYNTHESIS 44 articles were identified: eleven met eligibility criteria: of these , four articles are expert opinion/experience/descriptive study, one is a multicentre/descriptive study and six are review/systematic review. 33 articles were excluded because didn't meet inclusion criteria. The studies selection is focused on clinical processes in the operating theatre, guidelines for the Operating Room safety, correct procedures for Personal Protective Equipement use, experience and recommendations related to COVID-19 context. CONCLUSIONS despite the modest number of studies and high-evidence, all the publications show agreement about many aspects of Operating Room practice. Global experiences selection confirms the role and the importance of a standardized practice in operating theatre instead personal interpretation; this study aims to provide a guidelines qualitative synthesis for all surgical staff, enclosing basic behaviours for the staff and patient safety in a complex assistant approach on a pandemic time.
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9
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Laguardia GCDA, Püschel VADA, Oliveira PPD, Faria LRD, Cavalcante RB, Coelho ADCO, Santos KBD, Carbogim FDC. Controle de partículas aéreas nos procedimentos cirúrgicos durante a pandemia da Covid-19: revisão de escopo. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0579pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Mapear as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas em ambientes de procedimentos cirúrgicos durante a pandemia da Covid-19. Método: Revisão de escopo, de acordo com metodologia do Joana Briggs Institute, a partir de documentos indexados nas bases MEDLINE, BVS, CINAHL Cochrane, Embase, Scopus, Web of Science e literatura cinza, publicados em português, inglês ou espanhol. Foram considerados todos os estudos provenientes de periódicos científicos indexados e recomendações publicadas por órgãos internacionais ou associações acadêmicas, de 2019 a janeiro de 2022. Os achados foram sumarizados e analisados por estatística descritiva e síntese narrativa. Resultados: Foram selecionados 22 estudos, sendo 19 publicados em inglês, dois em espanhol, um em português, com predominância de revisões da literatura. Os achados foram categorizados em recomendações para o ambiente, a equipe e a técnica cirúrgica. Conclusão: a revisão mapeou as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas nos ambientes de procedimentos cirúrgicos. Envolvem desde o uso de equipamentos de proteção individual, treinamentos, modalidade anestésica, manipulação de vias aéreas, até a execução da técnica cirúrgica.
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Affiliation(s)
| | - Vilanice Alves de Araújo Püschel
- Universidade de São Paulo, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
| | | | | | | | | | - Kelli Borges dos Santos
- Universidade Federal de Juiz de Fora, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
| | - Fábio da Costa Carbogim
- Universidade Federal de Juiz de Fora, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
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10
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Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic. BMC Surg 2021; 21:422. [PMID: 34915893 PMCID: PMC8675110 DOI: 10.1186/s12893-021-01432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers. Methods Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared. Results Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001. Conclusions Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.
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11
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Chia DKA, Lim Z, Ang JJ, Tambyah PA, Lau KSH, Ong J, Chow VTK, Allen DM, Fung J, Lau KJX, Luhung I, Schuster SC, Lee CN, Kim G, So JBY, Lomanto D, Shabbir A. Coronavirus viability in surgical plume and methods for safe disposal: a preclinical model. Br J Surg 2021; 109:15-20. [PMID: 34792098 DOI: 10.1093/bjs/znab385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022]
Abstract
Smoke generated by cautery devices used during surgery may contain infective particles and may cause transmission of airborne viruses. This study determines whether live viruses are present in surgical smoke and evaluates the effectiveness of several proposed methods of removal so as to improve safety of healthcare workers.
