key: cord-0683053-h0sd34hi authors: Sparwasser, Peter; Brandt, Maximillian P.; Haack, Maximillian; Dotzauer, Robert; Boehm, Katharina; Gheith, Mohammed Kamal; Mager, Rene; Jäger, Wolfgang; Ziebart, Alexander; Höfner, Thomas; Tsaur, Igor; Haferkamp, Axel; Borgmann, Hendrik title: Robotic surgery can be safely performed for patients and healthcare workers during COVID‐19 pandemic date: 2021-06-03 journal: Int J Med Robot DOI: 10.1002/rcs.2291 sha: d2b978998fc82b2d8fc460957397c4c9da783d10 doc_id: 683053 cord_uid: h0sd34hi OBJECTIVES: To investigate the safety of robotic surgery during COVID‐19 pandemic concerning new‐acquired COVID‐19 infections for patients and healthcare workers. PATIENTS: We performed a retrospective single‐centre cohort study of patients undergoing robotic surgery in initial period of COVID‐19 pandemic. Patients and healthcare workers COVID‐19 infection status was assessed by structured telephone follow‐up and/or repeated nasopharyngeal swabs. RESULTS: After 61 robotic surgeries (93,5% cancer surgery), one patient (1.6%) had COVID‐19 infection. Sixty healthcare workers cumulatively exposed to 1187 h of robotic surgery had no infection. One patient with postoperative proof of SARS‐CoV‐2 had complete recovery. After this potentially contagious robotic surgery, eight healthcare workers had no COVID‐19 infection after follow‐up with each three nasopharyngeal swabs. CONCLUSIONS: Early clinical experience of robotic surgery during COVID‐19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID‐19 negative patients. We performed a retrospective data analysis on patients treated with robotic surgery at our Tertiary Referral Academic Centre after WHO declaration of the pandemic for a 2-months-period from March 12 to 11 May 2020. Initially we performed as a high volume center (in total 296 robotic surgeries in 2020) robotic surgery for benign and malign diseases but due to local increasing infections rates we rapidly initiate prioritization towards high-risk cancer patients according to ERUS (EAU Robotic Urology Section) guidelines. 11 The local ethic board approved the study (2020-0997). Demographical information about age and gender of patients was collected. Clinical information about date of surgery, type of surgery, ASA score, risk factors for an adverse COVID-19 outcome (age ≥ 50 years, circulatory disease, diabetes, respiratory disease, liver disease, renal disease, history of oncological disease, immunosuppression at the time of the interview, nicotine abuse and hypertension), surgery time, preoperative screening with SARS-CoV-2 swab or COVID-19 questionnaire, intraoperative adverse incident complication according to EAU classification, and postoperative complications according to Clavien Dindo Classification were collected. Patients were followed-up by structured telephone interviews on 25 May 2020 (minimum follow-up time: 14 days) for COVID-19 infection status and SARS-CoV-2 swabs performed postoperatively. We implemented preoperative swab PCR testing (maximum 24 h ago) for every robotic surgery ongoing since 26 May 2020. We This COVID-19 screening regimen, defined as extended COVID-19 screening regimen, was applied from 01 April until 20 April. As COVID-19 swab testing availability within the hospital decreased, swab testing was abolished again and the screening regimen, now defined as limited COVID-19 screening regimen, was restricted to using the COVID-19 screening questionnaire. These rapidly changing screening approaches are depicted in Figure 1 . Descriptive statistic was used for data reporting of patients and healthcare workers. Overall, 61 robotic surgery procedures were performed during the 2months-period. Robotic surgeries included robotic-assisted radical prostatectomy (n = 37, 60.7%), partial nephrectomy (n = 14, 23%), pyeloplasty (n = 3, 4.9%), radical cystectomy (n = 2, 3.3%), radical nephroureterectomy (n = 2, 3.3%), adrenalectomy (n = 1, 1.6%), simple prostatectomy (n = 1, 1.6%), and super-extended lymphadenectomy (n = 1, 1.6%), resulting in 57 (93.4%) cancer surgeries and 4 (6.6%) surgeries on benign disease. The preoperative screening questionnaire showed for none of these 61 patients symptoms that are suspicious for COVID-19 infection. Patient and surgery characteristics are listed in Table 1 . In 1/61 patients (1.6%), a COVID-19 infection was diagnosed postoperatively. Six patients (9.8%) had negative test results during the postoperative period. Overall, 60 healthcare workers were exposed to robotic surgery a total of 1187 h and 7 min including four urology console surgeons, eight urology bedside surgeons, 21 anaesthetists, 14 urology scrub nurses and 13 anaesthesia nurses ( Table 2) . All healthcare workers were tested negative for SARS-CoV-2 in nasopharyngeal swabs each three times during the study period. Complication rate of robotic surgery was low, with 6 (9.2%) intraoperative and 19 (31.1%) postoperative complications (Table 1) . Complication rate of robotic surgery was low, with 1 (1.6%) intraoperative and 7 (11.5%) postoperative complications ≥ grade 3 (Ta- The clinical course of one patient diagnosed with COVID-19 two days after robotic-assisted radical prostatectomy is depicted in COVID-19 and urology: A comprehensive review of the literature Elective surgery cancellations due to the COVID-19 pandemic: Global predictive modelling to inform surgical recovery plans Assessing the burden of nondeferrable major uro-oncologic surgery to guide prioritisation strategies during the COVID-19 pandemic: insights from three Italian high-volume referral centres Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection Perioperative outcomes of urological surgery in patients with SARS-CoV-2 infection Delivering urgent urological surgery during the COVID-19 pandemic in the UK: Outcomes from our initial 52 patients Martini-Klinik experience of prostate cancer surgery during the early phase of the COVID-19 pandemic COVID-19: Protecting health-care workers Minimally invasive surgery and the novel coronavirus outbreak: Lessons learned in China and Italy Society of robotic surgery review: Recommendations regarding the risk of COVID-19 transmission during minimally invasive surgery ERUS-EAU robotic urology section ERUS (EAU robotic urology section) guidelines during COVID-19 emergency. 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