The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma
Tushar Pawar, Ashish Pokharkar, Jayesh Gori, Diwakar Pandey, Jitender Rohila, Ashwin D’souza, Avanish Saklani
Abstract
Introduction: The recent COVID-19 pandemic outbreak has made surgeons change and take on newer strategies and safe exercises. All elective cases have been put off, but oncology cases need to be done to prevent progression of the disease. There is concern about minimally invasive surgery due to aerosol formation. Here we discuss how we have dealt with this in our colorectal surgery department taking into account current evidence about the danger of viral transmission during laparoscopic surgery. Discussion: We report a case of 28 years old female patient with carcinoma rectum. The patient had near total intestinal obstruction. She was operated on utilizing laparoscopic anterior resection. The air seal (CONMED, Utica, NY) and high-efficiency particulate air (HEPA) filter was utilized for safe gas evacuation. There is no evidence against laparoscopic surgery, which suggest viral transmission. One should take utmost precautions using N95 masks and personal protective equipment (PPE). Air filtration products like aerosol, HEPA filters will be of great aid in safe evacuation of gases. Conclusion: At present, there is no solid evidence to suggest viral transmission through surgical smoke. We believe due to effective smoke containment, less blood loss, and less postoperative stay, laparoscopy will be a non-inferior option than open surgical procedure. We advise taking all precautions for operating room staff to lessen the danger of transmission.