cord-001725-pw7coi3v	2015	title: Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. This study therefore aimed to describe the incidence, epidemiology, microbiology and outcomes of SSI in patients admitted with secondary or tertiary peritonitis to the ICU of a tertiary referral hospital. This study provides data on the incidence and microbiology of SSIs for a large cohort of critically ill patients admitted with secondary or tertiary peritonitis to a surgical ICU.
cord-006563-qmigctkp	2017	This is the reason why in the last decades a lot of clinical studies have been performed with the aim of reducing the magnitude of the postoperative pain, all of them directed to those factors which might influence the pain after surgery, such as: presence of preoperative chronic pain, anesthesia technique, or the need for an acute pain service. The list of proposals to be taken into consideration includes: a careful psychological evaluation and preparation of the surgical patient, a good preoperative sedation and even the use of antidepressants before surgery in specific cases. Regional anesthesia and ambulatory surgery: the role of continuous infusion devices in postoperative pain management in pediatrics Ralph J Beltran Department of Anesthesiology and Pain Medicine, Nationwide Children''s Hospital, Columbus, Columbus, OH, USA Continuous infusions of local anesthetic delivered via peripheral nerve block catheters (PNB) for postoperative pain management in adult patients has become more prevalent.
cord-006818-2lclcf1x	2008	The objective of the present paper is to review the most common reproductive emergencies in male, female, and neonatal camelids. Pregnant females may present with a variety of emergency clinical syndromes, ranging from severe colic, downer (lateral or sternal continuous recumbency), anorexia, diarrhea, depression, neurologic conditions, excessive straining, vaginal discharge, premature lactation, vulvar dilation, or vaginal prolapse. Difficulties encountered in transrectal evaluation for uterine torsion include physical limitations, particularly in alpacas (tight anal sphincter, narrow pelvis and size of the examiner''s hand and arm), as well as a lack of experience palpating late-pregnant camelids in a sternal position. Regarding obstetrical procedures, there are three major differences between camelids and ruminants: (1) the pelvic inlet is narrower; (2) the cervix and vaginal are more prone to laceration and severe inflammation (often leading to adhesions); (3) risks for neonatal hypoxia and death are increased by the forceful uterine and abdominal contractions and the rapid detachment of the microcotyledonary placenta.
cord-006849-vgjz74ts	2019	Methods: We are performing this procedures within a prospective randomized trial that is design to compare the long term results of LRYGB-B versus the standard laparoscopic Roux-en-Y gastric bypass.The video shows our technique in a case of a 46 years old female with a BMI of 46 Kg/m2. Material and methods: We present a video of the surgical intervention of a 32-year-old patient, with functional dyspepsia, with a casual diagnosis of a pseudocystic mass of the right colon after performing a CT scan: giant diverticulum of the hepatic colon angle with fecaloid content inside it under tension The patient goes to the emergency room for acute abdominal pain, pending colonoscopy, antibiotic treatment is established, and a laparoscopic approach is decided upon after the patient''s evolution. Method: We present the case of a 65-year-old patient with surgical antecedent of laparoscopic low anterior resection due to rectal cancer, presenting in postoperative period an anastomosis leakage with severe peritonitis was identified and a laparotomy with end colostomy was performed.
cord-006854-o2e5na78	2018	Totally Laparoscopic ALPPS Combined with the Microwave Ablation for a Patient with a Huge HCC Hua Zhang; Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting hepatic tumors that were previously considered unresectable due to the insufficient future liver remnant (FLR) which may result in postoperative liver failure (PLF). Not only does this case show that a large epiphrenic diverticulm can be successfully resected via the trans-abdominal laparoscopic approach, this case makes the argument that patients undergoing any minimally-invasive epiphrenic diverticulectomy and myotomy, with or without fundoplication, may be successfully managed with early post-operative contrast studies and dietary advancement, thus decreasing their length of hospitalization and overall cost of treatment. Introduction: There are reports of increased operative duration, blood loss and postoperative morbidity, caused by difficulties in obtaining good visualization and in controlling bleeding when laparoscopic resection is performed in obese patients with colon cancer.