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Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Zhixue Lim
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, Department of Medicine, University Medical Cluster, National University Health System, Singapore
| | - Kelly S H Lau
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Joe Ong
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Vincent T K Chow
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - David M Allen
- Division of Infectious Diseases, Department of Medicine, University Medical Cluster, National University Health System, Singapore
| | - Javis Fung
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Kenny J X Lau
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Irvan Luhung
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Stephan C Schuster
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Chuen Neng Lee
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Davide Lomanto
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, National University Health System, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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12
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Foo FJ, Ho LML, Tan WJ, Koh FH, Sivarajah SS, Park SY, Chen WTL, Chew MH. Colorectal cancer surgery in Asia during the COVID-19 pandemic: A tale of 3 cities. Asian J Surg 2021; 45:1095-1100. [PMID: 34483046 PMCID: PMC8413487 DOI: 10.1016/j.asjsur.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/02/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The COVID-19 pandemic has put tremendous strain on healthcare systems. Surgical societies worldwide have advised minimizing non-essential surgeries in order to preserve hospital resources. Given the medical resources and COVID-19 incidence between countries across the world differ, so should colorectal practices. No formal guidelines have emerged from Asia. We wanted to find out what the current practice was in Asian colorectal centres outside China. Introduction The COVID-19 pandemic has significantly impacted surgical practice worldwide. At the time of the writing of this paper, there are over 4.2 million cases reported with deaths exceeding 290 000 patients.1 With an abrupt disruption to worldwide supply chains, societal lockdowns and surge of cases into many hospitals, resource allocation was diverted and prioritised for all COVID-19 related services. Methods A questionnaire survey of current colorectal practice was carried out involving 3 major colorectal cancer centres, one each from 3 major cities: Singapore, Taichung and Daegu. Components of the survey include infrastructure and manpower, case selection, surgical approach, operating room management and endoscopy practice. Results All 3 centres continued to provide standard-of-care colorectal cancer surgery despite the COVID-19 pandemic. Two centres deferred surgery for benign colorectal conditions. Minimally Invasive Surgery (MIS) was still the preferred approach when indicated but with protocolized precautions undertaken. Other services such as pelvic exenteration, TATME and pelvic lymph node dissection were still offered if oncologically indicated. Elective diagnostic endoscopy services have also continued in two centres. Conclusion Elective colorectal services continue to take place in the 3 surveyed Asian hospitals with heightened precautions. Provided there is adequate resource, colorectal cancer services should still continue to prevent consequences of neglecting or delaying cancer treatment. Practice should hence be tailored to the local resource of individual centres accordingly.
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Affiliation(s)
- Fung Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore
| | | | | | - Frederick H Koh
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore
| | | | - Soo Yeun Park
- Colorectal Cancer Centre, Kyungpook National University Medical Centre, Daegu, South Korea
| | | | - Min Hoe Chew
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore.
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13
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Tommaselli GA, Grange P, Ricketts CD, Clymer JW, Fryrear RS. Intraoperative Measures to Reduce the Risk of COVID-19 Transmission During Minimally Invasive Procedures: A Systematic Review and Critical Appraisal of Societies' Recommendations. Surg Laparosc Endosc Percutan Tech 2021; 31:765-777. [PMID: 34320592 PMCID: PMC8635252 DOI: 10.1097/sle.0000000000000972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The coronavirus 2019 pandemic and the hypothetical risk of virus transmission through aerosolized CO2 or surgical smoke produced during minimally invasive surgery (MIS) procedures have prompted societies to issue recommendations on measures to reduce this risk. The aim of this systematic review is to identify, summarize and critically appraise recommendations from surgical societies on intraoperative measures to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the operative room (OR) staff during MIS. METHODS Medline, Embase, and Google Scholar databases were searched using a search strategy or free terms. The search was supplemented with searches of additional relevant records on coronavirus 2019 resource websites from Surgical Associations and Societies. Recommendations published by surgical societies that reported on the intraoperative methods to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the OR staff during MIS were also reviewed for inclusion. Expert opinion articles were excluded. A preliminary synthesis was performed of the extracted data to categorize and itemize the different types of recommendations. The results were then summarized in a narrative synthesis. RESULTS Thirty-three recommendation were included in the study. Most recommendations were targeted to general surgery (13) and gynecology (8). Areas covered by the documents were recommendations on performance of laparoscopic/robotic surgery versus open approach (28 documents), selection of surgical staff (13), management of pneumoperitoneum (33), use of energy devices (20), and management of surgical smoke and pneumoperitoneum desufflation (33) with varying degree of consensus on the specific recommendations among the documents. CONCLUSIONS While some of the early recommendations advised against the use of MIS, they were not strictly based on the available scientific evidence. After further consideration of the literature and of the well-known benefits of laparoscopy to the patient, later recommendations shifted to encouraging the use of MIS as long as adequate precautions could be taken to protect the safety of the OR staff. The release and implementation of recommendations should be based on evidence-based practices that allows health care systems to provide safe surgical and medical assistance.
