key: cord-0828983-zg8w6wko
authors: Huddy, J. R.; Rasheed, S.; Tilney, H. S.
title: Continuation of minimally invasive surgery in the COVID-19 pandemic
date: 2020-08-26
journal: Tech Coloproctol
DOI: 10.1007/s10151-020-02333-3
sha: eba4de4e188bca23b1162434f60c6cecc93c021b
doc_id: 828983
cord_uid: zg8w6wko

nan

The restructuring of surgical pathways as part of the response to COVID has, in our experience as well as commentary from this journal [4] , led to further expansion of units dedicated to clean, elective surgery. The time that staff have been able to dedicate to these patients has rationalised their care and led to improved short-term outcomes including a reduced length of stay and high patient satisfaction [5] . A pause to elective treatment was also introduced during the initial surge in COVID cases at Frimley Park Hospital. Prioritisation of cases was then performed according to clinical factors (including obstructive symptoms) and adverse radiological features (such as evidence of extra-mural vascular invasion). Doing so allowed the debate over minimally invasive colorectal surgery in the context of COVID to mature, with relaxation of the concerns regarding minimally invasive surgery. In view of this, with appropriate precautions, laparoscopic surgery has remained our default position for colonic resection, and robotics the default for rectal cancer surgery. Our indications for the use of defunctioning stomas have not changed, and in no cases has our operative strategy changed to perform a non-restorative procedure due to the perceived increased risks in the COVID era. This is in contrast to the experience of some authors internationally [1] and in spite of initial UK guidance cautioning against both minimally invasive surgery and restorative surgery [2] .

In summary, we believe that the use of minimally invasive surgery, in a 'clean' unit capable of flexing to the needs of the hospital in response to COVID surges offers the best paradigm for the surgical management of colorectal cancer, and other urgent colorectal conditions, in the current pandemic.

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