Full Text Article Open Access
Clinical Opinion
Is laparoscopic surgery safe during the COVID-19 Pandemic?
Folaranmi Semiu Eniola 1,2**, Sekeran Prabhu1,2,*.
1: Department of pediatric surgery
Severe acute respiratory syndrome coronavirus
2
(SARS-COV2) is the RNA virus
University Hospital of Wales
responsible for the current COVID-19 (Coronavirus Disease 2019) pandemic. It is a long
2: School of Medicine, Cardiff University
Cardiff Wales
single stranded RNA (30kb in length), surrounded by a lipid bilayer that is composed of
*Corresponding author
** Academic Editor
three proteins: E (envelope), M (membrane), and S(spike) proteins. SARS-CoV-2 uses
Correspondence to:
heavily glycosylated, extended spike protein to mediate initial cellular engagement and
Prabhu.Sekaran@wales.nhs.uk
Publication data:
begin the process of infection [1]. Once the host cell is penetrated, its RNA is released,
Submitted: April 14,2020
to replicate copies of itself. The virions produced burst out of the host cell and spread to
Accepted: May 27,2020
Online: June 30,2020
other cells where the process is repeated. The clinical presentation ranges from mild
respiratory symptoms in 80% of cases to severe pneumonia progressing to respiratory
and multi-organ failures in 5% of cases [2]. The virus may be aerosolized and transmitted
This article was subject to full peer-review
in smaller droplets in a gas suspension [3]. Phan et al stated that one of the modes of
transmission of SARS-CoV-2 is through respiratory droplets or aerosols from an infected
person, which can penetrate the lungs via inhalation through the nose or mouth [4].
Some articles have described a chimney effect which causes a jet of air to be blown
through the laparoscopic trocars, exposing personnel in the operating room to a high
concentration of infected virus particles [5]. This theoretical risk of transmission of the
virus to health care workers during aerosol generating procedures like Laparoscopic
surgery [1,5] has led the Royal College of Surgeons of England issuing guidance to seek
alternatives to laparoscopic surgery due to the increased risk of infection with SARS-Cov-
2 during laparoscopy. Although previous studies have shown that laparoscopy can lead
to aerosolization of blood borne viruses [7] like hepatitis B or HIV, there is no documented
evidence of an increased risk of transmission with laparoscopic surgery of these blood
borne viruses which have been around for decades [3]. The precursors to the COVID-19
virus, SARS and Middle East Respiratory Syndrome (MERS-CoV), have not demonstrated
evidence of disease transmission during laparoscopic surgery [8], which further lends
support to the argument against abandoning laparoscopy during this pandemic. Another
point in favor of not abandoning laparoscopy is that the closed surgical site offered by
laparoscopy compared to laparotomy, lowers the risk of contamination with infected
liquid. Additionally, there is no strong evidence that the virions are viable or are actually
transmitted during laparoscopy [9].
Despite the lack of strong evidence pointing to the transmission of the virus during
laparoscopic surgery, the theoretical risk of this happening warrants an approach to
mitigate this. These mitigating steps have been articulated jointly by The Society of
American Gastrointestinal and Endoscopic Surgeons
(SAGES) and The European
Association for Endoscopic Surgeons (EAES) [6].These include wearing full personal
protective equipment (PPE) for all laparoscopic cases, reduced CO2 insufflation pressure,
minimising intracoporeal electrocautery use, minimising port incisions to create a snug fit
for the ports, using a closed smoke evacuation/filtration system and evacuating the
pneumoperitoneum via a filtration system at the end of the procedure before removing
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tissue specimens or ports.
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share and adapt.
In summary there is a theoretical risk that laparoscopy, being an aerosol generating
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procedure, poses an increased risk of COVID-19 transmission. However, the evidence to
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support this theory in practice is lacking, therefore laparoscopic surgery can safely
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cannot be used for commercial purpose.
proceed provided precautionary steps as outlined by SAGES are adopted.
Citation: Folaranmi SE, Sekeran P. Is laparoscopic surgery safe during the COVID-19 Pandemic?Jr.med.res. 2020; 3(2):31-32.
Folaranmi et al © All rights are reserved. https://doi.org/10.32512/jmr.3.1.2020/31.32