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14
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Minervini A, Di Maida F, Mari A, Porreca A, Rocco B, Celia A, Bove P, Umari P, Volpe A, Galfano A, Pastore AL, Annino F, Parma P, Greco F, Nucciotti R, Schiavina R, Esposito F, Romagnoli D, Leonardo C, Falabella R, Gallo F, Amenta M, Sciorio C, Verze P, Tafuri A, Pucci L, Varca V, Zaramella S, Pagliarulo V, Bozzini G, Ceruti C, Falsaperla M, Cafarelli A, Antonelli A. Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions. Cent European J Urol 2021; 74:259-268. [PMID: 34336248 PMCID: PMC8318031 DOI: 10.5173/ceju.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01–5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00–1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07–0.79). Conclusions Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.
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Affiliation(s)
- Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Angelo Porreca
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo Dipartimento di Scienze della Salute - Università degli Studi di Milano, Milano, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Paolo Umari
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Antonio Luigi Pastore
- Department of Medical-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome, Urology Unit ICOT, Latina, Italy
| | | | - Paolo Parma
- Urology Department, Ospedale Poma, Mantova, Italy
| | | | | | | | - Fabio Esposito
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Daniele Romagnoli
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | | | - Roberto Falabella
- Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | - Fabrizio Gallo
- Department of Urology, San Paolo Hospital, Savona, Italy
| | | | | | - Paolo Verze
- Department of Urology, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - Luigi Pucci
- Department of Urology, AORN A. Cardarelli, Naples, Italy
| | - Virginia Varca
- Hospital G. Salvini, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | | | - Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Carlo Ceruti
- SCDU Urologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
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15
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Jacob S, Hameed A, Lam V, Pang TC. Consistency of global recommendations regarding open versus laparoscopic surgery during the COVID-19 pandemic: a systematic review. ANZ J Surg 2021; 91:1358-1363. [PMID: 33792122 PMCID: PMC8250243 DOI: 10.1111/ans.16761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
Background Throughout the COVID‐19 pandemic, there has been worldwide debate regarding whether open surgery should be performed in preference to laparoscopic surgery due to the theoretical higher risk of viral aerosolization by the release of pneumoperitoneum. We aimed to assess the consistency of national and international surgical society recommendations regarding the choice of surgical approach; assess the quality of evidence of viral emission in surgical aerosol; and assess the quality of evidence comparing aerosol generation by different surgical energy devices. Methods A systematic review of PubMed, Medline, Embase and Cochrane databases was performed. Three search strategies were employed. Twenty‐eight studies were included in the final analysis and quality appraised. Confidence in review findings was assessed using the GRADE‐CERQual (Confidence in Evidence from Reviews of Qualitative research) tool. Results Worldwide recommendations regarding open versus laparoscopic surgery are consistent, with a majority recommending that surgical approach is decided on a case‐by‐case, risk minimization approach. There is limited, low‐quality evidence that viral particles can be emitted in surgical aerosol. There is a paucity of literature on the quantity of aerosol produced by different surgical energy devices, and no evidence to support the use of certain surgical instruments to minimize aerosol production. Conclusions There is considerable consistency among worldwide recommendations regarding the choice of surgical approach, although the evidence base is lacking. To inform clinical recommendations, further research examining viral emission, transmission, infectivity and amount of surgical aerosol produced is required.
