A Low Cost, Safe and Effective Method for Smoke Evacuation in Laparoscopic Surgery for Suspected Coronavirus Patients - Annals of Surgery

In press; https://journals.lww.com/annalsofsurgery/Documents/A%20Low%20Cost,%20Safe%20and%20Effective%20Method%20for%20Smoke%20Evacuation%20in%20Laparoscopic%20Surgery%20for%20Suspected%20Coronavirus%20Patients.pdf
By: Mintz, et al.

Aim
Introduce a new, easy and low cost suction system for surgical laparoscopy smoke

Keys

• Standard electrostatic filters used for ventilation machines are effective filters against SARS-CoV-2. This filter can be connected via standard tubing to the trocar evacuation port to constitute an evacuation and filtering system which evacuates the generated smoke, as well as filter the potential viral load. In order to connect the filter to the tubing we use the endotracheal tube connector (figure 1a, 1b). No active suctioning is attached to this system.

Summary

• The discussion on aerosolization of virus particles during laparoscopic surgery has resurfaced due to the covid-19 outbreak
• In experimental setting aerosols remain in the air for 3 hours and on surfaces for up to 72 hours. 
• To protect surgical staff in the anticipation of a substantial number of future operations on covid-19 carriers or infected patients; proper evacuation of surgical smoke is necessary. 
• The authors suggest an appropriate, easy and low cost filtration system:
  • Standard electrostatic filters used for ventilation machines are effective filters against SARS-CoV-2. This filter can be connected via standard tubing to the trocar evacuation port to constitute an evacuation and filtering system which evacuates the generated smoke, as well as filter the potential viral load. In order to connect the filter to the tubing we use the endotracheal tube connector (figure 1a, 1b). No active suctioning is attached to this system.
• A survey by the EAES showed respondents reported simple and quick assembly and efficient smoke evacuation
• Discard according to hospital infection control protocols
• Authors do not advocate against the use of laparoscopic techniques. With proper safety measures it should be possible:
  • Instrument cleaning during surgery
  • Deflating pneumoperitoneum prior to removing trocars, conversion or specimen extraction etc.