COVID‐19 pandemic: perspectives on an unfolding crisis - British Journal of Surgery

Bron: 19-03-2020: https://bjssjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/bjs.11627(link is external)

Aim article
Overview of measures taken for surgical patients in Italy

Main points

• Outpatient clinic minimized
• Non-urgent, non-cancer elective surgery postponed
• Unclear whether the virus can be found in circulating CO2 used for laparoscopic surgery or aerosol generating procedures

Summary

• Most outpatient clinics have been suspended
• Screening for patients who do need to come to the outpatient clinic:
  • Called beforehand to check for corona symptoms or contact with COVID-19 positive individuals → if yes, appointment postponed
  • Checkpoint before entering hospital: asses symptoms and provide patients with surgical masks

• Elective surgery:
  • Non-urgent, non-cancer procedures stopped
  • Surgical theaters converted to additional intensive care units
  • Cancer patients prioritized by clinical priority and available resources:
    • Patients with need for postoperative intensive care → transported to specific, government-defined centers to free resources elsewhere
• Measures taken to be able to provide emergency surgery:
  • 1-2 consultant/attending surgeons with 1-2 trainee on the ward
  • Others surgeons used for emergency and accident services
  • Indications for surgery in COVID-19 patients in emergency conditions should not differ from patients who have tested negative
• Considerations for safe procedures:
  • No agreement if a dedicated COVID-19 staff should treat all infected patients
  • Due to shortage of protection equipment, hospital management tend to recommend to use full protective measurements only in COVID-19 positive cases
  • However, in corona affected areas, highest protective measures are being taken for all patients
  • Unclear whether the virus can be found in circulating CO2 used for laparoscopic surgery or aerosol generating procedures
  • Some allow use of laparoscopy but question transanal minimally invasive procedures, due to increased risk of exposure to aerosolized biological fluids
  • Laparoscopy may reduce intraoperative exposure to smoke compared to open surgery
  • Devices for smoke evacuation and cleansing are recommend when feasible
  • Attention should be paid to evacuating residual CO2 from the container and abdominal / thoracic cavity before removing the trocars.