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Affiliation(s)
- Susan Jacob
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tony Cy Pang
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
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16
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Serban D, Socea B, Badiu CD, Tudor C, Balasescu SA, Dumitrescu D, Trotea AM, Spataru RI, Vancea G, Dascalu AM, Tanasescu C. Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges. Exp Ther Med 2021; 21:519. [PMID: 33815592 DOI: 10.3892/etm.2021.9950] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
The present study investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of acute surgical abdomen. A retrospective study of emergency hospitalizations with a diagnosis of acute surgical abdomen between April and July 2020 vs. a similar period in 2019 was performed. The observation sheets and the operating protocols were analyzed. Between April and July 2020, 50 cases of acute surgical abdomen were hospitalized and treated, compared to 43 cases in the same period last year. The main types of pathology in both groups included: Occlusions (60%, respectively 44.2% in 2019) and peritonitis (32%, respectively 41.8% in 2019). There was an increased rate of patients with colorectal cancers neglected therapeutically or uninvestigated, who presented during the pandemic period with emergencies for complications such as occlusion or tumor perforation (32 vs. 6.97%, P=0.0039). One case, with gastric perforation, was COVID-positive, with no pulmonary symptoms at admission. The number of postoperative infectious complications was lower during the pandemic (2 vs. 13.95%, P=0.0461). As the COVID-19 pandemic appears to be still far from ending, we should learn to adapt our surgical protocols to the new evidence. Oncological patients are a vulnerable group, who were neglected in the first months of the pandemic. SARS-Cov-2 infection may be a cause of abdominal pain and should be taken into account in different diagnoses of acute abdomen in surgical wards. Correct wearing of adequate personal protective equipment (PPE) and respecting strict rules of asepsis and antisepsis are required for preventing in-hospital transmission of infection.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Fourth Department of Surgery, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Cristinel Dumitru Badiu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,General Surgery, Emergency Clinical Hospital 'Prof. Dr. Bagdasar Arseni', 041915 Bucharest, Romania
| | - Corneliu Tudor
- Fourth Department of Surgery, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
| | - Simona Andreea Balasescu
- Fourth Department of Surgery, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
| | - Dan Dumitrescu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Fourth Department of Surgery, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
| | - Andra Maria Trotea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Second Department of Anesthesia and Intensive Care, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania
| | - Radu Iulian Spataru
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Paediatric Surgery, Emergency Clinic Hospital for Children 'Maria S. Curie', 41451 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Third Department, 'Dr Victor Babes' Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ciprian Tanasescu
- Third Department of Surgery, Faculty of Medicine, 'Lucian Blaga' University Sibiu, 550169 Sibiu, Romania
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17
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Abstract
Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic. Supplementary Information The online version of this article (10.1007/s13304-021-01010-w) contains supplementary material, which is available to authorized users.
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18
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Rosenthal MG, Fakhry SM, Morse JL, Wyse RJ, Garland JM, Duane TM, Slivinski A, Wilson NY, Watts DD, Shen Y, Tabrizi MB. Where Did All the Appendicitis Go? Impact of the COVID-19 Pandemic on Volume, Management, and Outcomes of Acute Appendicitis in a Nationwide, Multicenter Analysis. ANNALS OF SURGERY OPEN 2021; 2:e048. [PMID: 37638248 PMCID: PMC10455274 DOI: 10.1097/as9.0000000000000048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/31/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The study objective was to evaluate effects of the COVID-19 pandemic on rates of emergency department (ED) acute appendicitis presentation, management strategies, and patient outcomes. Summary Background Data Acute appendicitis is the most commonly performed emergency surgery in the United States and is unlikely to improve without medical or surgical intervention. Dramatic reductions in ED visits prompted concern that individuals with serious conditions, such as acute appendicitis, were deferring treatment for fear of contracting COVID-19. Methods Patients from 146 hospitals with diagnosed appendicitis and arrival between March 2016 and May 2020 were selected. Electronic medical records data were retrospectively reviewed to retrieve patient data. Daily admissions were averaged from March 2016 through May 2019 and compared with March 2020. April-specific admissions were compared across the 5-year pre-COVID-19 period to April 2020 to identify differences in volume, demographics, disease severity, and outcomes. Results Appendicitis patient admissions in 2020 decreased throughout March into April, with April experiencing the fewest admissions. April 2020 experienced a substantial decrease in patients who presented with appendicitis, dropping 25.4%, from an average of 2030 patients (2016-2019) to 1516 in 2020. An even greater decrease of 33.8% was observed in pediatric patients (age <18). Overall, 77% of the 146 hospitals experienced a reduction in appendicitis admissions. There were no differences between years in percent of patients treated nonoperatively (P = 0.493) incidence of shock (P = 0.95), mortality (P = 0.24), or need for postoperative procedures (P = 0.81). Conclusions Acute appendicitis presentations decreased significantly during the COVID-19 pandemic, while overall management and patient outcomes did not differ from previous years. Further research is needed focusing on putative explanations for decreased hospital presentations unrelated to COVID-19 infection and possible implications for surgical management of uncomplicated acute appendicitis.Keywords: acute appendicitis, COVID-19, decreasing volumes, multicenter study.
