Tivey David R, Davis Sean S, Kovoor Joshua G, Babidge Wendy J, Tan Lorwai, Hugh Thomas J, Collinson Trevor G, Hewett Peter J, Padbury Robert T A, Maddern Guy J
Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2020 Sep;90(9):1553-1557. doi: 10.1111/ans.16089. Epub 2020 Jun 28.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a global pandemic. Surgical care has been impacted, with concerns raised around surgical safety, especially in terms of laparoscopic versus open surgery. Due to potential aerosol transmission of SARS-CoV-2, precautions during aerosol-generating procedures and production of surgical plume are paramount for the safety of surgical teams.
A rapid review methodology was used with evidence sourced from PubMed, Departments of Health, surgical colleges and other health authorities. From this, a working group of expert surgeons developed recommendations for surgical safety in the current environment.
Pre-operative testing of surgical patients with reverse transcription-polymerase chain reaction does not guarantee lack of infectivity due to a demonstrated false-negative rate of up to 30%. All bodily tissues and fluids should therefore be treated as a potential source of COVID-19 infection during operative management. Caution must be taken, especially when using an energy source that produces surgical plumes, and an appropriate capture device should also be used. Limiting the use of such devices or using lower energy devices is desirable. To reduce perceived risks association with desufflation of pneumoperitoneum during laparoscopic surgery, an appropriate suction irrigator system, attached to a high-efficiency particulate air filter, should be used. Additionally, appropriate use of personal protective equipment by the surgical team is necessary during high-risk aerosol-generating procedures.
As a result of the rapid review, evidence-based guidance has been produced to support safe surgical practice.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）已造成全球大流行。外科护理受到影响，人们对手术安全提出了担忧，尤其是在腹腔镜手术与开放手术方面。由于SARS-CoV-2可能通过气溶胶传播，在产生气溶胶的手术过程中以及手术烟雾产生时采取预防措施对于手术团队的安全至关重要。
采用快速综述方法，证据来源于PubMed、卫生部、外科协会和其他卫生当局。据此，一个由专家外科医生组成的工作组制定了当前环境下手术安全的建议。
由于逆转录聚合酶链反应检测手术患者的术前检测显示高达30%的假阴性率，因此不能保证无传染性。因此，在手术管理过程中，所有身体组织和液体都应被视为COVID-19感染的潜在来源。必须谨慎操作，尤其是在使用产生手术烟雾的能源时，还应使用适当的收集装置。限制此类装置的使用或使用低能量装置是可取的。为降低腹腔镜手术期间与气腹减压相关的感知风险，应使用连接高效空气过滤器的适当吸引冲洗系统。此外，在高风险产生气溶胶的手术过程中，手术团队必须正确使用个人防护设备。
通过快速综述，已制定了循证指南以支持安全的手术操作。
