Alonso Poza A.

Alvarez-Gallego M.

Benavides Buleje J.A.

Blas Laina J.L.

Calderon Duque T.

Cano Pecharroman E.

Carrano F

Costa Henere D.

Cros Montalban B.

Diez Izquierdo J.

Diéguez Fernández B.

García Sanchez F.

García Virosta M.

García-Granero A.

González-Argente F.X.

Hernández García M.

Herrero Fonollosa E.

Losada Ruiz M.

López Morales P.

Martinez Sanz N.

Molina-Romero F.X.

Moncada Iribarren E.

Morón Canis J.M.

Nogués Pedival A.

Palma-Zamora E.

Parra Baños P.A.

Pascual-Miguelañez I.

Pata F.

Pellino G.

Peña Ros E.

Pujol Cano N.

San Ildefonso Pereira A.

Sanchez Santos R.

Sánchez López D.

Spinelli A.

Vaquero Rodriguez A.

Vigorita V.

Yánez Benítez C.

English

Archivio della ricerca- Università di Roma La Sapienza

the deluge of extension requests that will arrive towardsthe end of the pandemic, the Health Research Authority(HRA) could allow currently approved studies to extendrecruitment commensurate with lost time without theneed for prior approval. The process of securing approvalsto conduct even low-risk surgical research in the UK isByzantine in complexity. Securing central approvals to achange in terms of this research as simple as adding a sitecan be a drawn-out affair. Many of our prior efforts tosecure approvals are now at risk of ‘timing out’, andapprovals will need to be sought to refresh or extendrecruitment and follow-up periods from the central HRA.If the HRA acts promptly, additional delays ofmonths for studies which wish to resume recruitment ina period after they were due to have closed could beavoided. Such action would also allow resources to bemoved to processing, with the expected surge inrequests for new approvals as clinical practice redevelopsmomentum following the current crisis. In addition,attention could also turn to development of a stream-lined process for the set up of low-risk studies (e.g.observational) to optimize the recovery of our vibrantresearch community.M. Lee*† , S. Brown† , S. Moug‡ ,D. Vimalachandran§ and A. Acheson¶*Department of Oncology and Metabolism, The Medical School,University of Sheffield, Sheffield, UK; †Department of General Surgery,Sheffield Teaching Hospitals, Sheffield, UK; ‡Department of GeneralSurgery, Royal Alexandra Hospital, Paisley, UK; §Department of GeneralSurgery, Countess of Chester Hospital, Chester, UK, and ¶Departmentof General Surgery, Nottingham University Hospital, Nottingham, UKE-mail: m.j.lee@sheffield.ac.uk@wannabehawkeyeReceived 23 March 2020; accepted 24 March 2020; Accepted Articleonline 8 April 2020Reference1 DHSC issues guidance on the impact of COVID-19 onresearch funded or supported by NIHR. https://www.nihr.ac.uk/news/dhsc-issues-guidance-on-the-impact-on-covid-19-on-research-funded-or-supported-by-nihr/24469 (accessed23/03/2020).How to manage smoke evacuation and filterpneumoperitoneum during laparoscopy tominimize potential viral spread: differentmethods from SoMe - a video vignettedoi:10.1111/codi.15086Dear Editor,Even though previous studies on hepatitis B virusshowed that it could be found in the intra-abdominalgas, there is no evidence so far of the presence ofSARS-CoV2 particles in the gas used during laparo-scopy, but it is prudent to perform laparoscopy withsafety strategies to avoid diffusion of potentially infectedintra-abdominal aerosol into the operating room [1-6].Appropriate personal protective equipment based onpatient status and adequate precautions must beadopted, using ultrafiltration (smoke evacuators and/orfilters) during the procedure and monitoring of smoke/gas evacuation and final exsufflation [1-6]. Trocar inci-sions should be minimized to avoid gas leakage aroundports, with CO2 insufflation and pneumoperitoneum ata minimum possible level [1,4]. Ports should be main-tained closed