Gynecological Surgery and Its Five Steps Towards Resilience: Minimally Invasive Approach in the COVID-19 Era.

Prados IG, Del Amo MB, Román RR, Santos FJG
Journal of minimally invasive surgery · 2020 · doi:10.7602/jmis.2020.23.4.153 · PMID:35601632 · PMC8985628
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This paper outlines five resilience steps for gynecological surgery during the COVID-19 pandemic, including dynamic prioritization of procedures like endometriosis management and minimizing aerosol risks through minimally invasive techniques.

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This paper outlines a five-step framework for maintaining resilient gynecological surgical services during the COVID-19 pandemic, focusing on prioritization, minimally invasive techniques, optimization, screening, and protection. It details consensus guidelines from major societies for triaging patients based on disease severity and comorbidities, while addressing the theoretical risks of aerosol generation in laparoscopic procedures. The authors recommend specific precautions such as low-pressure pneumoperitoneum and enhanced personal protective equipment to mitigate viral transmission risks during surgery. Relevance to endometriosis: listed as one indication for surgical intervention within prioritization levels, with specific guidance on managing deep infiltrating endometriosis involving intestinal obstruction or requiring open approaches due to higher viral presence in the digestive tract.

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Abstract

After the declaration of the coronavirus disease 2019 (COVID-19) pandemic, gynecological surgery joins the readjustment process that this great global health crisis implies. In the light of current literature, the five steps towards its resilience are described as below; (1) Dynamic prioritization of surgical indications and reintroduction of elective surgeries: Diverse surgical prioritization lists are published including the most common gynecological pathologies. (2) Minimally invasive surgery through laparoscopy and robotic assistance: Some authors suggest a theoretical but unproven risk of viral transmission during these approaches because of the aerosol generation. These theories are opposed to the well-proven advantages of these approaches compared to open surgery. (3) Optimization of surgical procedures, according to the recommendations of different societies aimed at reducing the dispersion of aerosols and surgical smoke. (4) Clinical, epidemiological and microbiological screening of all patients awaiting prompt surgery: This screening should be adapted to the local alert state. (5) Protection through the reduction of number of persons present in the operating room, and the use of adapted personal protective equipment according to physical proximity to the patient.
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Intro

On 31 December 2019, the World Health Organization receives notification of the first cases of pneumonia of unknown etiology detected in Hubei province. 1 Shortly after, the coronavirus disease (COVID-19) pandemic is declared, a global health crisis that will break the health systems implemented to date from their foundations. Within the broad health impact caused, gynecological surgery joins the readjustment process in respect of which, multiple societies establish consensus for action. The five pillars of this process, the five steps towards resilience of a gynecological surgery that grows strong in the face of a world crisis, are described below.

Other

Use of adapted personal protective equipment according to screening results and physical proximity to the patient. Furthermore, the need to limit the number of persons in the operating room is highlighted. Recommendations in COVID positive patients or suspected infection, when surgery cannot be postponed, are as follows 19 , 24 , 25 : ◊“Bedside assistants”: Level III protection. Work uniform, surgical cap, well-fitted medical protective mask FFP2/3, long-sleeved latex gowns and gloves, full-face respiratory protective devices. ◊Surgeon at console: Level II protection. Work uniform, surgical cap, well-fitted medical protective mask FFP2/3, longsleeved latex gowns and gloves, goggles.

Conclusion

Laparoscopy finds an essential role in the establishment of gynecological surgery in the midst of the COVID-19 pandemic, being easily integrated into it by the five steps towards its resilience: prioritization, minimal invasion, optimization, screening and protection.

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