DOI: http://dx.doi.org/10.18203/2349-2902.isj20213193

Safe laparoscopy during COVID-19 pandemic by SARS-CoV-2: bio innovation of the closed-circuit system

Shrenik Govindaraj, Clement Prakash, Sridar Govindaraj

Abstract


Background: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) transmission during laparoscopy while using energy devices through the carbon dioxide pneumoperitoneum is a big concern in operation theatre. So, we had to alter the way we vent carbon dioxide through a closed-circuit system (CCS) to avoid contamination.

Methods: We did a prospective study in the safety of the CCS during elective laparoscopic surgeries. We had recruited 184 patients from a single unit in three quarters. The first quarter had 52 patients where the SARS-CoV-2 status was unknown as rapid antigen test (RAT) and reverse transcription polymerase chain reaction (RT- PCR) was not done as per government guidelines. So, we presumed all patients to be potential carriers. Later in the 2nd and 3rd quarter we had recruited 132 patients; all were tested by RAT/RT-PCR and positive patients were excluded from our study. Postoperatively we observed for COVID-19 symptoms in our health care workers (HCW) and confirmed by RT-PCR.

Results: Of the total 184 laparoscopic surgeries performed during this period, only 2 (1.09%) patients developed COVID-19 symptoms and this was in the 1st quarter when routine testing by RT-PCR was not done. None (100%) of our HCW developed symptoms of COVID-19.

Conclusions: Closed circuit system is an innovative and safe technique during laparoscopy. We strongly recommend RT-PCR for COVID-19 before elective surgery.


Keywords


SARS-CoV-2, Laparoscopy, CCS, Pneumoperitoneum, Energy device

Full Text:

PDF

References


Kwak HD, Kim SH, Seo YS, Song KJ. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med. 2016 Dec;73(12):857-63.

Zhou Q, Hu X, Zhou J, Zhao M, Zhu X, Zhu X. Human papillomavirus DNA in surgical smoke during cervical loop electrosurgical excision procedures and its impact on the surgeon. Cancer Manag Res. 2019;11:3643-54.

Ferenczy A, Bergeron C, Richart RM. Human papillomavirus DNA in CO2 laser- generated plume of smoke and its consequences to the surgeon. Obstet Gynecol. 1990;75(1):114-8.

Wong SH, Lui RN, Sung JJ. COVID-19 and the digestive system. J Gastroenterol Hepatol. 2020;35(5):744-8.

Coccolini F, Tartaglia D, Puglisi A, Giordana C, Pistello M, Lodata M et al. SARS-CoV-2 is present in peritoneal fluid. Ann Surg. 2020;272(1):32-7.

Somashekhar SP, Shivaram HV, Abraham SJ. ASI’s Consensus Guidelines: ABCs of what to do and what not during the Covid-19 Pandemic. Indian J Surg. 2020;82:240-50.

Liu Z, Zhang Y, Wang X, Zhang D, Diao D, Chandramohan K, Christopher M. Booth. Recommendations for Surgery During the Novel Coronavirus (COVID-19) Epidemic. Indian J Surg. 2020;82(2):1-5.

Yadav SK, Agrawal V, Agarwal P. Rapid Scoping Review of Laparoscopic Surgery Guidelines During the COVID-19 Pandemic and Appraisal Using a Quality Appraisal Tool “EMERGE”. Indian J Surg. 2020;82:930-40.

Bains L, Mishra A, Gupta L, Singh R, Lal P. Surgery in COVID-19 Times: A Comprehensive Review. MAMC J Med Sci. 2020:6;163-75.

Ingrid Arevalo-Rodriguez. False negative results of initial RT PCR assay for COVID 19: a systematic review. BMJ, medRxiv. 2020.

Eubanks S, Newman L, Lucas G. Reduction of HIV transmission during laparoscopic procedures. Surg Laparosc Endosc. 1993;3(1):2-5.

Diettrich NA, Kaplan G. Laparoscopic surgery for HIV-infected patients: minimizing dangers for all concerned. J Laparoendosc Surg. 1991;1(5):295-8.

Goon, Peter KC. Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns" or "Smoke and Mirrors "in the Operating Theatre?”. Dermatol therapy. 2017;7(2):249-54.

Hallmo P, Naess O. Laryngeal papillomatosis with human papillomavirus DNA contracted by a laser surgeon. Eur Arch Otorhinolaryngol. 1991;248:425-7.

Calero L, Brusis T. Laryngeal papillomatosis: first recognition in Germany as an occupational disease in an operating room nurse. Laryngorhinootol. 2003;82(11):790-3.

Rioux M, Garland A, Webster D, Reardon E. HPV positive tonsillar cancer in two laser surgeons: case reports. J Otolaryngol Head Neck Surg. 2013;42(1):54.

Cho K, Hogan C, Lee M, Biswas P, Landman J, Champault G et al. Cells are present in smoke created during laparoscopic surgery. Br J Surg. 1997;84(7):993-5.

Knolmayer TJ, Asbun HJ, Shibata G, Bowyer MW. An experimental model of cellular aerosolization during laparoscopic surgery. Surg Laparosc Endosc. 1997;7(5):399-402.

Ikramuddin S, Lucas J, Ellison EC, Schirmer WJ, Melvin WS. Detection of aerosolized cells during carbon dioxide laparoscopy. J Gastrointest Surg. 1998;2(6):580-3.

Nikhil Gupta, Himanshu Agrawal. COVID19 and laparoscopic surgeons, the Indian Scenario-Perspective. IJS. 2020.

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

SAGES and EAES Recommendations Regarding Surgical Response to COVID‐ 19 Crisis. Available at: https://www.sages. org/recommendations-surgical-response-covid-19/. Accessed on 10 Jan 2021.

Dellamonica J, Boisseau N, Goubaux B, Raucoules-Aime M. Comparisons of manufactures specifications for 44 types of heat and moisture exchanging filter. BJA: Bri J Anaesthesia. 2004;93(4):532-9.

Angioni S. Laparoscopy in the corona virus disease 2019 (COVID-19) era. Gynecol Surg. 2020;17:3.

Mintz Y, Arezzo A, Bonni L, Chand M, Brodie R, Fingerhut A. A low cost, safe and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients. Ann Surg. 2020;272(1):e7-8.

Kapoor D, Perwaiz A, Singh A. Elective Gastrointestinal Surgery in COVID Times. Indian J Surg. 2021;83:277-83.

Choudhary GR, Ranjan DK. Simple Device Design for Plume Management after Pneumoperitoneum in Laparoscopy in COVID-19 Outbreak. Indian J Surg. 2020;1-2.

Somashekhar SP, Acharya R, Manjiri S, Talwar S, Ashwin KR, Kumar C. Adaptations and Safety Modifications to Perform Safe Minimal Access Surgery (Minimally Invasive Surgery: Laparoscopy and Robotic) during the COVID-19 pandemic. Practice Modifications Expert Panel Consensus Guidelines from Academia of Minimal Access Surgical Oncolog (AMASO). Indian J Surg Oncol. 2020.

Fit Fix Suction Container System-COOPDECH Fit Fix, Japan. Disposable suction container system. Available at: https://www.daiken-iki.co.jp. Accessed on 10 January 2021.