Abstract
Background:To evaluate gynecologic oncologists’ trends and attitudes towards the use of Minimally invasive surgery (MIS) in active period of the COVID-19 pandemic in Turkey. Methods:Online national survey sent to members of Turkish Endoscopy Platform consisting of six sections and 45 questions between the dates 1-15 June 2020 in Turkey to explore their surgical practice during the pandemic in three hospital types: Education and research hospital/university hospital, state hospital and private Hospital. Participants were gynecologic oncologists who are members of Turkish Endoscopy Platform. Results: Fifty-eight percent of participants canceled all operations except for cancer surgeries and emergent operations. About a quarter of participants (28%) continued to operate laparoscopically and/or robotically. For the evaluation of the suspected adnexial mass (SAM) 64% used laparotomy and only 13 % operated by laparoscopy (L/S). For the management of low-risk early-stage endometrial cancer only fifth of the participants preferred to perform L/S. For endometrial cancer with high-intermediate risk factors more than half of participants preferred complete staging with laparotomy. For advanced stage ovarian cancer, one-fifth of the participants preferred to perform an explorative laparotomy, whilst 15 % preferred diagnostic laparoscopy to triage the patients for either NACT or cytoreductive surgery. On the contrary 41 % of participants chose to have cytology by paracentesis for neo-adjuvant chemotherapy (NACT). Gynecologic oncologists with >10 years L/S experience used MIS more for SAM. Furthermore, experienced surgeons used L/S more for endometrial cancer patients. In busy COVID hospitals, more participants preferred laparotomy over L/S. Conclusion:Use of MIS decreased during the pandemic in Turkey. More experienced surgeons continued to perform MIS. Surgical treatment was the preferred approach for SAM, early-stage endometrial cancer. However, NACT was more popular compared to radical surgery.
Highlights
After the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in China and quick transmission of the disease worldwide, routine practices in all fields of clinical medicine have changed significantly (Nakayama et al, 2020; Soreide et al, 2020)
Online national survey sent to members of Turkish Endoscopy Platform consisting of six sections and 45 questions between the dates 1-15 June 2020 in Turkey to explore their surgical practice during the pandemic in three hospital types: Education and research hospital/ university hospital, state hospital and private Hospital
Anecdotal studies reported a higher virus load on the peritoneal cavity, which all contributed to a decreased use of Minimally invasive surgery (MIS) in gynecologic oncologic practice (Coccolini F, 2020) the societies have quickly published their guidelines amid the pandemic, the real-life experience regarding the use of MIS for the management of patients with gynecologic malignancies has not been fully investigated
Summary
After the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in China and quick transmission of the disease worldwide, routine practices in all fields of clinical medicine have changed significantly (Nakayama et al, 2020; Soreide et al, 2020). Anecdotal studies reported a higher virus load on the peritoneal cavity, which all contributed to a decreased use of MIS in gynecologic oncologic practice (Coccolini F, 2020) the societies have quickly published their guidelines amid the pandemic, the real-life experience regarding the use of MIS for the management of patients with gynecologic malignancies has not been fully investigated. In this cross-sectional nationwide study, we aimed to evaluate gynecologic oncologists’ trends and attitudes towards the use of MIS in the active period of the COVID-19 pandemic in Turkey.
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