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Coronavirus disease 2019 and laparoscopic surgery in resource-limited settings
Hemanga K Bhattacharjee1, Shafneed Chaliyadan1, Eshan Verma1
1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Insights
A novel, cost-effective system was developed to filter surgical smoke and CO2 during laparoscopic procedures, enhancing safety for patients and staff during the COVID-19 pandemic.
Area of Science:
- Minimally invasive surgery
- Infectious disease control
- Biomedical engineering
Background:
- Laparoscopic surgery use was limited during COVID-19 due to aerosol generation risks.
- Commercial CO2 aerosol filtration systems are expensive and not widely available.
- A custom-made system was designed to mitigate these challenges.
Purpose of the Study:
- To describe a custom-made system for safe surgical smoke and CO2 removal during laparoscopy.
- To report its use in a case of laparoscopic cholecystectomy during the COVID-19 pandemic.
Main Methods:
- A system combining underwater seal chest tube drainage and an electrostatic membrane filter was utilized.
- It was connected to a port for controlled CO2 pneumoperitoneum egression.
- Laparoscopic cholecystectomy was performed with the system managing CO2 and surgical aerosols.
Main Results:
- The system effectively filtered CO2 aerosol particles and surgical smoke.
- A laparoscopic cholecystectomy was successfully completed with the custom system.
- Instrument exchange was minimized by temporary desufflation.
Conclusions:
- The custom-designed system is safe and cost-effective for laparoscopic surgery.
- It is a valuable tool for resource-limited settings during and after the COVID-19 pandemic.
Introduction:
During the coronavirus disease 2019 (COVID-19) pandemic, the use of laparoscopy has been discouraged by the Intercollegiate General Surgery because of its potential for aerosol generation and infection. In contrast, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association of Endoscopic Surgery recommend continuing to use laparoscopy but with devices to filter released CO2 aerosol particles. However, commercially available systems are costly and may not be readily available. Herein, we describe a custom-made system to safely remove surgical smoke and CO2 , as well as a case of laparoscopic cholecystectomy in which we used it.
Materials And Surgical Technique:
The patient had had multiple episodes of biliary pancreatitis and required urgent cholecystectomy during the COVID-19 pandemic. Although India was in complete lockdown, it was decided to operate with precaution. A system was designed using underwater seal chest tube drainage and an electrostatic membrane filter with a viral retention function greater than 99.99%. The system was connected to an extra port for continuous controlled egression of CO2 pneumoperitoneum. A regular four-port cholecystectomy was performed at an intra-abdominal pressure of 12 mm Hg. The gas flow rate was 10 L/min. CO2 for pneumoperitoneum, surgical aerosol, and effluents passed through the system before collecting in the suction apparatus. The exchange of operating instruments through the ports was kept to a minimum. It was done after the abdomen was temporarily desufflated using this system.
Discussion:
The system we designed appears safe and is cost-effective. In resource-limited settings, it will be handy in patients requiring laparoscopic surgery both during and after the COVID-19 pandemic.