cord-011402-sk4tgdf8	2020	title: Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore Keywords: COVID-19 Health policy Infectious diseases Healthcare administration Surgery Designated pandemic wards managed confirmed or high-risk cases, providing natural segregation among nursing staff, who are ward-based. Central to our plan was the reorganization of medical staff in our department into three independent teams (Fig. 1) to prevent the standing team from working continuously and avoid the complete shutdown of outpatient services should any team become afflicted with the virus. To study the impact on patient care, operational and safety data in the month immediately post-activation of our pandemic preparedness plan were retrieved and compared with data from a similar period in 2019. There were 338 reported incidents for surgical patients from February to March 2020, compared to 397 for the same period in 2019 (Fig. 2d) .
cord-015368-a0qz4tb9	2007	Surgical treatment and evaluation, complications, short and long term patency of our patients were compared to interventional techniques and international literature. The aim of the study was to investigate: i) relevant and combined determinants of the development, management and outcome of a representative patient cohort (n ¼ 9.991) with acute appendicitis enrolled in a prospective unicenter study through a time period of 27 years (middle Europe), and ii) the frequency and impact of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings, complications), correlation and relative risk factors of the disease and its prognosis. From 01=1997 until 12=2006 198 TEM procedures were performed in 194 patients, 104 males, 90 females, mean age was 68.9 years (38-91), the median hospital stay was 8 days . No conversion to open technique had to be performed, no postoperative surgical complications were observed, one patient died 4 weeks postoperative due to liver failure following esophageal varices bleeding.
cord-025176-f0frlpwh	2020	15 Most recommendations from public health officials have suggested that a steady decrease in the number of new COVID-19 cases over a period of 14 days (decreased incidence), associated with a similar trend in hospital and ICU admission, is necessary to consider resuming elective surgery (box 1). However, it is important that a staged system be implemented with partial reopening followed by interval full reassessment of the system, as the incidence of COVID-19 infection may have decreased further, allowing the opening of more operating rooms, increasing the overall number of procedures performed. After a functional period in stage 1, a reassessment of the COVID-19 infection in the community and in the hospital should occur to determine if adding operating room capacity and increasing the number of surgical cases is warranted.
cord-026031-hnf5vayd	2009	Fresh whole blood Coagulopathy with active hemorrhage (disseminated intravascular coagulation, thrombocytopenia; massive acute hemorrhage; no stored blood available) Stored whole blood Massive acute or ongoing hemorrhage; hypovolemic shock caused by hemorrhage that is unresponsive to conventional crystalloid and colloid fluid therapy; unavailability of equipment required to prepare blood components Packed red blood cells Nonregenerative anemia, immune-mediated hemolytic anemia, correction of anemia before surgery, acute or chronic blood loss Fresh frozen plasma Factor depletion associated with active hemorrhage (congenital: von Willebrand''s factor, hemophilia A, hemophilia B; acquired: vitamin K antagonist, rodenticide intoxication, DIC); acute or chronic hypoproteinemia (burns, wound exudates, body cavity effusion; hepatic, renal, or gastrointestinal loss); colostrum replacement in neonates Frozen plasma Acute plasma or protein loss; chronic hypoproteinemia; (contains stable colostrum replacement in neonates; hemophilia B and clotting factors) selected clotting factor deficiencies Platelet-rich plasma* Thrombocytopenia with active hemorrhage (immune-mediated thrombocytopenia, DIC); platelet function abnormality (congenital: thrombasthenia in Bassett hounds; acquired: NSAIDs, other drugs) Cryoprecipitate
cord-028285-n4dommet	2020	With there being a short interval from the time of the first COVID-19 case presentation, to the development of a global pandemic, validated management algorithms to support changes in operative strategies are lacking. The key components of NHS preoperative patient screening for COVID-19 are: structured questionnaires with temperature monitoring, viral real-time polymerase chain reaction (RT PCR) for SARS-CoV-2, and chest imaging. Full PPE (fluid resistant gown, double gloving, visor or goggles, fit-tested FFP3 mask or respirator, disposable hat, shoe covers) should be worn in the operating rooms for any suspected or positive COVID-19 case, for AGP 38 (Table 3) , and for procedures for which the risk is unknown. All surgical cases require a discussion about the patient''s COVID-19 status, the degree of aerosol risk for each part of the procedure (induction of anaesthesia, extubation, and for all operative phases), with PPE requirement stated for each stage.