during the procedure, evacuating all pneu-moperitoneum via the filtering system before extractingthe specimen and removing the trocars [1-4]. Commer-cially available closed filtration systems are recom-mended by the Canadian Association of GeneralSurgeons, which discourages the use of nonfiltereddevices [4].Recently, surgeons have shared on social media(SoMe) various methods for filtering gas in laparoscopyduring the COVID-19 pandemic, where other systemsare not available.In this video (Video S1) the authors propose a fewstrategies. Readers should be made aware that, due tothe rapidly evolving scenario, it is recommended tocheck regularly for updates about the correct measuresto adopt when performing laparoscopy during theCOVID-19 pandemic. Hopefully, this trend towards ahigher level of safety in surgery may result in a definitiveadoption of the strategies described in the video.Author listConception and design, collection of material, draftingof the text, preparation of the video: Francesco Pata(corresponding author: Unita Operativa di ChirurgiaGenerale, Ospedale Nicola Giannettasio, Via Ippocrate,localita Rossano, Corigliano-Rossano (Cs), Italy.francesco.pata@gmail.com), Alvaro Garcıa-Granero(Colorectal Unit, Son Espases University Hospital,Palma de Mallorca, Spain), Gianluca Pellino (Universitadegli Studi della Campania ‘Luigi Vanvitelli’, Naples,Italy and Vall d’Hebron University Hospital, Barcelona,Spain).Co-authors (order based on date technique sharedon SoMe): Isabel Pascual-Miguela~nez, Mario Alvarez-Gallego (Colorectal Surgery Department, HospitalUniversitario La Paz, Madrid, Spain); Manuel LosadaRuiz, Miguel Hernandez Garcıa, Beatriz DieguezFernandez, Alberto Vaquero Rodriguez, Alfredo AlonsoPoza (Servicio de Cirugıa General y del AparatoColorectal Disease ª 2020 The Association of Coloproctology of Great Britain and Ireland. 22, 641–649644Correspondence 14631318, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/codi.15086 by Sbbl- Sistema Bibliotecario Biomedico Lombardo, Wiley Online Library on [08/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons LicenseDigestivo, Hospital Universitario de Arganda del Rey,Madrid, Spain); Carlos Yanez Benıtez, Beatriz CrosMontalban, Ana Nogues Pedival, Juan L Blas Laina(General and GI Surgical Department, Hospital RoyoVillanova, Zaragoza, Spain); Mariana Garcıa Virosta,Daniel Sanchez Lopez (Hospital Universitario InfantaSofıa, San Sebastian de los Reyes, Madrid); VincenzoVigorita, Alberto San Ildefonso Pereira, Enrique Mon-cada Iribarren, Raquel Sanchez Santos (Department ofGeneral and Digestive Surgery – University HospitalComplex of Vigo – Galicia Sur Health Research Insti-tute, IIS Galicia Sur, Spain); Julia Diez Izquierdo,Felipe Garcıa Sanchez, Esther Cano Pecharroman, Ter-esa Calderon Duque (Hospital Nuestra Sra Del Prado,Talavera de la Reina, Toledo, Spain); Jorge AlejandroBenavides Buleje, Nuria Martinez Sanz, Pedro LopezMorales, Emilio Pe~na Ros, Pedro Antonio Parra Ba~nos(Hospital General Universitario Reina Sofıa, Murcia,Spain); Antonino Spinelli, Francesco Carrano (Humani-tas Clinical and Research Center – IRCCS, Rozzano,Italy); Daniel Costa Henere, Eric Herrero Fonollosa(Hospital Universitario Mutua Terrassa, Spain); Fran-cesc Xavier Molina-Romero, Natalia Pujol Cano, ElıasPalma-Zamora, Jose Miguel Moron Canis, FrancescXavier Gonzalez-Argente (Son Espases UniversityHospital, Palma de Mallorca, Spain).MIS Filtration Group¶E-mail: francesco.pata@gmail.com@drfrancescopataReceived 8 April 2020; accepted 10 April 2020; Accepted Article online23 April 2020†All authors are listed in the ‘Author list’ section.References1 Joint Society of American Gastrointestinal and EndoscopicSurgeons (SAGES) and European Association for Endo-scopic Surgery (EAES) Guidelines (29/03/20). https://www.sages.org/recommendations-surgical-response-covid-19/ (accessed 31 March 2020).2 Recommendations of the Spanish Association of Surgeons(Asociacion Espa~nola de Cirujanos, AEC) (31/03/20).https://www.aecirujanos.es/Documentos-de-posicionamiento-y-recomendaciones-de-la-AEC-en-relacion-con-la-cirugia-y-COVID19_es_1_152.html (accessed 31 March 2020).3 Recommendations of the Spanish Association of Coloproc-tology (Asociacion Espa~nola de Coloproctologıa, AECP)(31/03/20). https://aecp-es.org/index.php/recomendaciones (accessed 31 March 2020).4 Canadian Association of General Surgeons – statementfrom the CAGS Committee re: Laparoscopy and the riskof aerosolization (24/03/2020). https://cags-accg.ca/wp-content/uploads/2020/03/Laparoscopy-and-the-risk-of-aerosolization.pdf (accessed March 2020).5 Spinelli A, Pellino G. COVID-19 pandemic: perspectives onan unfolding crisis. Br J Surg 2020. [Epub ahead ofprint].https://doi.org/10.1002/bjs.116276 Di Saverio S, Pata F, Gallo G et al. Coronavirus pandemicand colorectal surgery: practical advice based on the Italianexperience. Colorectal Dis 2020; 22: 625–34.Supporting InformationThe video may be found in the online version of thisarticle and also on the Colorectal Disease JournalYouTube and Vimeo channels:Video S1. How to manage smoke evacuation and filterpneumoperitoneum during laparoscopy.Ambulatory management of perianalCrohn’s disease during the COVID-19pandemicdoi:10.1111/codi.15104Dear Editor,Since the outbreak of severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) almost all surgical serviceshave been shut down in the newly reorganizedCOVID-19 hospitals. In particular, all day-case proce-dures, such as exploration under anaesthesia (EUA) foranal fistula, have been postponed.Symptomatic anal fistula in patients with Crohn’sdisease (CD) requires proper and timely treatment inorder to avoid perianal sepsis and allow prompt initia-tion of anti-TNF-alpha treatment [1]. Guidelines andclinical recommendations specific for this period of glo-bal crisis for inflammatory bowel disease (IBD) suggestthat IBD is treated as usual and recommend that anytherapy should be administered while minimizing expo-sure of people and potential transmission [2]. EUA isthe accepted gold standard for diagnosis and treatmentof anal fistula in CD patients [3]. This operation is gen-erally offered under narcosis in operating theatres but iscurrently not available in order to try and prevent theexhaustion of resources.Since 2016, we have offered our CD patients underregular follow-up with symptomatic anal fistula anambulatory exploration of the anal canal and rectum(outpatient exploration, OE) in order to reduce waitingtimes for surgical exploration. OE consists of an exami-nation of the anal canal and lower rectum (proctoscopy)followed by fistula probing, seton insertion and drai-nage of small abscesses. We have reported a high rate ofColorectal Disease ª 2020 The Association of Coloproctology of Great Britain and Ireland. 22, 641–649 645Correspondence 14631318, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/codi.15086 by Sbbl- Sistema Bibliotecario Biomedico Lombardo, Wiley Online Library on [08/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

How to manage smoke evacuation and filter pneumoperitoneum during laparoscopy to minimize potential viral spread: different methods from SoMe - a video vignette

https://iris.uniroma1.it/bitstream/11573/1702110/1/Pata_Manage-smoke-evacuation_2020.pdf

How to manage smoke evacuation and filter pneumoperitoneum during laparoscopy to minimize potential viral spread: different methods from SoMe - a video vignette

Abstract

Similar works

Full text

Available Versions

Archivio della ricerca- Università di Roma La Sapienza