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Affiliation(s)
| | - Samir M. Fakhry
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Jennifer L. Morse
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Ransom J. Wyse
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Jeneva M. Garland
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | | | | | - Nina Y. Wilson
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Dorraine D. Watts
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Yan Shen
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
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19
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Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era. Surg Endosc 2021; 36:1243-1250. [PMID: 33616729 PMCID: PMC7899056 DOI: 10.1007/s00464-021-08394-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Background Surgical smoke during operation is a well-known health hazard for medical staff. This study aimed to investigate the dynamics of surgical smoke during open surgery or laparoscopic surgery for colorectal disease. Methods This study quantitated particulate matter (PM) counts as part of surgical smoke in 31 consecutive patients who underwent colectomy at the Niigata City General Hospital using a laser particle counter. Particles were graded by size as ≤ 2.5 μm PM (PM2.5) or > 2.5 μm PM (large PM). Operative procedures were categorized as either open surgery (n = 14) or laparoscopic surgery (n = 17). Results The median patient age was 72 (range 41–89) years and 58.1% were male. The total PM2.5, PM2.5 per hour, and maximum PM2.5 per minute counts during operation were significantly higher in open surgery than in laparoscopic surgery (P = 0.001, P < 0.001, and P = 0.029, respectively). Large PM counts (total, per hour, and maximum per minute) were also higher in the open surgery group than in the laparoscopic surgery group. The maximum PM2.5 concentration recorded was 38.6 µm/m3, which is considered “unhealthy for sensitive groups” according to the U.S. Environment Protection Agency air quality index standards, if it was a 24-h period mean value. Conclusion Exposure to surgical smoke is lower during laparoscopic surgery than during open surgery for colorectal diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08394-1.
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20
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Agrawal V, Yadav SK, Agarwal P, Sharma D. Strategies for Optimizing the Use of PPE During Surgery in COVID-19 Pandemic: Rapid Scoping Review of Guidelines. Indian J Surg 2021; 83:17-27. [PMID: 33424182 PMCID: PMC7785932 DOI: 10.1007/s12262-020-02713-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022] Open
Abstract
Personal protective equipment (PPE) plays a fundamental role in the prevention of spread to Health Care Professionals (HCP) ; especially in a surgical setting. This scoping review of surgery guidelines was performed to appraise the quality of appropriate PPE recommendations and propose a strategy to optimize the PPE usage. This rapid scoping review of guidelines on surgery during COVID-19 was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Important databases were searched from January 1, 2020 to July 31, 2020, for relevant studies produced by a national/international academic association/organization, in English literature, using relevant keywords. Quality of evidence was graded according to GRADE guidelines. The searches yielded a total of 1725 studies, out of these 41 guidelines on surgery during COVID-19 matching with pre-defined criteria were evaluated. The level of evidence was uniformly rated "low," as assessed by GRADE guidelines and recommendations provided by them were mostly non-specific covering a narrow range of items. The crucial issue of optimization of PPE was not addressed at all. Economic implications demand optimization of PPE and conservation of resources. A simple decision-making algorithm addressing all the limitations of guidelines can be constructed, which allows HCPs to safeguard themselves and at the same time optimize/ conserving resources.