cord-029789-ttql1jpv	2020	authors: Bittner, Elizabeth; Ueland, Walker; Nisiewicz, Michael J.; Siddiqi, Hussain; Plymale, Margaret A.; Davenport, Daniel L.; Roth, John Scott Clinical characteristics including patient age, gender, BMI, and medical comorbidities were similar between patients boarded on surgical versus non-surgical units. There were no differences in ICU or PACU stay, cost, or postoperative complications in patients housed on surgical versus non-surgical units. Evaluation of patient outcomes and LOS in open ventral hernia repair patients based on hospital unit is unique to this study. The purpose of this study was to evaluate the impact of postoperative hospital units, including medical, surgical, and intensive care, upon hospital length of stay and early clinical outcomes of VHR patients. Our study did not find an increased risk of early postoperative complications, including cellulitis and wound complications, with patients housed on non-surgical units. Postoperative VHR patients experience an increased LOS and rate of location transfer when housed on a non-surgical unit.
cord-032756-ag7a0dx0	2020	title: Regarding "Development of a Surgical Video Atlas for Resident Education: 3-Year Experience" Regarding ''''Development of a Surgical Video Atlas for Resident Education: 3-Year Experience'''' DOI: 10.1177/2473974X20959069 We read with great interest the article by Brown et al, 1 ''''Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.'''' In this article, the authors present their excellent work collaborating with the Journal of Medical Insight (JOMI) to produce 29 otolaryngology surgical videos to aid in surgical education. We congratulate the authors on their contributions and excellent work developing a high-quality product, and we look forward to seeing other innovative ways that clinicians incorporate intraoperative video resources into surgical training, particularly during this time when supplemental educational content is vital. Development of a surgical video atlas for resident education: 3-year experience An openaccess, comprehensive otolaryngology-head and neck surgery video atlas for resident education
cord-254686-pclq855r	2020	The challenges faced by surgical specialties include, but are not limited to the risk of exposure to non-COVID-19 patients, transmission to healthcare workers (HCWs), judicious use and allocation of valuable resources such as ventilators, personal protective equipment (PPE), and blood products. The members of the paediatric surgery division of University of Malaya Medical Centre (UMMC) assumed additional responsibilities to provide assistance to both frontline HCWs and the management, in areas in need of support. This study describes the adaptive measures taken and evolving roles of the members of this paediatric surgery division upon the characterisation of COVID-19 as a pandemic. The biggest challenge we faced were to formulate a set of guidelines that ensured the safety of patients and healthcare personnel alike, at a time when there was limited published literature on the delivery of paediatric surgical service during a pandemic.
cord-258118-j26v354r	2020	Apart from the numerous chemicals, surgical smoke had been shown to harbour intact bacterial and virus particles especially COVID-19 in the current time. OBJECTIVE: To identify the inhalational, infectious, chemical, and mutagenic risks of surgical smoke and suggest evidence-based hazard reduction strategies. Heating of tissues causes vaporisation of protein and fat which results surgical smoke(2) which contain particles from combustion and numerous chemicals like hydrocarbons, acrylonitrile, phenols and fatty acids and biological particles, viruses, and bacteria which are known to be potentially hazardous. In COVID-19 outbreak scenario, the use of surgical diathermy has to be minimised or avoided due to the very high risk of viral spread among operating room personals. Multiple precautions like use of a standard surgical mask, laser or high filtration mask, masks coated with nanoparticles, operating room ventilation guidelines, and use of wall suction have been using to reduce the health hazards, but each one has its own limitations.
cord-258243-2utl2mfl	2018	We investigated the distribution of the three major categories of surgical indication according to sex, age group (<5 years, 5-11 years, 11-17 years, 18-40 years, and >40 years), hospital level (medical centers, regional hospitals, and local hospitals), and insured residence areas according to the NHI divisions (Taipei, Northern, Central, Southern, Kaoping, and Eastern). In the adult subgroup (Figs 2B and 3B) , the incidence and proportion of AT performed for RICI decreased from 46 (78%) in 1997 to 32 Table 3 indicates the number and percentage of the three categories of surgical indications according to sex, age groups, hospital level, and insured residence areas in the total study population. The trend in the AT rate and the proportion of surgical indications by the calendar year according to sex, age groups, hospital level, and insured residence areas in the total study population are shown in the supplemental data (S1 File).
cord-258762-vabyyx01	2020	
cord-259566-qtlq7a6l	2020	title: Transforming laparoendoscopic surgical protocols during COVID-19 pandemic; big data analytics, resource allocation and operational considerations; a review article Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up provides a brief account of the impact of the COVID-19, big data analytics of response of medical personnel in curtailing and understanding the disease process and the consensus guidelines for carrying out laparoscopic and endoscopic procedures. -Limiting the number of operating room personnel, use of disposable instruments, negative pressure air flow, and setting electrocautery energy devices at low modes can possibly reduce disease transmission during laparoendocsopic procedures.
