The 2020 pandemic of the novel coronavirus, COVID‐19, has raised concerns about the risk of virus transmission to staff in the operating room. This relates not just to intubation and extubation of the airway during anaesthesia, but also to the release of potential infectious particles in laparoscopic smoke or plume.
The risks of laparoscopic smoke, or plume, have been recognized for a long time, but the advent of COVID‐19 has brought its importance into sharp relief1. The Society of American Gastroenterology and Endoscopic Surgeons updated their advice on 30 March 20202: 'Although previous research has shown that laparoscopy can lead to aerosolization of blood‐borne viruses, there is no evidence to indicate that this effect is seen with COVID‐19, nor that it would be isolated to MIS [minimally invasive surgery] procedures. Nevertheless, erring on the side of safety would warrant treating the coronavirus as exhibiting similar aerosolization properties. For MIS procedures, use of devices to filter released CO2 for aerosolized particles should be strongly considered'.
A rapid, joint publication from Italian and Chinese surgeons3 has shared excellent advice based on their experiences in the preceding months. The UK and Ireland Intercollegiate Board has also continued to update its guidance. It moved from a statement that 'laparoscopy should generally not be used' to its most recent guideline on 27 March 20204, which states: 'Laparoscopy is considered to carry some risks of aerosol‐type formation and infection and considerable caution is advised. The level of risk has not been clearly defined and it is likely that the level of PPE [personal protective equipment] deployed may be important. Advocated safety mechanisms (filters, traps, careful deflating) are difficult to implement. Consider laparoscopy only in selected individual cases where clinical benefit to the patient substantially exceeds the risk of potential viral transmission in that particular situation'. This expeditious advice is a pragmatic response to the widespread anxiety surrounding possible virus transmission in the operating room.
This article reviews the best available evidence to understand the risk of transmission of COVID‐19 in laparoscopic smoke, and what steps, based on physical properties of the virus, may be best placed to reduce this and justify continuing laparoscopic surgery under strict safety guidelines.