Page 49 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Resuming Elective Laparoscopic Surgery during COVID-19

Pandemic: Our Experience and Challenges Faced

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Apoorv Goel , Roli Bansal , Shyam Kothari , Megha Sharma , C Deva Rahul , VB Jindal , Aman Mathur 7
AbstrAct
Background: SARS-CoV-2 virus infection was detected and discovered in Wuhan, China, in December 2019, and it was declared a pandemic by
WHO in March 2020. Since then a lot of changes were noticed in surgical practice. Various recommendations were released by eminent surgical
associations all over the world. This study was designed to study and analyze the findings and experience after resuming elective minimal
invasive surgery during the pandemic.
Materials and methods: This observational study was conducted at St Joseph’s Hospital, Ghaziabad, from May 2020 to May 2021. Various
preoperative and postoperative findings were noticed and analyzed. The presence of SARS-CoV-2 virus was also analyzed in endotracheal
aspirate and surgical smoke.
Observation and results: A total of 287 cases underwent surgery. Most commonly performed surgery was laparoscopic cholecystectomy. The
positivity rate for SARS-CoV-2 during preoperative work-up was 2.87%. Slightly more than 5% of cases in postoperative period had COVID-19-like
symptoms. None of those patients were found positive on RT-PCR, and X-ray/CT findings were also suggestive of early postoperative changes
only. Presence of SARS-CoV-2 virus was not detected in either endotracheal aspirate or surgical smoke. Neither surgery team nor OT staff had
infection during this period. There was no mortality, and only 1 patient was found to be infected 2 weeks after discharge.
Conclusion: Minimal invasive surgery for elective cases can be safely performed by taking precautions like PPE and smoke evacuation system
during the COVID-19 pandemic. There is no evidence of transmission of infection through endotracheal aspirate or surgical smoke.
Keywords: COVID-19 pandemic, Minimal invasive surgery, SARS-CoV-2.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1507

IntroductIon 1,3 Department of General Surgery, St Joseph’s Hospital, Ghaziabad,
SARS-CoV-2 virus is a lipid-enveloped virus from the Coronaviridae Uttar Pradesh, India
family that was first detected in Wuhan, China, and was responsible 2 Department of Medicine, UCMS and GTB Hospital, New Delhi, India
for the COVID-19 pneumonia outbreak around the globe, which 4 Department of Obstetrics and Gynaecology, St Joseph’s Hospital,
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was finally declared a pandemic by WHO in March 2020. Since Ghaziabad, Uttar Pradesh, India
the outbreak of pandemic, lot of changes were brought in surgical 5 Department of Pulmonology, St Joseph’s Hospital, Ghaziabad, Uttar
practice. Non-emergency and elective cases were postponed Pradesh, India
immediately as per the recommendations by reputed eminent 6,7 Department of Internal Medicine, St Joseph’s Hospital, Ghaziabad,
surgical associations. There was a state of confusion and uncertainty Uttar Pradesh, India
among surgeons regarding their own safety and overall patient Corresponding Author: Apoorv Goel, Department of General
care. 4–8 There was clear evidence of high mortality and morbidity Surgery, St Joseph’s Hospital, Ghaziabad, Uttar Pradesh, India, e-mail:
among patients suffering from SARS-CoV-2 undergoing surgical drapurvgoel@gmail.com
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procedures. During this crisis, cases like cholelithiasis, hernia, and How to cite this article: Goel A, Bansal R, Kothari S, et al. Resuming
other benign conditions were put on hold from the declaration Elective Laparoscopic Surgery during COVID-19 Pandemic: Our
of pandemic and implementation of lockdown in the nation. 5–8 Experience and Challenges Faced. World J Lap Surg 2022;15(2):
Only emergency procedures were performed. In Asian countries 145–148.
like India, where there were no proper guidelines and protocols Source of support: Nil
were available initially as well as testing centers and resources Conflict of interest: None
were also limited. Planning and conducting elective minimal
invasive surgeries was difficult, and hence, at our institute, it was
decided to hold all elective laparoscopic procedures till further on surgical smoke, abdominal fluid, and aerosol generation during
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recommendations. In late April and May, recommendations surgery to be a potential source of infection and subsequently
by the Society of American Gastrointestinal and Endoscopic increasing risk of transmission. However, there were lot of studies
Surgeons (SAGES), European Association for Endoscopic Surgeons that demonstrated no evidence of any potential risk of transmission
(EAES), Endoscopic and Laparoscopic Surgeons of Asia (ELSA), and from surgical smoke. However other studies also recommended the
Association of Surgeons of India (ASI) were released, and with use of smoke evacuation devices. 13–17
availability of reverse transcription-polymerase chain reaction This study is done to analyze the challenges faced, various
(RT-PCR) tests and personal protective equipment (PPE) kits, it preoperative and postoperative parameters, results, and overall
was decided to resume elective laparoscopic surgery in a phased experience while resuming elective laparoscopic surgery during
manner. 10–12 Another challenge faced was the reports and studies COVID-19 pandemic.

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