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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,
                                                       1–3
            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.

            © The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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