1
|
Cizmic A, Eichel VM, Weidner NM, Wise PA, Müller F, Rompen IF, Bartenschlager R, Schnitzler P, Nickel F, Müller-Stich BP. Viral load of SARS-CoV-2 in surgical smoke in minimally invasive and open surgery: a single-center prospective clinical trial. Sci Rep 2023; 13:20299. [PMID: 37985848 PMCID: PMC10662446 DOI: 10.1038/s41598-023-47058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
At the beginning of the COVID-19 pandemic, it was assumed that SARS-CoV-2 could be transmitted through surgical smoke generated by electrocauterization. Minimally invasive surgery (MIS) was targeted due to potentially higher concentrations of the SARS-CoV-2 particles in the pneumoperitoneum. Some surgical societies even recommended open surgery instead of MIS to prevent the potential spread of SARS-CoV-2 from the pneumoperitoneum. This study aimed to detect SARS-CoV-2 in surgical smoke during open and MIS. Patients with SARS-CoV-2 infection who underwent open surgery or MIS at Heidelberg University Hospital were included in the study. A control group of patients without SARS-CoV-2 infection undergoing MIS or open surgery was included for comparison. The trial was approved by the Ethics Committee of Heidelberg University Medical School (S-098/2021). The following samples were collected: nasopharyngeal and intraabdominal swabs, blood, urine, surgical smoke, and air samples from the operating room. An SKC BioSampler was used to sample the surgical smoke from the pneumoperitoneum during MIS and the approximate surgical field during open surgery in 15 ml of sterilized phosphate-buffered saline. An RT-PCR test was performed on all collected samples to detect SARS-CoV-2 viral particles. Twelve patients with proven SARS-CoV-2 infection underwent open abdominal surgery. Two SARS-CoV-2-positive patients underwent an MIS procedure. The control group included 24 patients: 12 underwent open surgery and 12 MIS. One intraabdominal swab in a patient with SARS-CoV-2 infection was positive for SARS-CoV-2. However, during both open surgery and MIS, none of the surgical smoke samples showed any detectable viral particles of SARS-CoV-2. The air samples collected at the end of the surgical procedure showed no viral particles of SARS-CoV-2. Major complications (CD ≥ IIIa) were more often observed in SARS-CoV-2 positive patients (10 vs. 4, p = 0.001). This study showed no detectable viral particles of SARS-CoV-2 in surgical smoke sampled during MIS and open surgery. Thus, the discussed risk of transmission of SARS-CoV-2 via surgical smoke could not be confirmed in the present study.
Collapse
Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa M Eichel
- Department of Infectious Diseases, Section Infection Control University Hospital Heidelberg, Heidelberg, Germany
| | - Niklas M Weidner
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp A Wise
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Müller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingmar F Rompen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
| |
Collapse
|
2
|
Romero-Velez G, Ponce de Leon-Ballesteros G, Al Zubaidi M, Barajas-Gamboa JS, Dang J, Corcelles R, Strong AT, Navarrete S, Kroh M. Presence of SARS-CoV-2 in abdominal tissues and biologic fluids during abdominal surgery: a systematic review. Surg Endosc 2023:10.1007/s00464-023-10130-w. [PMID: 37219799 DOI: 10.1007/s00464-023-10130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Viral transmission to healthcare providers during surgical procedures was a major concern at the outset of the COVID-19 pandemic. The presence of the severe acute respiratory disease syndrome coronavirus (SARS-CoV-2), the virus responsible for COVID-19, in the abdominal cavity as well as in other abdominal tissues which surgeons are exposed has been investigated in several studies. The aim of the present systematic review was to analyze if the virus can be identify in the abdominal cavity. METHODS We performed a systematic review to identify relevant studies regarding the presence of SARS-CoV-2 in abdominal tissues or fluids. Number of patients included as well as patient's characteristics, type of procedures, samples and number of positive samples were analyzed. RESULTS A total of 36 studies were included (18 case series and 18 case reports). There were 357 samples for detection of SARS-CoV-2, obtained from 295 individuals. A total of 21 samples tested positive for SARS-CoV-2 (5.9%). Positive samples were more frequently encountered in patients with severe COVID-19 (37.5% vs 3.8%, p < 0.001). No health-care provider related infections were reported. CONCLUSION Although a rare occurrence, SARS-CoV-2 can be found in the abdominal tissues and fluids. It seems that the presence of the virus in the abdominal tissues or fluids is more likely in patients with severe disease. Protective measures should be employed in the operating room to protect the staff when operating patients with COVID-19.
Collapse
Affiliation(s)
- Gustavo Romero-Velez
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Avenue, Mail Code F20, Cleveland, OH, 44195, USA.
| | | | - Maryam Al Zubaidi
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan S Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ricard Corcelles
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew T Strong
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Salvador Navarrete
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mathew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Vimalachandran D, Jones RP, Dickson E, Seehra J, Acheson A, Griffiths EA, Kamarajah S, Leung E, Torrance A, Ottensmeier C, Beggs AD, Whiteside E, Sanna H, Bury D, Youd E, Leopold G, Pugh M, Sundar S, Taylor GS. SARS-CoV-2 in the abdomen or pelvis: SAFE SURGERY study. Br J Surg 2023; 110:306-309. [PMID: 36168210 PMCID: PMC9620655 DOI: 10.1093/bjs/znac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Dale Vimalachandran
- Department of General and Colorectal Surgery, Countess of Chester NHS Trust, Chester, UK
| | - Robert P Jones
- Department of General and Hepatobiliary Surgery, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Ed Dickson
- Department of General and Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jaspreet Seehra
- Department of General and Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Austin Acheson
- Department of General and Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ewen A Griffiths
- Upper GI Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Sivesh Kamarajah
- Upper GI Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Elaine Leung
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Torrance
- Department of General and Colorectal Surgery, Sandwell and West Birmingham NHS Trust, City Hospital,, Birmingham, UK
| | - Christian Ottensmeier
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Andrew D Beggs
- Upper GI Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Ellen Whiteside
- Department of Molecular Pathology, Blackpool Victoria Hospital NHS Trust, Blackpool, UK
| | - Helen Sanna
- Department of Molecular Pathology, Blackpool Victoria Hospital NHS Trust, Blackpool, UK
| | - Danielle Bury
- Department of Molecular Pathology, Blackpool Victoria Hospital NHS Trust, Blackpool, UK
| | - Esther Youd
- Department of Pathology, Royal Glamorgan Hospital, Cwm Taf University Health Board, Llantrisant, UK
| | - Gareth Leopold
- Department of Cellular Pathology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Matthew Pugh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Graham S Taylor
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| |
Collapse
|