Abstract
BackgroundThe SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers.MethodsCholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared.ResultsOpen cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001.ConclusionsLaparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.
Highlights
The Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been affecting our global health-care system
Cholecystectomy was performed in the 12 subjects which were divided into 4 groups: laparoscopic cholecystectomy (LC), laparoscopic cholecystectomy with smoke evacuator (LCE), open cholecystectomy (OC), and open cholecystectomy with smoke evacuator (OCE) (Fig. 1)
The increased particle counts between open and laparoscopic cholecystectomy The increased Particle count (PC) of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm in open approach were significantly higher than laparoscopic approach (Table 2)
Summary
The Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been affecting our global health-care system. The SAR-CoV-2 spreads mainly through the respiratory droplets (the particles that are Taweerutchana et al BMC Surgery (2021) 21:422 greater than 5 μm) produced by coughing and sneezing [1, 2]. Another potential mode of transmission as aerosols (those are smaller than 5 μm) could not be excluded [2, 3]. Potentially infectious surgical smoke may be produced during the abdominal operations and pose health risks to the surgical personnel [14]. The potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers
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