Aldrighetti Luca, Boggi Ugo, Falconi Massimo, Giuliante Felice, Cipriani Federica, Ratti Francesca, Torzilli Guido
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
Department of Transplant and General Surgery, University of Pisa, Pisa, Italy.
Updates Surg. 2020 Jun;72(2):241-247. doi: 10.1007/s13304-020-00815-5. Epub 2020 May 29.
The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable.
在新冠疫情期间，微创手术的安全性仍备受争议，尤其是在意大利这样一个国家，在肝胆胰领域，微创技术已逐渐广泛地进入临床实践。本文提供了新冠疫情期间意大利全国范围内肝胆胰微创手术活动管理的概况：在意大利肝胆胰外科医生协会（AICEP）内部开展并进行了一项调查，最终目的是将经验、知识和意见汇总成一份统一报告，以实现更有效的危机管理。调查结果（81名受访者）显示，在意大利医院，尽管有新冠疫情，微创手术仍保持其作用，登记的病例减少与肝胆胰外科手术活动的总体减少成比例。受访者一致认为，对于技术复杂性高的病例，从微创技术转为开放技术可被视为一种有效的选择。有几个问题值得特别关注：应普遍进行病毒阳性筛查；只有专业的手术团队才能为阳性患者手术，并且必须遵循降低手术期间生物污染风险的特定技术措施。建议开展专门研究以确定微创手术中的真正风险。此外，地区医疗系统对患者进行标准化和明确的优先排序过程是可取的。
