The status of laparoscopic surgery in the COVID-19 crisis: a narrative review of current recommendations

SARS-CoV2 (COVID-19) is an unprecedented pandemic which has required thoughtful resource management for all specialties, including general surgery. There is uncertainty regarding risks of virus aerosolization and laparoscopic surgery. This narrative review discusses these concerns of virus exposure and transmission for health care workers in the operating room by summarizing currently available recommendations and describing our institution's experience. Our virology review was performed by compiling published data on various viruses' presence in blood, peritoneal fluid and surgical smoke. Our recommendations review was performed by researching official organizational guidelines and medical archives (medRxiv) pre-prints. SARS-CoV-2 is mainly transmitted via respiratory droplets. Previous studies have demonstrated the ability of other viruses to form aerosol particles in peritoneal fluid and surgical smoke. Aerosol-generating medical procedures (AGMPs) are considered important risks for nosocomial transmission of viruses, but there is no consensus to include all surgical procedures as so. Most local and international organizations highlight the concerns surrounding laparoscopy, but are not strictly discouraging this modality. They recommend proceeding with caution to minimize surgical smoke exposure by ensuring the use of filtration systems, tight air-seals and fewer incisions. We can extrapolate from other viruses that SARS-CoV-2 may present a potential infectious risk in the operating room. Until evidence arises otherwise, we recommend considering all surgical procedures to be aerosolizing. Laparoscopy continues to be a safe and appropriate modality. Full airborne personal protective equipment (PPE) should be utilized in all emergent cases, and droplet PPE only in urgent elective cases for asymptomatic, screen- and test-negative patients.