Closed circuit system in laparoscopy: SARS-CoV-2 pandemic
DOI:
https://doi.org/10.18203/2349-2902.isj20204424Keywords:
SARS-CoV-2, Laparoscopy, CCS, Pneumoperitoneum, Energy device, COVID-19Abstract
Background: There is a big concern regarding transmission of Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) during laparoscopy and using energy devices through the carbon dioxide (CO2) pneumoperitoneum. So, we decided to use a novel indigenous innovative closed-circuit system (CCS) to avoid this contamination in operation theatre.
Methods: We set out to do a prospective study in the safety of this innovative closed-circuit system in elective surgeries over 3 consecutive months of May to July 2020, during the peak of SARS-CoV-2 pandemic in a tertiary teaching hospital. We recruited 52 patients undergoing elective laparoscopic surgery in a single laparoscopy unit. The Coronavirus disease 2019 (COVID-19) status was unknown, so we presumed all patients to be potential carriers of SARS-CoV-2. However, we followed the Indian council for medical research (ICMR) and Government of Karnataka (GOK) guidelines of clinical screening before surgery. We observed the postoperative outcome regarding COVID-19 symptoms in Health care workers (HCW) involved in the operation theatre. If required, we do a real time reverse transcription polymerase chain reaction (RT-PCR) to find the true positives.
Results: Of the total 52 (basic and advanced) laparoscopic surgeries performed during this period, only 2 (3.84%) patients turned positive in the postoperative period. They developed COVID-19 symptoms and were tested positive by RT-PCR. None (100%) of the HCW developed any symptoms of COVID-19.
Conclusion: Closed circuit system is a safe and promising technique during laparoscopy.
References
Kwak HD, Kim SH, Seo YS, Song KJ. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med. 2016;73(12):857-63.
Zhou Q, Hu X, Zhou J, Zhao M, Zhu X. Human papillomavirus DNA in surgical smoke during cervical loop electrosurgical excision procedure and its impact on the surgeon. Cancer Manag Res. 2019;29(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;35:744-8.
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):32-37.
Somshekar SP, Shivaram HV, Santosh JA, Abhay D, Arvind K, Dilip G, et al. Ind J Surg. 2020;9:1-11.
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 PKC, Goon PKY, Tan EKH, Crawford RAF, Levell NJ, Sudhoff H. Virus induced cancers of the skin and mucosa: are we dealing with ‘smoking guns’ or ‘smoke and mirrors’ in the operating theatre? Dermatol Ther Heidelb. 2017;7:249-54.
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. Laryngorhinootologie. 2003;82:790-3.
Rioux M, Garland A, Webster D, Reardon E. HPV positive tonsillar cancer in two laser surgeons: case reports. J Otolaryngol Head Neck Surg. 2013;42:54.
Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer. 2019;10:2788-99.
Ilmarinen T. Transmissionof HPV from patient to surgical masks, gloves, oral mucosa of medical personnel during treatment of laryngeal papillomas and genital warts. Eur Arch Oto-Rhino-Laryngol. 2012;269(11):2367-71.
Baggish MS, Poiesz BJ, Joret D, Williamson P, Refai A. Presence of human immunedeficiency virus DNA in laser smoke. Lasers Surg Med. 1991;11:197-203.
Cho K, Hogan C, Lee M, Biswas P, Landman J, Champault G, et al. Cells are present in smoke crated 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.
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;203:631-7.
Weld KJ, Dryer S, Ames CD. Analysis of surgical smoke produced by various energy- based instruments and effect on laparosopic visibility. J Endourol. 2007;21(3):347-51.
Society of American Gastroenterology and Endoscopic Surgeons. SAGES and EAES. Recommendations Regarding Surgical Response to COVID‐19 Crisis. Available at: https://www.sages. org/recommendations-surgical-response-covid-19/. Accessed on 6 April, 2020.
Stefano Angioni. Laparoscopy in the corona virus disease 2019 (COVID-19) era. Gynecol Surg. 2020;17(1):3.
Yoav M, Alberto A, Luigi B, Manish C, Ronit B, Abe F. Technical Committee of EAES. Ann Surg. 2020;272(1):e7-8.
Dellamonica J, Boisseau N, Goubaux B. Comparison of manufactures specifications for 44 types of heat and moisture exchanging filter. Br J Anaesth. 2004;93:532-9.
FitFix Suction Container System-COOPDECH FitFix, Japan. Disposable suction container system. Available at: www.daiken-iki.co.jp. Accessed on 6 April, 2020.