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Affiliation(s)
- Vikesh Agrawal
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Sanjay Kumar Yadav
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Pawan Agarwal
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
| | - Dhananjaya Sharma
- Pediatric Surgery Division, Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, 482002 India
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Nishida Y, Otagiri N, Tauchi K. Emergency abdominal surgeries remain unchanged in the COVID-19 affected environment: A single-center experience at a community hospital in Japan. Acute Med Surg 2021; 8:e623. [PMID: 33510897 PMCID: PMC7814991 DOI: 10.1002/ams2.623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 01/19/2023] Open
Abstract
Aim This study assessed whether emergency abdominal surgeries were changed in the coronavirus disease (COVID‐19)‐affected environment at a community hospital in Japan, with the goal of planning and preparing hospital resources against the further spread of COVID‐19. Methods A total of 179 patients who underwent emergency abdominal surgery over 4 months during the pandemic (1 March, 2020 to 30 June, 2020) and a control period (1 March, 2019 to 30 June, 2019) were enrolled in this retrospective study. Patient demographics, hospital visiting patterns (visit time, ambulance transport, and duration of symptom onset to hospital visit), severity of patients’ condition, and surgical characteristics were compared between the two periods. Results The number of patients undergoing emergency abdominal surgery during the pandemic did not decrease in comparison to the control period (89 patients versus 90 patients). The duration of symptom onset to hospital visit during the pandemic was not prolonged compared to the control period. Other hospital visiting patterns, severity of patients’ condition, and surgical characteristics were also similar in both periods. Conclusion Although the situation of the pandemic was different between countries and regions, the number of emergency surgeries in our hospital remained unchanged, and those patients visited the emergency room no later than usual.
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EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic. Surg Endosc 2020; 35:1-17. [PMID: 33170335 PMCID: PMC7653984 DOI: 10.1007/s00464-020-08131-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023]
Abstract
Background COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. Methods Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. Results A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. Conclusion The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems. Electronic supplementary material The online version of this article (10.1007/s00464-020-08131-0) contains supplementary material, which is available to authorized users.
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Fedorov AV, Kurganov IA, Emelyanov SI. [Surgical care during the new coronavirus (Covid-19) pandemic]. Khirurgiia (Mosk) 2020:92-101. [PMID: 33030009 DOI: 10.17116/hirurgia202009192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Safe and reasonable surgical care in the context of COVID-19 pandemic is difficult task. The main current issues are selection of patients for surgical treatment, principles of surgical treatment in cancer patients, possibilities of endoscopic surgery, organization of surgical department and operating theatre, surgical strategy in infected patients. Own experience and rational implementation of the recommendations developed by international research and practical communities are extremely important for optimizing surgical treatment of patients in a pandemic, as well as for ensuring the safety of patients and medical staff.
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Affiliation(s)
- A V Fedorov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - I A Kurganov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S I Emelyanov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Rapid Scoping Review of Laparoscopic Surgery Guidelines During the COVID-19 Pandemic and Appraisal Using a Simple Quality Appraisal Tool "EMERGE". Indian J Surg 2020; 82:930-940. [PMID: 32958987 PMCID: PMC7494978 DOI: 10.1007/s12262-020-02596-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
The theoretical danger of virus transmission during laparoscopic surgery (LS) via surgical smoke and laparoscopy gas has led to the formulation of many guidelines during the COVID-19 pandemic. This rapid scoping review of these guidelines was done to assess the quality of their evidence and appraise them for their impact on surgical services from the global south. A simple quality appraisal tool was constructed which can be used to evaluate rapidly emerging guidelines for evidence as well as for the needs of the global south. This rapid scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Electronic databases were searched with predefined strategy and retrieved papers were screened according to relevant criteria. A simple objective tool to assess the quality of rapidly emerging guidelines including evidence, methodology, ease, resource optimization, geography, and the economy was constructed. Twenty studies met the inclusion criteria. None of the guidelines qualified to be evidence-based clinical practice guidelines as the level of evidence was uniformly rated “low”. A newly constructed tool showed good validation, reliability, and internal consistency. This rapid scoping review found two major research gaps: lack of systematic review of evidence during their development and insufficient weightage of their impact on surgical services from the global south. These significant issues were addressed by constructing a simple and more representative tool for evaluating rapidly emerging guidelines which also gives the rightful importance of their impact on surgical services from the global south.