cord-259984-csdf1a69	2020	
cord-260907-uuaa9ta2	2020	Clinical clerkships in surgery, obstetrics and gynecology, and anesthesiology require students to participate in surgeries and procedures to learn technical skills, and then demonstrate such skills to assess competence. The remainder of this paper focuses on the potential solutions and barriers to providing adequate undergraduate medical education in procedure-oriented fields in the setting of the COVID-19 pandemic. Educators looking to provide examples of surgical videos to their learners need to curate these collections with the knowledge base of the learner in mind [12, 13] . Creating educational tools that instruct students in surgical assisting may fill an important need. Sharing web-based video examples of appropriate communication techniques has been shown to be effective in teaching surgical trainees [23] . Students at our institution who were asked which remote teaching methods they considered the most helpful gave similar ratings to interactive online cases, remote lectures, and faculty-guided surgical videos. The effect of degree of immersion upon learning performance in virtual reality simulations for medical education
cord-262141-th2edwh4	2013	Surgical masks are also used to protect health care providers from contact with large infectious droplets (> 5 micrometer [mcm] in size)." 17(p357) The term protective facemask refers to a surgical N95 respirator or surgical mask that covers at least the nose and mouth to reduce the wearer''s risk of inhaling hazardous airborne particles (including dust particles and infectious agents). These fit-tested devices are personal protective devices that are worn on the face, cover at least the nose and mouth, and are composed of a filter that prevents the passage of a wide size range of hazardous airborne particulate matter, including dust particles and infectious agents, from entering the wearer''s breathing space. 47 According to the AORN "Recommended practices for laser safety in perioperative practice settings," during high-risk or aerosol-generating procedures in patients with or suspected of having transmissible infections (eg, HPV, tuberculosis, rubeola, varicella), respiratory protection that is at least as protective as a fit-tested surgical N95 respirator should be used in conjunction with local exhaust ventilation.
cord-266977-5swwc6kr	2020	authors: Secker, Thomas.J.; Leighton, Timothy.G.; Offin, Douglas.G.; Birkin, Peter.R.; Hervé, Rodolphe.C.; Keevil, Charles.W. title: Journal of Hospital Infection A cold water, ultrasonic activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel Aim: To test the efficacy of an ultrasonically activated stream for the removal of tissue 27 proteins, including prion-associated amyloid, from surgical stainless steel (SS) surfaces. This study has tested the efficacy of UAS technology for the removal of 239 total protein and prion-amyloid from stainless steel, which is considered the most difficult 240 contaminant to decontaminate in the surgical field. 335 J o u r n a l P r e -p r o o f Tissue protein (Dark grey bars) and prion-associated amyloid (light grey bars) attachment 545 from different prion-infected brain homogenates (22L, ME7 and 263K) to surgical stainless 546 steel pre and post treatment with an ultrasonically activated stream (UAS) (Graph A).
cord-269457-i02brfzr	2020	title: Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. CASE PRESENTATION: A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications. The presentation of our patient with a periumbilical mass and discharge of pus at the umbilicus prompted the potential differential diagnosis of an infected urachal cyst. This case shows that the diagnosis of gossypiboma can be complicated by its nonspecific presentation, which clinically and radiologically imitates other common pathologies, such as abscesses and tumors, and rare conditions, such as urachal cysts.
cord-275985-rj0o7lg2	2020	Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. The COVID-19 pandemic has indeed created an abrupt need for new and innovative end-to-end training solutions, as well as a greater willingness for trainers and trainees to use novel technologies for surgical education. Social media and digital learning tools may be the ideal alternative platforms to meet the changing needs in surgical training and professional development. 5 Applications of SoMe specific for surgical education include live dissemination of research from peer-reviewed journals, live tweeting at medical conferences, online journal clubs, transmission of news from professional societies and surgical departments, coordination of research collaborative groups, and consultations/general discussion to further medical learning. A prime example of this communication ability is a closed Facebook group the Robotic Surgery Collaborative, which allow surgeons to share de-identified cases, post informal polls, and exchange questions and experiences regarding particular techniques or practices (Figure 1 ).
