key: cord-1044913-hpesp8u4
authors: Aminnejad, Reza; Salimi, Alireza; Bastanhagh, Ehsan
title: Regarding "Understanding the "Scope" of the Problem: Why Laparoscopy is Considered Safe During the COVID-19 Pandemic"
date: 2020-04-25
journal: J Minim Invasive Gynecol
DOI: 10.1016/j.jmig.2020.04.030
sha: 9ba4ebe5718c55dc6ca7a378ae8698e68bf579bd
doc_id: 1044913
cord_uid: hpesp8u4

nan

We read the editorial entitled "Understanding the "Scope" of the Problem: Why Laparoscopy Is Considered Safe During the COVID-19 Pandemic" recently published in the journal with great interest.(1) In recent weeks anesthesiologists are at the frontline of the fight against COVID-19 particularly at the time of airway management. When we are talking about a surgery, surgeons and other operating room medical personnel are at risk of infection at the same time. Postponing all unnecessary surgeries during COVID-19 pandemic has become a standard of care today, but there are still many cases in which it is not possible to delay surgery. It makes sense that as much as we care about the patient, we care about the health of the staff. Under normal circumstances, laparoscopic approaches may be of great benefit to the patient, but in a crisis caused by a respiratory infection, the situation will definitely be different. The major rout of transmission for SARS-CoV-2 is respiratory droplets and the most dangerous situation for health care workers is laryngoscopy and intubation. Therefore, avoiding general anesthesia, which requires airway management (e.g. intubation), is one of the most important ways to protect them.(2, 3) Thus, local methods such as neuraxial blocks are superior to general techniques of anesthesia. Because most laparoscopic surgeries require requirements such as Trendelenburg positioning, which is best done under general anesthesia, laparoscopic approaches cannot be insisted on as much as before for surgeries.

On the other hand, we are at risk of the virus spreading due to the process itself. It is true that due to restrictions on feasibility of research, no case of virus transmission through surgical plume or smoke has been proven yet, but no research has been conducted that refutes such a possibility. The presence of the virus RNA in the stool has been proven nearly half of patients even after the patient has recovered.(4) Furthermore the possibility of virus shedding in urine is another concern.(5) In this way, no space in the abdominopelvic cavity can be considered virus-free and importing a laparoscopic trocar to any point of this space carries the risk of spreading the virus throughout the operating room by gas insufflation. However, in the interaction between the anesthesiologist and the surgeon if the benefits of this technique outweigh the potential harms, laparoscopy can be performed by considering appropriate precautions which is mentioned in the article to reduce the risk of virus transmission as much as possible.

Understanding the "Scope" of the Problem: Why Laparoscopy is Considered Safe During the COVID-19 Pandemic

Perspectives on Surgery in the time of COVID-19: Safety First

What we do when a COVID-19 patient needs an operation: operating room preparation and guidance

Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis

Focus on the "Crosstalk" Between COVID-19 and Urogenital Systems