Medical Affairs, Ethicon Inc., Cincinnati, OH.
Surg Laparosc Endosc Percutan Tech. 2021 Jul 28;31(6):765-777. doi: 10.1097/SLE.0000000000000972.
The coronavirus 2019 pandemic and the hypothetical risk of virus transmission through aerosolized CO2 or surgical smoke produced during minimally invasive surgery (MIS) procedures have prompted societies to issue recommendations on measures to reduce this risk. The aim of this systematic review is to identify, summarize and critically appraise recommendations from surgical societies on intraoperative measures to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the operative room (OR) staff during MIS.
Medline, Embase, and Google Scholar databases were searched using a search strategy or free terms. The search was supplemented with searches of additional relevant records on coronavirus 2019 resource websites from Surgical Associations and Societies. Recommendations published by surgical societies that reported on the intraoperative methods to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the OR staff during MIS were also reviewed for inclusion. Expert opinion articles were excluded. A preliminary synthesis was performed of the extracted data to categorize and itemize the different types of recommendations. The results were then summarized in a narrative synthesis.
Thirty-three recommendation were included in the study. Most recommendations were targeted to general surgery (13) and gynecology (8). Areas covered by the documents were recommendations on performance of laparoscopic/robotic surgery versus open approach (28 documents), selection of surgical staff (13), management of pneumoperitoneum (33), use of energy devices (20), and management of surgical smoke and pneumoperitoneum desufflation (33) with varying degree of consensus on the specific recommendations among the documents.
While some of the early recommendations advised against the use of MIS, they were not strictly based on the available scientific evidence. After further consideration of the literature and of the well-known benefits of laparoscopy to the patient, later recommendations shifted to encouraging the use of MIS as long as adequate precautions could be taken to protect the safety of the OR staff. The release and implementation of recommendations should be based on evidence-based practices that allows health care systems to provide safe surgical and medical assistance.
2019 年冠状病毒病大流行以及微创外科手术（MIS）过程中产生的气溶胶化二氧化碳或手术烟雾传播病毒的假设风险促使各协会发布了降低这种风险的措施建议。本系统评价的目的是确定、总结和批判性评估外科协会关于减少 MIS 术中手术室（OR）工作人员感染严重急性呼吸综合征冠状病毒 2 风险的术中措施的建议。
使用搜索策略或自由词搜索 Medline、Embase 和 Google Scholar 数据库。还通过搜索外科协会和学会的 2019 年冠状病毒资源网站上的其他相关记录对搜索进行了补充。还审查了外科协会发表的报告减少 MIS 期间严重急性呼吸综合征冠状病毒 2 向 OR 工作人员传播风险的术中方法的建议，以纳入研究。排除专家意见文章。对提取的数据进行初步综合，对不同类型的建议进行分类和分项。然后以叙述性综合的方式总结结果。
本研究共纳入 33 项建议。大多数建议针对普通外科（13 项）和妇科（8 项）。文件涵盖的领域包括腹腔镜/机器人手术与开放手术的选择（28 篇文献）、手术人员的选择（13 篇）、气腹管理（33 篇）、能量器械的使用（20 篇）以及手术烟雾和气腹放气的管理（33 篇），这些文件对具体建议的共识程度各不相同。
尽管早期的一些建议反对使用 MIS，但它们并非严格基于现有科学证据。在进一步考虑文献和腹腔镜对患者的明显益处后，后来的建议转向鼓励使用 MIS，只要能够采取充分的预防措施来保护 OR 工作人员的安全。建议的发布和实施应基于循证实践，使医疗保健系统能够提供安全的手术和医疗援助。
