Safe management of surgical smoke in the age of COVID-19.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
08
04
2020
accepted:
09
04
2020
pubmed:
5
5
2020
medline:
17
12
2020
entrez:
5
5
2020
Statut:
ppublish
Résumé
The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
Sections du résumé
BACKGROUND
BACKGROUND
The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery.
METHODS
METHODS
The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff.
RESULTS
RESULTS
Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail.
CONCLUSION
CONCLUSIONS
There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
Identifiants
pubmed: 32363596
doi: 10.1002/bjs.11679
pmc: PMC7267397
doi:
Substances chimiques
Smoke
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1406-1413Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
Références
AORN J. 2017 May;105(5):498-500
pubmed: 28454615
Ann Surg. 2008 Nov;248(5):695-700
pubmed: 18948793
Ann Surg. 2020 Jul;272(1):e5-e6
pubmed: 32221118
J Med Virol. 1991 Jan;33(1):47-50
pubmed: 1901908
J Cutan Aesthet Surg. 2019 Jan-Mar;12(1):1-7
pubmed: 31057262
J Prev Med Hyg. 2013 Sep;54(3):131-7
pubmed: 24783890
J Am Acad Dermatol. 1995 Mar;32(3):436-41
pubmed: 7868712
Medicine (Baltimore). 2015 Jul;94(27):e1104
pubmed: 26166102
J Am Acad Dermatol. 2018 Oct;79(4):746-755
pubmed: 29902546
Surg Endosc. 2014 Jul;28(7):2057-65
pubmed: 24570011
Surg Endosc. 1998 Aug;12(8):1017-9
pubmed: 9685533
J Virol. 2006 Aug;80(16):7918-28
pubmed: 16873249
Emerg Microbes Infect. 2020 Dec;9(1):601-604
pubmed: 32178593
AORN J. 2012 Mar;95(3):337-50
pubmed: 22381553
Anesthesiology. 2020 Jun;132(6):1307-1316
pubmed: 32195699
J Endourol. 2007 Mar;21(3):347-51
pubmed: 17444785
J Occup Environ Hyg. 2018 Nov;15(11):773-781
pubmed: 30156970
Eur Arch Otorhinolaryngol. 1991;248(7):425-7
pubmed: 1660719
Am J Infect Control. 2013 Dec;41(12):1218-23
pubmed: 23768438
Ann Surg Oncol. 2016 Dec;23(Suppl 5):592-598
pubmed: 26842487
Ann Surg Oncol. 2013 Oct;20(11):3504-11
pubmed: 23765417
Nature. 2020 May;581(7809):465-469
pubmed: 32235945
Surg Endosc. 2013 Sep;27(9):3100-7
pubmed: 23605191
Part Fibre Toxicol. 2008 Nov 11;5:15
pubmed: 19014466
J Otolaryngol Head Neck Surg. 2013 Nov 18;42:54
pubmed: 24246045
Eur Arch Otorhinolaryngol. 2012 Nov;269(11):2367-71
pubmed: 22588197
J Cancer. 2019 Jun 2;10(12):2788-2799
pubmed: 31258787
Science. 2020 Mar 27;367(6485):1444-1448
pubmed: 32132184
Am J Infect Control. 2013 Jan;41(1):8-13
pubmed: 22475568
Lasers Surg Med. 1998;23(3):172-4
pubmed: 9779652
J Hosp Infect. 2006 Dec;64(4):371-8
pubmed: 17046110
Lasers Surg Med. 1991;11(3):197-203
pubmed: 1907345
AORN J. 2017 May;105(5):488-497
pubmed: 28454614
Laryngorhinootologie. 2003 Nov;82(11):790-3
pubmed: 14634897
Dermatol Ther (Heidelb). 2017 Jun;7(2):249-254
pubmed: 28484898
Surg Endosc. 2018 Oct;32(10):4290-4298
pubmed: 29770884
Occup Environ Med. 2016 Dec;73(12):857-863
pubmed: 27484956