Pandemi Döneminde Laparoskopik Cerrahi Güvenli Mi?

Yıl 2021, Cilt: 11 Sayı: 6, 795 - 798, 20.11.2021

Murat Bulut Özkan , Doğukan Durak , Ramazan Topcu , Murat Baki Yıldırım

https://doi.org/10.16899/jcm.950567

Öz

Amaç: Covid-19 pandemisi bütün dünyada sağlık sistemini önemli bir şekilde etkilemiştir. Pandemi başında küresel olarak önemli kararlar verilmiştir. Bu kararlar içinde elektif ameliyatların durdurulması ve cerrahların başka birimlerde görevlendirilmesi de vardır. Yeni bilgiler ışığında pandeminin birkaç yıl sürebileceği ve pandemi kısmen de olsa kontrol altına alındıkça önce elektif ameliyatlara sonra da laparoskopik vakalara tekrar başlanma kararı alınmıştır. Covid-19 virüsü abdominal kavitede tespit edilmiş olup bu tespit edilen virüsün virulansı ile ilgili bir bilgi henüz doğrulanmamıştır. Cerrahi birliklerin yayınladıkları kılavuzlar doğrultusunda gerekli önlemlerin alınması ile minimal invaziv cerrahilerin yapılabileceği ancak pozitif vakalarda açık/konvansiyonel cerrahinin tercih edilmesi gerektiği vurgulanmıştır. Biz de bu bilgiler ışığında gerekli önlemlerle birlikte laparoskopik ameliyatların hem hasta hem de cerrahi ekip açısından ek bir risk oluşuturup oluşturmadığını bulmayı hedefledik
Gereç ve Yöntem: Ağustos 2020 ile Aralık 2020 tarihlerinde Hitit Üniversitesi Erol Olçok Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde gerçekleştirilen laparoskopik vakaları geriye yönük olarak taradık. Hastaların demografik verileri, preoperatif Covid test sonuçları ve postoperatif 1 aylık dönemde Covid tanısı konulup konulmadıklarını inceledik. Aynı zamanda bu tarihler arasında laparoskopik cerrahiye katılmış cerrahi ekipleri de bu vakalar sonrasındaki 2 haftalık süreçte Covid tanısı açısından sorguladık.
Bulgular: Belirtilen tarihler arasında toplamda 124 laparoskopik vaka yapıldığı ve bu vakaların büyük çoğunluğunu (%68,5) kolesistektomilerin oluşturduğunu tespit ettik. Hastalar postoperative dönemde minimum 1 ay takip edilmiştir. Dokuz hasta postoperative dönemde hafif şikayetlerle Covid Polikliniğine başvurmuş ve 3 hastanın PCR testi pozitif gelmiştir. Bu 3 hasta ayaktan Favipiravir tedavisi almıştır, diğer hastalar semptomatik tedavi ile ayaktan takip edilmişlerdir. Hiçbir hastanın hastane yatışı olmamıştır. Ayrıca, ameliyat ekibi için yapılan sorgulamada bu ameliyatlara dahil olan ekipten hiç kimsede Covid-19 enfeksiyonu olmadığı saptanmıştır.
Sonuç: Covid 19 virüsünün laparoskopik cerrahi ile sağlık personeline kontamitasyonu gösterilmemiş olmakla beraber bu konuda yeterli çalışma yapılmamıştır. Çalışmamız sonucunda Covid 19 pandemisi döneminde gerekli önemler alınması durumunda laparoskopik cerrahinin güvenle yapılabileceğini düşünmekteyiz. 

Anahtar Kelimeler

Laparoskopi, Covid-19, pandemik, minimal invaziv cerrahi

Is Laparoscopic Surgery Safe During the Pandemic Period?

Öz

Abstract

Background:

The COVID-19 pandemic has significantly affected healthcare service systems and personnel worldwide. Important decisions have been made such as surgical activity changes, recommendations to cancel elective surgery, and shifting surgeons to other medical activities. However, following the collection of new data and acceptance that this pandemic would last for at least a few years, firstly elective cases and then laparoscopic operations were started again. While it was reported that the COVID-19 virus was detected in the abdominal cavity in studies published in the form of series of a few cases, there is no clear information about the virulence of this detected virus yet. In guidelines published as recommendations by surgical associations, it is stated that it could be performed by taking the necessary precautions, but open surgery needs to be preferred in positive cases. We aimed in this study to show minimally invasive surgery is safe with all the precautions made preoperatively for both patients and surgical crew.

