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Laparoscopic surgery in covid-19 crisis

Among surgeons, a concern with the use of laparoscopy has been raised due to a proposed risk of viral transmission of the corona virus disease with the creation of pneumoperitoneum. Despite the concern regarding aerosolization, there is currently no evidence of viral transmission during laparoscopy.

Laparoscopy carries the advantage of a decreased length of stay and consequent increased hospital bed availability. For the patient, laparoscopy may result in a decrease risk of complications and a faster recovery. Laparoscopy allows a self-contained operative field with less risk of fluid spillage.

There is no scientific evidence to support the use of laparoscopy over open surgery to reduce viral transmission of covid-19. There may be a theoretical risk of transmission from the abdomen of an infected individual. So, the following recommendations during laparoscopic procedure to reduce the possible risks of covid-19 transmission.

  • Routine use of covid-19 testing
  • Routine use of full PPE
  • Laparoscopic surgery should be performed by trained laparoscopic surgeons, in order to minimise operating time and potential for aerosolization.
  • Routine use of closed-circuit smoke evacuation
  • Appropriate port size selection
  • Minimising instrument exchanges
  • Use of disposable ports that may reduce gas loss
  • Use of the lower abdominal insufflation pressure (12mmHg or less)
  • Minimal use of energy devices during procedures, to reduce smoke plume and particle aerosolization
  • Closed evacuation of all gas at the end of procedure

These recommendations may be of low or debatable benefit; however, may be considered in all laparoscopic cases in this covid-19 crisis.

Dr.S.Balamurali, MS, FMAS, FIAGES, Fellow in endoscopy
Consultant General & laparoscopic surgeon
Dr.Mehta’s Hospitals, global campus

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