key: cord-1018418-2a00cohw
authors: Zheng, Min Hua; Boni, Luigi; Fingerhut, Abe
title: Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy
date: 2020-04-27
journal: Ann Surg
DOI: 10.1097/sla.0000000000003924
sha: cad9b238a5a977cf6c54e70eebcf7b813f3c0079
doc_id: 1018418
cord_uid: 2a00cohw

nan

The Centers for Disease Control and Prevention recently published recommendations that were upgraded by the American College of Surgeons (1). Both recommended to stop elective surgery and to take general precautions, but there was little on the pragmatic aspects of surgery.

In laparoscopic surgery, an essential part of the technique is the establishment and maintenance of an artificial pneumoperitoneum; with this comes the risk of aerosol exposure for the operation team. Ultrasonic scalpels or electrical equipment commonly used in laparoscopic surgery can easily produce large amounts of surgical smoke, and in particular, the low-temperature aerosol from ultrasonic scalpels cannot effectively deactivate the cellular components of virus in patients. In previous studies, activated corynebacterium, papillomavirus and H.I.V. have been detected in surgical smoke (2) (3) (4) and several doctors contracted a rare papillomavirus (5) suspected to be connected to surgical smoke exposure. The risk of 2019-ncov infection aerosol should not be any exception. One study found that after using electrical or ultrasonic equipment for 10 minutes, the particle concentration of the smoke in laparoscopic surgery was significantly higher than that in traditional open surgery (6) . The reason may be that due to the low gas mobility in the pneumoperitoneum, the aerosol formed during the operation tends to concentrate in the abdominal cavity. Sudden release of trocar valves, non-air-tight exchange of instruments or even small abdominal extraction incisions can potentially expose the health care team to the pneumoperitoneum aerosol; the risk is definitely higher in laparoscopic than in traditional open surgery. This outbreak thus poses a great challenge to the clinical work of surgeons who practice MIS.

As the epidemic spreads and pandemics, we surgeons have the responsibility of raising the level of awareness, prevention and control of transmission, not only for the current epidemic, but also, Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

in general, as a principal for all surgeries (7) . Even if all elective surgery has been curtailed if not stopped in countries of the current pandemic, the risk is present for patients who require emergency surgery or operations for malignancy, and above all, for the surgeons and operating room staff who undertake these operations.

We would like to share the following, based on our recent experience in Shanghai and Milan. 1) General protection: all surgery patients must complete preoperative health screening, whether they are symptomatic or not. As operating staffs might become infected, and therefore reduced in number, all medical personnel have to comply with the tertiary protection regulations (8, 9) . Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment

Human immunodeficiency virus-1 (HIV-1) in the vapors of surgical power instruments

Risk of acquiring human papillomavirus from the plume produced by the carbon dioxide laser in the treatment of warts

Characterization of smoke generated during the use of surgical knife in laparotomy surgeries

Twenty year progression and future directions of minimally invasive surgery

General Office of National Health and Family Planning Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (version 6 th )

General Office of National Health and Family Planning Commission of the People's Republic of China. Novel coronavirus pneumonia prevention and control program (Fifth Edition)

Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited