Minimally invasive surgery in the COVID-19 pandemic: An early single centre experience

Editor Surgical practice has changed dramatically during last few months owing to the COVID-19 pandemic. Concern for the safety of patients and staff with concerning outcomes reported by some units worldwide has generated controversy1. Various surgical societies published guidelines which were not in favour of minimally invasive surgery (MIS) due to the perceived risk of virus spread from aerosolisation2,3. Initial experience from China and Italy favours open surgery over laparoscopic4. Variability in surgical practice was noted globally due to poor understanding of how the virus is transmitted5. As of 15th May 2020, the global death toll from COVID-19 had passed 300,000 with nearly 4⋅5 million people infected worldwide. Overall, there have been 45 deaths in our hospital. MIS has become the standard approach across several disciplines including general surgery, gynaecology and urology, in the elective and emergency setting. MIS leads to better short term outcomes including, less post-operative pain, wound infections, chest infections and shorter length of hospital stay. As open surgery is associated with an increased hospital stay, it may increase exposure to nosocomial COVID transmission, with added pressure on resources and ITU capacity. Guidelines have suggested caution with a perceived risk of virus spread through aerosol generating procedures (AGPs) including laparoscopy and robotic surgery. They have advocated a shift in practice towards open surgery and conservative management where appropriate. The risk of virus spread with AGPs can be minimised by using ports with balloons, smaller skin incisions and Table 1 Table showing total number of cases, done by laparoscopy/robotics and open. Covid-19 positive cases in all groups. AirSeal®(CONMED, Utica, New York, USA)