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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 69-70

Gynecological surgeries during COVID-19 pandemic: A laparoscopist's viewpoint


Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission11-Oct-2020
Date of Decision12-Oct-2020
Date of Acceptance26-Nov-2020
Date of Web Publication30-Jan-2021

Correspondence Address:
Dr. Kavita Khoiwal
Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_130_20

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How to cite this article:
Khoiwal K, Chaturvedi J. Gynecological surgeries during COVID-19 pandemic: A laparoscopist's viewpoint. Gynecol Minim Invasive Ther 2021;10:69-70

How to cite this URL:
Khoiwal K, Chaturvedi J. Gynecological surgeries during COVID-19 pandemic: A laparoscopist's viewpoint. Gynecol Minim Invasive Ther [serial online] 2021 [cited 2021 Apr 21];10:69-70. Available from: https://www.e-gmit.com/text.asp?2021/10/1/69/308431



Dear Editor,

COVID-19 is the recent global threat to humankind caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In pre-COVID era, laparoscopy was the preferred route of surgery for most of the gynecological indications. Whereas, in the current scenario, it has been postulated to avoid laparoscopy because of the theoretical risk of aerosolization of virus through pneumoperitoneum and surgical smoke.[1] The aim of this report is to identify the optimum route of gynecological surgeries in times of COVID-19 which is safe for health-care workers and results in a better patient outcome.

There is no evidence of the presence of SARS-CoV-2 in surgical smoke, and if present, infective potential is yet to be studied. The risk is only hypothetical based on the evidences for other viruses such as HIV, hepatitis B virus (HBV), and human papillomavirus in surgical smoke.[2] Even after the presence of these viruses in surgical smoke, the incidence of transmission through pneumoperitoneum and surgical smoke is zero.[3] Moreover, laparoscopy is a preferred mode of surgery in patients infected with HIV, HBV, and hepatitis C virus as the risk of exposure of surgeons is much less. In addition, if we talk about other similar respiratory diseases in the past such as severe acute respiratory syndrome and Middle East respiratory syndrome, there was no evidence of transmission of these viruses through surgical smoke or pneumoperitoneum.[2] Therefore, it has been suggested that respiratory and blood-borne viruses should not transmit from surgical smoke and pneumoperitoneum.[4]

The risk of presence and transmission of SARS-CoV-2 via this route is merely theoretical, and advantages of laparoscopy over open route should not be disregarded because of speculations. Furthermore, advantages of laparoscopy such as early postoperative recovery, short hospital stay, and less complications will result in less exposure of health-care workers and patients than open surgery. The smoke generated in laparoscopy remains contained and can be evacuated through smoke evacuators or filtration system. While, it is not possible in open surgeries and the risk of exposure is high. Data to support the safety of open surgery are also limited. Therefore, it is not rational to adopt open surgical approach for all gynecological cases. This is further supported by various international societies of gynecology and endoscopy who recommend laparoscopic surgery over open surgery wherever feasible.[5],[6],[7],[8],[9],[10] Laparoscopy should be avoided in gynecological cases with a suspicion of bowel involvement.[11]

Hysteroscopy is an integral part of gynecological endoscopy. There are no data available for hysteroscopy and its safety in COVID era. Considering the fact that SARS-CoV-2 is not documented in the female genital tract, and general anesthesia is not necessary, hysteroscopy appears to be safe. Operative hysteroscopy is also associated with low risk as the use of electrosurgery produces very less smoke than laparoscopy.[8],[10]

To emphasize, the current evidences do not suggest an increased risk of transmission of SARS-CoV-2 during gynecological laparoscopic surgery, provided all preventive measures taken. Laparoscopy should be preferred over open surgery wherever feasible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Li CI, Pai YJ, Chen CH. Characterization of smoke generated during the use of surgical knife in laparotomy surgeries. J Air Waste Manag Assoc 2020;70:324-32.  Back to cited text no. 1
    
2.
Chang L, Yan Y, Wang L. Coronavirus disease 2019: Coronaviruses and blood safety. Transfus Med Rev 2020;34:75-80.  Back to cited text no. 2
    
3.
Bree K, Barnhill S, Rundell W. The dangers of electosurgical smoke to operating room personnel: A review. Workplace Health Saf 2017;65:517-26.  Back to cited text no. 3
    
4.
MorrisSN, Fader AN, Milad MP, Dionisi HJ. Understanding the “Scope” of the problem: Why laparoscopy is considered safe during the COVID-19 pandemic. J Mini Invas Gynecol 2020;27:789-91.  Back to cited text no. 4
    
5.
Royal College of Obstetricians and Gynaecologists. Joint RCOG/BSGE Statement on Gynecological Laparoscopic Procedures and COVID-19; 2020. Available from: https://www.bsge.org.uk/news/joint-rcog-bsge-statement-on-gynaecological-laparoscopic-procedures-and-covid-19. [Last assessed on 2020 Aug 27].  Back to cited text no. 5
    
6.
European Society for Gynaecological Endoscopy. ESGE Recommendations on Gynaecological Laparoscopic Surgery during COVID-19 Outbreak; 2020. Available from: https://esge.org/wp-content/uploads/2020/03/Covid19StatementESGE.pdf. [Last assessed on 2020 Aug 29].  Back to cited text no. 6
    
7.
American Association of Gynecologic Laparoscopists. Joint Statement in Minimally Invasive Gynecologic Surgery during the COVID-19 Pandemic. 2020: Available from: https://www.aagl.org/news/covid-19-joint-statement-on-minimally-invasive-gynecologic-surgery. [Last assessed on 2020 Sep 02].  Back to cited text no. 7
    
8.
Thomasa V, Maillard C, Barnard A. International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020;253:133-40.  Back to cited text no. 8
    
9.
Pryor A. SAGES and EAES Recommendations Regarding Surgical Response to COVID-19 Crisis; 2020. Available from: https://www.sages.org/author/aurora-pryor. [Last assessed on 2020 Aug 29].  Back to cited text no. 9
    
10.
SASREG. Guidance for Endoscopic Surgery during COVID-19; 2020. 1-9. Available from: https://sasreg.co.za/guidance-for-endoscopic-surgery-during-covid-19-6-april-2020. [Last assessed on 2020 Aug 28].  Back to cited text no. 10
    
11.
Transfusion Transmitted Diseases Committee. Update: Impact of 2019 Novel Coronavirus and Blood Safety. Available from: http://www.aabb.org/advocacy/regulatorygovernment/Documents/Impact-of-2019-Novel-Coronavirus-on-Blood-Donation.pdf. [Last assessed on 2020 Aug 30].  Back to cited text no. 11
    




 

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