Minimally invasive surgery during the COVID-19 pandemic. The approach to laparoscopic surgery in endometriosis and oncology

The global coronavirus pandemic has a major impact on the healthcare services and professionals. It brings challenges to the gynecologists’ work in optimizing the care of their patients. In an effort to restrain the transmission of the virus and prioritize the treatment of patients with COVID-19, the elective surgeries were limited during the pandemic. Nevertheless, the urgent procedures must be performed. In this paper, we reviewed the articles regarding the advantages and risks of minimally invasive surgery and the methods to perform a safe surgery during the COVID-19 pandemic. At this time, there is limited evidence that laparoscopy represents a high risk of infection, because there is limited data on the presence of the virus in the surgical smoke. However, it is thought that the best option for all the surgeons would be to use certain strategies to minimize any theoretical risk of viral transmission during laparoscopic surgery. Recommendations and guidelines have been made by authorities, by the Ministry of Health from Romania and by professional societies on how to operate under extreme circumstances within a system where the priority is, first and foremost, the patients who need immediate care under safe circumstances. The laparoscopy advantages regarding the reduced hospitalization time, the smoke and fluids that can be restrained and evacuated in a safer way and the less traumatic surgical maneuvers are very helpful during this pandemic. Recommendations were made regarding the protection during emergency surgery in COVID-19 patients that specifically include the use of N95 masks for anesthesia and surgical teams. The patient should also wear a fluid-resistant surgical face mask. A checklist that can be considered both a new standard for hospitals and a tool that helps healthcare personnel and patients to feel safe during their hospital stay was developed in order to decrease the risk of viral spread.