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Serban D, Smarandache CG, Tudor C, Duta LN, Dascalu AM, Aliuș C. Laparoscopic Surgery in COVID-19 Era-Safety and Ethical Issues. Diagnostics (Basel) 2020; 10:E673. [PMID: 32899885 PMCID: PMC7555582 DOI: 10.3390/diagnostics10090673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
(1) Background: The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery. (2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until 10 July. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 030167 Bucharest, Romania; (C.G.S.); (A.M.D.)
- IVth Department of Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.N.D.); (C.A.)
| | - Catalin Gabriel Smarandache
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 030167 Bucharest, Romania; (C.G.S.); (A.M.D.)
- IVth Department of Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.N.D.); (C.A.)
| | - Corneliu Tudor
- IVth Department of Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.N.D.); (C.A.)
| | - Lucian Nicolae Duta
- IVth Department of Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.N.D.); (C.A.)
| | - Ana Maria Dascalu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 030167 Bucharest, Romania; (C.G.S.); (A.M.D.)
| | - Cătălin Aliuș
- IVth Department of Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.N.D.); (C.A.)
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Sanmugam A, Vythilingam G, Singaravel S, Nah SA. Assess, adapt and act: a paediatric surgery division’s initial approach in a rapidly evolving pandemic. Pediatr Surg Int 2020; 36:925-931. [PMID: 32594243 PMCID: PMC7320241 DOI: 10.1007/s00383-020-04704-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period. METHODS We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties. RESULTS The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres. CONCLUSION Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.
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Affiliation(s)
- Anand Sanmugam
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ganesh Vythilingam
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Srihari Singaravel
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shireen Anne Nah
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kabir T, Kam JH, Chew MH. Cholecystectomy during the COVID-19 pandemic: Current evidence and an understanding of the 'new' critical view of safety: Correspondence. Int J Surg 2020; 79:307-308. [PMID: 32526267 PMCID: PMC7280106 DOI: 10.1016/j.ijsu.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore.
| | - Juinn Huar Kam
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Min-Hoe Chew
- Department of General Surgery, Sengkang General Hospital, Singapore
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Erol V, Sümer A, Savaş OA, Pekşen Ç, Gülay H, Aktimur R, Özmen MM. Recommendations for bariatric and metabolic surgical operations during the COVID-19 pandemic in Turkey. Turk J Surg 2020; 36:132-136. [PMID: 33015558 PMCID: PMC7515644 DOI: 10.5578/turkjsurg.4875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
The world has been struggling with the COVID-19 virus since December 2019. Turkey has also been battling with the virus since March 2019. While struggling with this unknown virus, we have postponed our new bariatric surgeries like most elective surgery. However, curfew and quarantine period (increase in food intake and decreased physical activity) increases risks for morbidity and mortality because of obesity and diabetes. When the pandemic decreases and disappears, many obesity patients will seek treatment for obesity and the workload of surgeons will increase. Before bariatric and metabolic surgery operations, which is the most effective treatment of obesity and related comorbidities, necessary precautions must be determined and implemented to protect patients and healthcare workers before and during surgery. In this review, it was aimed to determine the pre-peri and postoperative periods of bariatric surgical requirements. This review has been written on behalf of the Turkish Society for Metabolic and Bariatric Surgery as an initiative in order to answer some questions about bariatric and metabolic surgery during the COVID-19 pandemic.
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Affiliation(s)
- Varlık Erol
- Türk Metabolik ve Bariatrik Cerrahi Derneği Yönetim Kurulu Girişimi Adına
| | - Aziz Sümer
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Osman Anıl Savaş
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Çağhan Pekşen
- Başkent Üniversitesi Zübeyde Hanım Uygulama ve Araştırma Merkezi, Genel Cerrahi Bölümü, İzmir, Türkiye
| | - Hüseyin Gülay
- Türk Metabolik ve Bariatrik Cerrahi Derneği Yönetim Kurulu Girişimi Adına
| | - Recep Aktimur
- İstinye Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
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