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10 maart 2020

COVID‐19 pandemic: perspectives on an unfolding crisis - British Journal of Surgery

Bron: 19-03-2020: https://bjssjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/bjs.11627(link is external)

Aim article
Overview of measures taken for surgical patients in Italy

Main points

  • Outpatient clinic minimized
  • Non-urgent, non-cancer elective surgery postponed
  • Unclear whether the virus can be found in circulating CO2 used for laparoscopic surgery or aerosol generating procedures


  • Most outpatient clinics have been suspended
  • Screening for patients who do need to come to the outpatient clinic:
    • Called beforehand to check for corona symptoms or contact with COVID-19 positive individuals → if yes, appointment postponed
    • Checkpoint before entering hospital: asses symptoms and provide patients with surgical masks
  • Elective surgery:
    • Non-urgent, non-cancer procedures stopped
    • Surgical theaters converted to additional intensive care units
    • Cancer patients prioritized by clinical priority and available resources:
      • Patients with need for postoperative intensive care → transported to specific, government-defined centers to free resources elsewhere
  • Measures taken to be able to provide emergency surgery:
    • 1-2 consultant/attending surgeons with 1-2 trainee on the ward
    • Others surgeons used for emergency and accident services
    • Indications for surgery in COVID-19 patients in emergency conditions should not differ from patients who have tested negative
  • Considerations for safe procedures:
    • No agreement if a dedicated COVID-19 staff should treat all infected patients
    • Due to shortage of protection equipment, hospital management tend to recommend to use full protective measurements only in COVID-19 positive cases
    • However, in corona affected areas, highest protective measures are being taken for all patients
    • Unclear whether the virus can be found in circulating CO2 used for laparoscopic surgery or aerosol generating procedures
    • Some allow use of laparoscopy but question transanal minimally invasive procedures, due to increased risk of exposure to aerosolized biological fluids
    • Laparoscopy may reduce intraoperative exposure to smoke compared to open surgery
    • Devices for smoke evacuation and cleansing are recommend when feasible
    • Attention should be paid to evacuating residual CO2 from the container and abdominal / thoracic cavity before removing the trocars.