Could Laparoscopic Concerns During Coronavirus Pandemic Affect the Care of Women With Pregnancy of Unknown Location/Ectopic Pregnancy?

Abstract

In the coronavirus pandemic elective surgery has been deferred and therefore emergency surgery for suspected ectopic pregnancy arises as the most commonly performed operation in gynecology. Laparoscopic management has traditionally been the gold standard, however recently concerns have been raised regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dissemination as aerosolized small particles are presumed to escape abdominal cavity. The rationale for this hypothesis is based on cohort studies confirming presence of blood-borne viruses such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in the surgical plume, whereas data for airborne viruses such as SARS-CoV-2 are scarce. Remarkably, there is no solid evidence up to date to associate inhalation of pneumoperitoneum viral particles with subsequent disease of theatre staff. Reverse transcription-polymerase chain reaction (RT-PCR) on blood samples of coronavirus disease 2019 (COVID-19)-infected patients presenting with fever, confirmed viremia in only 1% of cases. The viral ribonucleic acid (RNA) was isolated in stool samples in 29% of cases but was not found in urine samples. Therefore, the use of surgical energy devices on genital tract tissues bears little chance of producing aerosolized COVID-19 particles. The optimal surgical approach should be individualized according to a variety of factors: complexity of case and bowel involvement, length of procedure, comorbidities, hospital stay, as well as the surgeon’s familiarity with each approach. When necessary precautions are taken, laparoscopy for ectopic pregnancy appears safe. Operating theatres should meet technical specifications and maintain negative pressure if possible. Only essential personnel equipped with personal protective equipment should be attending theatres. Abdominal pressure should be set under 12 mm Hg and ultrasonic/bipolar device use minimized. Smoke evacuation filtration systems and disposable trocars with insufflation taps can contain surgical smoke. As more information is emerging, trusts will adjust to evolving circumstances with standard operating procedures. Changing established practice may be premature as clinicians should “first do no harm” . J Clin Gynecol Obstet. 2020;9(3):31-36 doi: https://doi.org/10.14740/jcgo657