Page 2 - World Journal of Laparoscopic Surgery

Editorial 10.5005/wjols-13-3-v

The world has been in the pandemic mode for a year and a half. The Covid-19 virus continues to spread at a slow
burn and intermittent lockdowns done in past are now near normal. Till now estimated 275 million people have
been infected worldwide, and 2.25 million are dead. The pandemic’s course in 2021 will depend greatly on the
arrival of a vaccine, and on how long the immune system stays protective after vaccination or recovery from
infection. There is so much we still don’t know about this virus, but we may hope that after a world-sweeping
outbreak, the virus could burn itself out and disappear by 2021.
This virus is going to stay with us for quite some time and we will have to learn to live in harmony with it.
As a minimal access surgeon, we must continue our services to the needy in this pandemic. Anesthetists and
laparoscopic surgeons are at risk in the operation theatre. Although we didn’t find any scientific evidence to
support it and we hope that more data comes to light in near future. If clear data comes, we can have streamlined decision-making to
reduce the risk to the surgeon. Despite the reduction in the number of elective laparoscopic surgeries conducted, many emergency and
semi emergency laparoscopic surgeries will need to be done. Although still there is no documented evidence, laparoscopic procedures
have a theoretical risk of generating aerosols during the creation of pneumoperitoneum, and while using energy devices due to the
generation of fume.
In this challenging time, minimal access surgical societies felt the need to take immediate action to define ways to protect surgeons
who are caring for suspected or confirmed COVID-19 patients. The World Association of Laparoscopic Surgeons (WALS), Society of
American Gastrointestinal and Endoscopic Surgeons (SAGES), and The European Association for Endoscopic Surgeons (EAES), in their joint
recommendations, have advised that RT-PCR test should be done in every patient before surgery. Most of the operation theatres have
positive pressure ventilation which prevents nonsterile air to enter in OR but there is the risk of the spread of aerosols faster. Therefore,
negative pressure ventilation is required to prevent this from happening.
Port incisions should be optimum to just allow the port to pass and there should not be any unnecessary gap for pneumoperitoneum
leak. The pre-set pressure of the CO2 insufflator should be kept at 12 mm Hg. We recommend that a smoke evacuation system should be
used in laparoscopic surgery and we should be minimum use of energy devices and cold hemostasis should be used whenever possible.
We should also use appropriate filters for suction devices as they can be a potential source of virus dissemination. These strategies
increase the cost of the surgery but could improve safety. Between two cases, a minimum of 1 h should be there to disinfect the OR, and
1% hypochlorite solution should be used for cleaning OT tables and anesthesia instruments.
We advise that all of you, after finishing surgery should remove scrub clothes and consider having a shower before changing into home
clothes to prevent infection to your loved one. Wey should wash hands frequently and maintain safe social distancing. This pandemic
has given a major challenge to surgeons who practice minimally invasive surgery, but we hope that some solution will come soon, and
we will operate normally in the coming year 2021.
At last, I wish all of you a happy, healthy, and prosperous new year 2021.
RK mishra
Editor-in-Chief
Chairman
World Laparoscopy Hospital
Gurugram, Haryana, India

World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020) v