Surgical Smoke in the Era of the COVID-19 Pandemic: Is It Time to Reconsider Policies on Smoke Evacuation?

THE novel coronavirus outbreak (2019-nCOV) has profoundly impacted surgical practice including urology. Performing surgeries during this pandemic presents risks to the surgical team given the unclear incidence of asymptomatic COVID-19 carriers in the absence of widespread testing. Surgical smoke has long been studied as a potential occupational hazard, with aerosolized isolates including viral particles and carcinogens. As COVID-19 has been identified in the respiratory and gastrointestinal system, saliva, sputum and blood, as well as the genitourinary tract, aerosol production during surgery on these tissues is especially relevant given the highly contagious transmissibility of COVID-19. Although viral shedding appears to be limited in urine, viral RNA was detected by reverse transcriptase-polymerase chain reaction in 4 of 58 (6.9%) convalescent COVID-19 positive cases in a recent study. There are implications across many common urological operations, particularly those involving bowel (eg bowel reconstruction during cystectomy) and oral access (buccal mucosa graft harvesting for urethroplasty). Specific to minimally invasive procedures, the buildup of surgical smoke in the pneumoperitoneum can concentrate particulates that can be released into the operating room during removal of trocars, specimen extraction or open conversion. Many surgical societies including the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), European Society for Gynaecological Endoscopy, Society of European Robotic Gynaecological Surgery and EAU Robotic Urology Section (ERUS) have acknowledged this potential risk and have released recommendations. In considering the safety of operating room personnel during this pandemic, it is timely to review the impact of surgical smoke not only as a possible route of COVID-19 transmission, but also as an occupational risk.