cord-277971-7upcsmg4	2020	Whilst we commend the authors for their work and comprehensive actions put in place, there was an omission of a critical factor highly pertinent to dermatologic surgery and potential COVID-19 transmission, namely surgical plume. The use of surgical masks may offer partial protection to respiratory droplets; however fine aerosolised particles from surgical plume may continue to pose an infectious risk to patient and staff. The use of specialised masks able to filter particles smaller than 5 microns (the threshold size for surgical masks) such as laser-specific masks or N95 masks offer better protection to aerosolised particles 4, 5 . Given that many dermatologic surgical procedures involve the head and neck area, careful attention to hazards posed by surgical plume and ablative lasers and attempts to mitigate these are essential interventions in the COVID-19 era.
cord-281656-8anh8rhm	2020	At our knowledge, up until now, only one article demonstrated the presence of HBV in the surgical smoke in 10 of 11 HBV-positive patients undergoing laparoscopic or robotic surgery. Despite HIVand HBV being blood-borne viruses, laparoscopic surgery is being performed in HIV and HBV patients for many years, and no clear demonstration is available of viral transmission through the pneumoperitoneum or surgical smoke. For these reasons, we do not believe that results from the available literature can be extrapolated to the COVID-19 pandemic as to justify the current too restrictive guidelines on laparoscopic surgery against the evident and well-known and evidence-based advantages of laparoscopy with respect to the open approach in many fields of surgery. Thus, treating by laparotomy a reduced number of high-priority elective cases and surgical emergencies (sometimes failures of nonoperative management and, then, associated with a nonnegligible risk of conversion) may represent the safest option for patients, health workers, and system sustainability during the critical periods of COVID-19 outbreak.
cord-282786-kbr1p8e9	2020	We noticed that our surgical trainees have had more time to spend on academic rather than administrative work, resulting in reduced symptoms of burnout amongst attending and resident surgeons. The construction of low-cost laparoscopic box trainers has been previously outlined [3] , and institutions that do not have access to high-end surgical training kits can still provide their surgical residents with opportunities using this accessible tool during the current pandemic. Institutions have had to adapt to K COVID-19: an opportunity to restructure surgical education different ways in which their surgical trainees learn, and-in our institution at least-have focused on reducing clinical activities and the high workload associated with surgical training to instead focus on academic and technical skills'' training. Future studies on the wider implications of this pandemic on surgical education would better outline the further adaptations required to deliver surgical training in a post-COVID-19 world.
cord-287376-wxldnlih	2020	Finally, the choice of surgical method, whether open surgery or minimally invasive procedures, is critical in determining how many colleagues are exposed to the risk of infection from COVID-19 patients, sometimes for hours. Here, robot-assisted surgery can comply with the pandemic''s requirement to "keep your distance" in a unique way, since the surgeon can operate at virtually any distance from the surgical site, at least with regard to aerosol formation and exposure. There were two central factors in the German hospital landscape that led to the restrictions described below: First, the call by the German Federal Ministry of Health to substantially increase the number of intensive care beds which would allow invasive ventilation of patients by temporarily postponing elective procedures; and second, the shortage of personal protective equipment (PPE), which is mainly produced in China, that accompanied the beginning of the pandemic.
cord-290209-gkx57lyq	2020	At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. The presence of a drain and a contaminated or dirty type of surgery (according to SWC) could increase the overall rate of SSIs, but the presence of a drain did not demonstrate an increased risk of superficial and/or deep SSIs. On the other hand, protection with surgical masks for both patient and surgeon during the post-operative period in the surgical unit and the absence of visitors, dramatically reduced superficial and deep SSIs. These two simple precautions emerged as independently associated with the reduction of both superficial and deep SSIs. Quality improvement initiatives aimed at reducing SSI rates are often hindered by limited or even conflicting evidence for proposed interventions to reduce SSI [33] . Surgery and the postoperative management of surgical wound carries a non-negligible risk of SSIs. In this study, we provided important insights into the superficial and deep surgical site infection risk assessment for patients who underwent surgery.
cord-292129-m1ookq0l	2008	Objectives: This study aimed at determining the protection factors (PFs) provided by N95 filtering facepiece respirators and surgical masks against particles representing bacterial and viral size ranges (aerodynamic size: 0.04–1.3 μm). Methods: The protection levels of N95 filtering facepiece respirators (four models) and surgical masks (three models) were investigated while they were donned by 12 subjects performing the OSHA (US Occupational Safety and Health Administration) fit-testing exercises in a test chamber. In this study, the number concentrations of NaCl particles (challenge aerosol) were size-selectively measured using the ELPI, so that the protection levels provided by N95 filtering facepiece respirators and surgical masks were determined when human subjects donned the tested respirators and performed the OSHA fit-testing exercises: normal breathing, deep breathing, turning head side to side, moving head up and down, talking, grimace, bending over and returning to normal breathing (Department of Labor, Occupational Safety and Health Administration, 1998) .
