Page 41 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Innovative Technique to Control the COVID-19 Transmission

by Laparoscopic Fume: Could It be Possible to Capture the

Betal inside the Bottle?

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Ashok Kumar , Nalinikanta Ghosh 2

AbstrAct
Aim and objective: This article aims to conceptualize the modification in the laparoscopic port to minimize the risk of COVID-19 virus transmission
through the aerosol during laparoscopic procedures.
Background: A recent situation of COVID-19 pandemic has produced so many new unknown challenges for surgeons. Surgical fume is a known
theoretical biohazard for the operating team. There are many suggestions from the international and national surgical societies and already
available equipment which could minimize the risk transmission. Still, there is no technique available to contain and discharge surgical fume
in the proper way. Here, we conceptualize a technique to reduce the risk of COVID-19 transmission in the operating team.
Technique: Here, we have suggested the modification in the laparoscopic port. We advise adding an intermediate transparent, pliable, polythene/
silicon bag that could able to contain the leaked surgical fume and safely discharge in an underwater seal bottle, filled with sanitizer liquid.
Conclusion: The theoretical, potential risk of COVID-19 transmission during laparoscopic surgery has raised many doubts and apprehension
of virus transmission through the surgical fume. There are many suggestions and available equipment to minimize the spread; however, no
definite solution already out surgical fume; here, our suggestion of modification in port could be a permanent solution to the surgical fume
problem. However, this is an initial concept that has the potential to addition and suggestion to improve the technique.
Clinical significance: The theoretical risk of surgical fume causing COVID-19 virus transmissions completely changes our surgical practice. Here,
in this article, we suggested our concept and technique contain and safely discharge of surgical fume during laparoscopic surgery.
Keywords: COVID-19, SARS-CoV-2, Surgical smoke, Viral transmission.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1421

bAckground 1,2 Department of Surgical Gastroenterology, Sanjay Gandhi
The recent scenario of the COVID-19 pandemic has changed the Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh,
indications of emergency surgery and has been making significant India
changes in the algorithm of surgical disease management. The Corresponding Author: Ashok Kumar, Department of Surgical
theoretical concern of COVID-19 viral transmission during open Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical
or laparoscopic surgeries is the main topic of debate in a recent Science, Lucknow, Uttar Pradesh, India, Phone: +91 5222495537,
situation. There are known advantages of minimally invasive e-mail: drashok97@gmail.com
surgery, e.g., less postoperative pain, early recovery, shorter hospital How to cite this article: Kumar A, Ghosh N. Innovative Technique to
stay, in turn, is increasing availability of beds in limited recourses Control the COVID-19 Transmission by Laparoscopic Fume: Could It
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and ultimately better outcomes. However, we are unable to be Possible to Capture the Betal inside the Bottle? World J Lap Surg
take the full advantages of laparoscopic surgery in the COVID-19 2020;13(3):140–143.

pandemic due to concern of virus transmission through surgical Source of support: Nil
fume. Laparoscopic surgery provides a self-contained operative Conflict of interest: None
field which significantly minimized the risk of direct contact with
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biological fluid or tissue. There are many suggestions and available theoretical risk of COVID-19 transmission). This is theorized that
equipment to minimize the risk of transmission. However, no advice aerosol and fume generated during the use of energy sources may
or device contained unavoidable leaked fume which is already out cause transmission of virus infection. There are few steps during
from the abdominal cavity. Here, in this article, we conceptualized laparoscopic surgery where the operating team might come in
and proposed the technique to contain and discharge the surgical contact with aerosol/surgical fume.
fume.
• At the time of insertion of the first port where the
pneumoperitoneum created with a closed technique.
technique • Insertion of other ports for instruments or cameras.
Concept behind This Technique • Repeated insertion of scope or instruments during the
All reported advantages of laparoscopic surgery over open surgery procedure (where CO can leak by the side of the instrument).
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in the COVID-19 scenario, in terms of shorter hospital stay and • The usual practice of deflation CO through the stopcock at the
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less chance of spread of infection (fewer chances of exposure time of repeated fogging of a camera lens.
to biological fluids and tissue are taken away from due to a • At the end of the procedure during deflation of the abdomen.
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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