Material and Method:

We retrospectively examined the laparoscopic cases included between August 2020 and December 2020 at the General Surgery Clinic of the Hitit University Erol Olçok Research and Training Hospital from the hospital’s information system. We collected the ages of the found cases, their preoperative COVID diagnostic tests, and their COVID polyclinic visitation data in their postoperative follow-up. We also examined whether or not the surgical team involved in the surgeries of these patients was diagnosed with COVID-19 within 2 weeks following these surgeries.

Results:

A total of 124 laparoscopic cases were included at our clinic between August 2020 and December 2020. Most of these cases (68.5%) were laparoscopic cholecystectomy cases. A total of 124 laparoscopic cases were included at our clinic between August 2020 and December 2020. Most of these cases (68.5%) were laparoscopic cholecystectomy cases. The surgical team comprised the surgical nurse and operating room personnel under the leadership of the surgeon. Based on verbal questioning, it was determined that no person from the team involved in these surgeries was infected with SARS-CoV-2.
Conclusion:
In our study, as a result of our application of all these recommendations in the literature, we did not encounter any contamination in the 124 laparoscopic surgery cases we examined. In conclusion, we think that laparoscopic surgery may be performed safely with taking the necessary precautions during the COVID-19 pandemic period.

Anahtar Kelimeler

laparoscopy, Covid-19, pandemic, minimally invasive surgery

Kaynakça

• 1. Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol [Internet]. 2020;5(4):536–44. Available from: https://doi.org/10.1038/s41564-020-0695-z
• 2. Kurihara H, Bisagni P, Faccincani R, Zago M. COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community. J Trauma Acute Care Surg. 2020 Jun;88(6):719–24.
• 3. Royal College of Surgeons of Edinburgh (RCSEd). Updated General Surgery Guidance on COVID-19, 2nd Revision, 7th April 2020. 2020;(May):56000. Available from: https://www.rcsed.ac.uk/news-public-affairs/news/2020/april/updated-general-surgery-guidance-on-Covid-19-2nd-revision-7th-april-2020
• 4. Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet (London, England). 2020 Feb;395(10223):514–23.
• 5. European Society Gynecologist Endoscopics. ESGE Recommendations on Gynaecological Laparoscopic Surgery during Covid-19 Outbreak. ESGE site. 2020;
• 6. Zheng MH, Boni L, Fingerhut A. Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy. Ann Surg. 2020 Jul;272(1):e5–6.
• 7. Barberis A, Rutigliani M, Belli F, Ciferri E, Mori M, Filauro M. SARS-Cov-2 in peritoneal fluid: an important finding in the Covid-19 pandemic. BJS (British J Surgery) [Internet]. 2020 Sep 1;107(10):e376–e376. Available from: https://doi.org/10.1002/bjs.11816
• 8. Alp E, Bijl D, Bleichrodt RP, Hansson B, Voss A. Surgical smoke and infection control. J Hosp Infect. 2006 Jan;62(1):1–5.
• 9. El Boghdady M, Ewalds-Kvist BM. Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations. Surgeon. 2020 Aug;
• 10. Kwak HD, Kim S-H, Seo YS, Song K-J. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med. 2016 Dec;73(12):857–63.
• 11. Cohen SL, Liu G, Abrao M, Smart N, Heniford T. Perspectives on Surgery in the Time of COVID-19: Safety First. Vol. 27, Journal of minimally invasive gynecology. 2020. p. 792–3.
• 12. Emken JL, Mcdougall EM, Clayman R V. Training and assessment of laparoscopic skills. JSLS J Soc Laparoendosc Surg. 2004;8(2):195–9.
• 13. Francis N, Dort J, Cho E, Feldman L, Keller D, Lim R, et al. SAGES and EAES recommendations for minimally invasive surgery during COVID-19 pandemic. Surg Endosc. 2020 Jun;34(6):2327–31.
• 14. Laparoscopy in The Covid-19 Environment - ALSGBI Position Statement - ALSGBI [Internet]. [cited 2020 Dec 23]. Available from: https://www.alsgbi.org/2020/04/22/laparoscopy-in-the-Covid-19-environment-alsgbi-position-statement/#comments
• 15. COVID-19: Elective Case Triage Guidelines for Surgical Care [Internet]. [cited 2020 Dec 24]. Available from: https://www.facs.org/Covid-19/clinical-guidance/elective-case