cord-300689-dz6lybgi	2020	Surgery programs are a source of surge capacity during the COVID-19 response, both in terms of inpatient bed capacity and clinical personnel, with many surgeons redeployed to focus on critical care or staffing COVID-19 procedure teams. COVID-19 and the resulting pandemic response broadly impact short-and long-term health outcomes for surgical patients. Payment and Delivery System What is the direct financial impact of delaying elective surgical care to hospitals, and outcomes including hospital closures, personnel layoffs, and decreased access to care for patients? Does postponement of emergency general surgery or use of nonoperative interventions to manage emergency general surgical conditions during the pandemic adversely impact outcomes for non-COVID patients, compared to emergency general surgery after prepandemic standards of care? COVID-19 will profoundly affect the US surgical system, including changes to healthcare infrastructure, payment systems, safety standards, clinical training, and population health.
cord-302104-wjad5q9q	2020	title: Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era
cord-305282-x2zzzw43	2020	
cord-306226-znj4gp87	2020	According to the precautionary principle, every patient undergoing emergency surgery not already tested for COVID-19, must be considered as potentially infected, an issue that entails putting into practice of all precautions. This principle of safety for all healthcare professionals obviously translates into implementing all the provisions used in confirmed COVID-19 patients for surgical interventions that are not postponable and that require the immediate availability of the operating room (such as trauma, shock, bleeding, suicide attempts, peritonitis, etc). Patients with a negative swab for COVID-19 who require surgery undertake the "clean" pathway with dedicated operating rooms and the possibility of hospitalization in the Covid-free surgical ward. If we consider also the apparent reduction/absence of polytrauma due to social distancing measures imposed by the government, a minor human contact in patient handover (even if digital platforms are provided) and the difficulties in the technical management of surgical COVID-19 patients in emergency settings, this pandemic era is further tempering the spirit of surgeons.
cord-309751-7elnvjk3	2020	The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Relevant information was digested and organized under 5 main headings; the impact of COVID-19 pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, perioperative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopaedic cases during the COVID-19 pandemic Perioperative considerations in urgent surgical care of suspected and confirmed COVID-19 orthopedic patients: Operating rooms protocols and recommendations in the current COVID-19 pandemic
cord-315089-csqjgozm	2020	title: Non-face-to-face basic surgical skill education in the novel coronavirus disease 2019 (COVID-19) outbreak: obstacle vs. Therefore, it is considered important to develop the systematic non-face-to-face education system for proper basic surgical skill education in the novel COVID-19 pandemic moment. The education program for basic surgical sills was largely composed of student''s surgical skill practice using a portable surgical training kit and several online lectures. In the case of personal individual surgical skill practice, portable surgical training kits were previously rented to students, and pretraining education materials, such as video files showing how to perform basic surgical skills were produced and provided before the class. To establish a more effective non-face-to-face surgical education system, not to mention of more suitable portable surgical training kit, the development of a specialized SNS-based education system that can provide effective feedback between students and supervisors, and appropriate device for recording student surgical basic skills are necessary. Non-face-to-face basic surgical skill education in the COVID-19
cord-316483-nrx8ovvq	2020	All started and spread in the Lombardy region, the most populated region in Italy (10.2 million of inhabitants), with an outbreak accounting for most of the Italian registered cases of COVID-19, thousands of hospitalized patients, 15% of whom required an admission in intensive care units 2 . The current regional model of prioritization in surgical oncology, based on the "first-come, first-served" principle and able Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. With respect to the second aim, we proposed a renowned system of priority for patients with gastro-intestinal malignancies (about one quarter of the surgical volume for oncological indications) 5 largely drawn from organ transplant allocation principles, namely from the longstanding area of surgery in which the imbalance between demand and supply is permanent 6, 7 . In conclusion, an allocation scheme of priority for surgical oncology is proposed to face the dramatic restrictions in elective surgery resources during the COVID19 pandemic.
