Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Istituto Di Ricovero e Cura a Carabettere Scientifico Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
JMIR Public Health Surveill. 2020 Jun 23;6(2):e18928. doi: 10.2196/18928.
The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital.
We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19.
We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature.
The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery.
There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.
当前的冠状病毒病（COVID-19）大流行正在席卷全球。流行病学家已经表明，当医疗保健系统受到 COVID-19 的压力时，死亡率风险更高。因此，保持医疗保健提供者的健康并防止感染至关重要。在半急性手术中，将需要一组重要的人员来治疗 COVID-19 患者，他们是医疗保健提供者。人们担心腹腔镜手术比开放性手术增加污染的风险更高；因此，平衡医疗保健提供者的安全性和腹腔镜手术对患者的益处至关重要。
我们旨在概述医疗保健提供者可能面临的潜在污染途径和风险；我们还旨在根据当前有关对 COVID-19 患者进行腹腔镜手术的文献和专家意见提出研究问题。
我们进行了范围界定审查，并添加了五个有关可能污染途径的其他问题。在 PubMed、CINAHL 和 Embase 数据库中进行了系统搜索，并添加了灰色文献的结果。该搜索不仅包括 COVID-19，还扩展到了一般的病毒污染。如果社论和专业协会声明没有为现有文献提供新的见解，则将其排除在外。
最初的搜索提供了 2007 条记录，之后考虑了 267 篇全文论文。最后，我们使用了 84 篇论文，其中 14 篇讨论了严重急性呼吸系统综合症冠状病毒 2（SARS-CoV-2）。8 篇论文讨论了在低压手术室进行插管的附加值，主要基于 2003 年 SARS 爆发的经验。13 篇论文详细阐述了插管和插管对医疗保健提供者和 SARS-CoV-2 的风险，19 篇论文讨论了其他病毒的情况。他们的结论是，有大量证据表明插管和拔管是一种高风险的气溶胶产生程序。没有发现关于 SARS-CoV-2 和手术烟雾风险的论文，尽管有 25 篇论文提供了有关人乳头瘤病毒、乙型肝炎、脊髓灰质炎和狂犬病感染风险的相互矛盾的证据。没有发现关于腹腔镜手术后外科烟雾提取或气腹放气风险的论文。
文献中似乎存在共识，即插管和拔管对医疗保健提供者来说是高风险的程序，需要使用最大程度的防护设备。另一方面，关于腹腔镜手术本身期间医疗保健提供者污染的实际风险，以及手术室内压力，外科烟雾，组织提取或 CO 放气的实际风险，可用的证据很少。但是，每天都有新的研究从当前的经验中发布，并且社论声明不断更新。似乎没有理由为了开放手术而放弃腹腔镜手术。但是，不应低估风险，只有在必要时才应在 COVID-19 患者上进行手术，并且医疗保健提供者应通过在安全和受保护的环境中进行手术来运用逻辑和常识来保护自己和他人。
