Minimally Invasive Surgery and Surgical Smoke, Decoding Fear and Ensuring Safety: Adaptations and Safety Modifications D
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ORIGINAL ARTICLE
Minimally Invasive Surgery and Surgical Smoke, Decoding Fear and Ensuring Safety: Adaptations and Safety Modifications During COVID Pandemic S. P. Somashekhar1 • Mohammed Basheeruddin Inamdar1 • S. Manjiri2 • Sumit Talwar3 • Rudra Prasad Acharya4 K. R. Ashwin1 • Vijay Ahuja1 • C. Rohit Kumar1
•
Received: 21 July 2020 / Accepted: 6 August 2020 Association of Gynecologic Oncologists of India 2020
Abstract The most fearful word starting from C, Cancer has now been replaced with COVID-19 owing to its associated physical, emotional and financial hardships as well as its social stigma. Never before we as medical fraternity been challenged to take care of patients and at the same time consider the safety of ourselves, family members and our fellow healthcare workers. Emotions and fear-driven treatments that are otherwise inefficacious may contribute to a false sense of security, unwarranted side-effects, divert resources and delay research into treatments that may actually work. Decoding fear with available evidence i.e. practicing evidence-based medicine will guide us in better handling of situations in this pandemic. The objective of this review is to discuss the modifications required in the operating theatre during COVID-19 times for minimal access, laparoscopy and robotic surgery, especially with regard to the handling of surgical smoke, minimally invasive surgical instruments, trocars with smoke evacuator and special personal protection equipment. Although there is no evidence of viral transmission through laparoscopic or open approaches, we recommend modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device use. We have come up with Rule of 20 for 2020 pandemic in operation theatres and modification of trocar for safe handling of surgical smoke in MIS which can be used in resource-limited settings. Hospitals must follow specific protocols and arrange suitable training of the healthcare workers. We believe that ‘‘Fears are educated into us, and can, if we wish, be educated out’’. Keywords Covid pandemic MIS Laparoscopic and robotic surgery Surgical smoke Safe practices Smoke evacuators
& C. Rohit Kumar [email protected] S. P. Somashekhar [email protected] Mohammed Basheeruddin Inamdar [email protected] S. Manjiri [email protected] Sumit Talwar [email protected]
Vijay Ahuja [email protected] 1
Department of Surgical and Gynecological Oncology, Manipal Comphrensive Cancer Centre, Manipal Hospital, Old Airport Road, Rustum Bagh, Bangalore 560 017, India
2
MS Ramaiah Medical College, Bangalore, India
3
Department of Bariatric Surgery, Manipal Hospital, Bangalore 560 017, India
4
Department of Surgical Oncology Max Cancer Center, Max Super Speciality Hospital, New Delhi, India
Rudra Prasad Acharya [email protected] K. R. Ashwin [email protected]
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Introduction Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that
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