cord-318333-rzhrgp5q	2020	BACKGROUND: This study aimed to describe the epidemiologic and clinical characteristics of coronavirus disease 2019 (COVID-19) in surgical patients and medical staff. 8 In this study, we report the epidemiological and clinical characteristics, treatment, and outcomes of surgical patients with confirmed COVID-19 pneumonia infection and the infection transmission from surgical patients to medical staff. 10 Patients with COVID-19 pneumonia were considered positive for SARS-CoV-2 with the use of the Chinese Center for Disease Control and Prevention (CDC) recommended kit (BioGerm, Shanghai, China), following WHO guidelines for qRT-PCR, 5 or by chest computed tomographic (CT) scans. 10 In the early stage of this epidemic (before January 23th, 2020), the nucleic acid tests were performed only on the suspected surgical patients with fever more than 37.3 ℃ and/or pulmonary infection (Chest CT/X-R ray showing) when entering the operating room, and medical staff only used the surgical mask to protect themselves.
cord-324396-91v7uxnd	2020	The authors highlight several limitations to residency training including: facilities and equipment, whereby some countries may not have access to adequate animal models, simulations or cadavers to practice first hand; impact on research with reduced sample sizes and less people consenting to research; changes to learning with teaching reduced to case reports and seminars, reduced learning opportunities for junior residents in both the operating theatre and the subsequent management of surgical patients; changes to hospital processes including cancellation of elective procedures, less people attending an operating theatre at one time to reduce risk of transmission, the redeployment of surgical trainees onto COVID-related wards and the difficulties surrounding the use of personal protective equipment (PPE). Overall, we wholeheartedly agree with the authors on the potential negative consequences that the COVID-19 pandemic may have on the surgical speciality and it''s trainees and by extension, the repercussions on medical students, as we have identified.
cord-325110-cfo5f99l	2020	
cord-325290-hbzbyqi4	2020	title: Redeployment of surgical trainees to intensive care during the COVID-19 pandemic: evaluation of the impact on training and wellbeing OBJECTIVE: : The aim of this study was to evaluate the impact of redeployment of surgical trainees to intensive care units (ICUs) during the COVID-19 pandemicin terms of transferrable technical and non-technical skills and wellbeing. SETTING: : The study involved surgical trainees that had been redeployed to the (ICU) across all hospitals in London during the COVID-19 pandemic. CONCLUSIONS: : Redeployment of surgical trainees to ICU led to increased confidence in a number of technical and non-technical skills. 4 The aim of this study was to evaluate the impact of the redeployment of surgical trainees to critical care units during the COVID-19 pandemic in terms of transferrable skills, wellbeing and career development. Doctors working at postgraduate years two to four who were redeployed from surgical specialties to ICU during the COVID-19 pandemic were included.
cord-330940-ee63wosv	2020	OBJECTIVE: In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines recommend only urgent or emergent surgical procedures be performed to minimize viral transmission. This effectively limits standard training and practice for surgical residents. The purpose of this article is to describe opportunities in surgical simulation, and highlights the challenges associated with training in the COVID-19 era. CONCLUSIONS: This manuscript concisely discusses simulation options available to training programs, including the novel concept of "surgical kits." These kits include all instruments necessary to simulate a procedure at home, effectively pairing safety and utility. 3 In light of these concerns, surgical simulation appears to offer utility of both safety and procedural training for the surgical resident. In an effort to address current limitations on procedural education in our otolaryngology program, we have designed "simulation kits" to be distributed to otolaryngology junior residents.
cord-332282-nehpwsqn	2020	key: cord-332282-nehpwsqn Editor Hogan 1 reported in their correspondence that they ''endeavour, as always, to provide the highest level of patient care within the framework of imposed constraints and to preserve the health of the surgical workforce providing this care'' and that ''there is minimal evidence regarding emergency surgical Here, we describe a hybrid surgical tracheostomy using a percutaneous kit under a customized insulated field with the patient in a supine position using a thyroid drape (Fig. 1) . The goal was to avoid any leakage of viral particles through openings in the drape (made for the operator''s hands). Adding a customized insulated field and the hybrid technique, which avoids having to perform a fibreoptic bronchoscopy to check the tracheal puncture location or the final position of the Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services Global guidance for surgical care during the COVID-19 pandemic
cord-332960-h0be6pr0	2020	
cord-337958-472xu87g	2020	
cord-339196-2xkplp4g	2020	
cord-342592-sf3iv8t4	2020	
cord-344682-4vpm7m1h	2020	title: Impact of the COVID-19 Pandemic on Surgical Training and Learner Well-Being: Report of a Survey of General Surgery and Other Surgical Specialty Educators It included both closedand open-ended questions and the self-reported stages of GME during the COVID-19 pandemic as defined by the Accreditation Council for Graduate Medical Education (ACGME). Respondents reported the Sponsoring Institution''s (SI)ACGME Stage as either Stage 1: business as usual; Stage 2: increased but manageable clinical demand; or Stage 3: crossing a threshold beyond which the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care education and delivery must be reconfigured to focus only on patient care. The experience with the COVID-19 pandemic highlights the need for institutions to develop disaster plans that include disruption to educational programs that not only include the "rules of engagement" around clinical redeployment but also the continuation of didactics and psychological counseling and other supportive infrastructure including childcare that are critical to sustain the wellness of learners.
cord-348614-im7qtr9k	2020	These COVID-19 dedicated protocols addressed surgical team organization, operating room (OR) preparation, rational use of personal protective equipment (PPE), considerations on anesthesiology, and intraoperative management of emergency surgical pathology. Continuity performing their regular tasks was reported by 73 (54%) of the respondents, in contrast with the rest, whose newly assigned duties were to the emergency department COVID-19 triage (25%), the intensive care unit (ICU) activities (13%), or had to manage mechanically ventilated patients in the surgical ward (7%). About half (51%) of the respondents had not received training in the use of PPE for airborne infectious risk while performing emergency surgical procedures before the pandemic, and roughly over one-third (37%) had it during the studied period. This study provides an international snapshot of the level of adoption of the guidance for surgical team organization, adequacy of PPE availability and usage, OR preparation, anesthesiologic considerations, and intraoperative management of emergency surgical cases during 2 weeks of the COVID-19 pandemic.
cord-351373-a21453gz	2020	A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. The Society of American Gastroenterology and Endoscopic Surgeons updated their advice on 30 March 2020 2 : ''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. 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.
cord-352884-umlxwnid	2020	Dermatologists frequently undertake procedures using electrosurgical and ablative laser devices, generating a cloud of surgical smoke known as plume, which can pose harm to both patients and staff. A study reported the 70-year lifetime cancer risk of surgeons exposed to PAHs in electrocautery smoke was 117 times greater than that of a person exposed to the safe level of 1 9 10 À6 advised by the World Health Organization. 21 A study looking at concentrations of human papillomavirus (HPV) DNA from treated plantar warts in both ablative laser and electrocautery plume found the virus in 62% and 57%, respectively. Given the fact that ablative lasers generate greater concentrations of particles of greater infectious potential, it is highly recommended that ablative lasers are only used in patients confirmed as COVID-19free, with the maximum protection used such as filtering face piece (FFP)3 masks with appropriate filters, and plume extraction.
cord-352937-htmp0avc	2020	Comprehensive preoperative work‐up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. In accordance with that suggested by the hospital infection control unit, if resources allow, patients should be quarantined in hospital 14 days prior to surgery followed by two sets of polymerase chain reaction (PCR) test for nucleic acid sequence homology in nasopharyngeal and throat swabs taken 24 hours apart. However, when performing AGP for unknown, suspected and confirmed COVID-19 patients, WHO, Centres for Disease Control and Prevention (CDC) and CHP recommend full barrier protection to avoid disease transmission to health care providers. However, as a result of the COVID-19 pandemic, outpatient services and endoscopy services have been reduced by 60% and 80% respectively to minimize social contact, conserve PPE, and reduce the risk of viral transmission amongst patients and health care providers. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease (COVID-19) in Healthcare Settings
cord-353004-ocnp758o	2020	
cord-355319-2mn9cf79	2020	1 Regarding stress echocardiography, a key diagnostic tool in patients with coronary heart disease or suspected coronary heart disease, many studies have been delayed, giving priority to the pharmacological modality over the exercise modality, following previous ASE recommendations. 2 Nonetheless, exercise stress echocardiography (ESE) provides us with very valuable information such as the patient''s functional capacity and chronotropic response. The aim of our study was to assess whether the use of a surgical facemask during ESE negatively impacts on patients'' functional capacity and the percentage of conclusive studies. As a control group, we used patients who attended our center to perform an ESE with equal inclusion Previous studies have shown that heart rate during exercise is increased by the use of surgical facemasks in healthy participants. In conclusion, our study demonstrates that ESE with a surgical facemask is a feasible procedure.
cord-355431-efwuy8p9	2020