key: cord-0845858-o14yrdpb
authors: Ceppa, DuyKhanh P.
title: Commentary: This Port’s for YOU!
date: 2020-06-15
journal: JTCVS techniques
DOI: 10.1016/j.xjtc.2020.05.027
sha: 9472363ec46e47b06a4c7f878a391babcb096214
doc_id: 845858
cord_uid: o14yrdpb

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exposure and infection is paramount to the surgeon and the entire operating room team. In their techniques manuscript, Drs. Seco, Wood and Wilson describe such a process, which is especially important to the discipline of general thoracic surgery and pulmonary resections 4 .

Identified as critical to performing intrathoracic surgery during the "COVID" era are: (1) preoperative screening, (2) minimizing aerosolization during surgery with specific insufflation/desufflation ports, and (3) minimizing aerosolization during surgery by limiting instrument exchange and tissue handling. The authors screen elective patients with nasopharygeal swabs within 48hrs of elective surgery. A chest computed tomography scan is also performed, ideally within 48hrs of surgery. Intraoperatively, the authors limit potential exposure during port placement by using low pressure insufflation. The port system the author describes suctions out all intrathoracic gases prior to port and instrument exchanges. Smokeinducing energy devices have accompanying smoke evacuation. All suctioned gases are filtered.

Finally, specimens are set aside in the chest in separate but labeled "bags" and only retrieved once at the end of the operation prior to skin closure.

While the authors skillfully describe their process and technique, they, unfortunately, do not yet have data that this technique is successful in limiting exposure and infections in COVID-positive patients. This manuscript does, however, raise a few interesting questions to contemplate. In the era of COVID, as aerosolization is easier to control or limit using small incisions and minimally invasive techniques, should we as a community strive even harder to increase the adoption of minimally invasive surgery across all surgeon generations? In traditional thoracoscopic surgery, sealed ports, insufflation and desufflation is not typically used. Should thoracoscopic surgeons adopt the use of these devices? Or, more controversially, should thoracoscopic surgeons convert to robotic surgery? The answers to those questions are well beyond the scope of this manuscript and this editorial. However, it is clear that during this new "post-COVID era" whether we adopt Drs. Seco, Wood and Wilson's technique or another, we all need to be even more deliberate in the conduct of our cases, thinking not only about the patient and their disease process but now also of ourselves and the health of our colleagues and team. So, SARS-CoV-2, this insufflation/desufflation port is for you!

COVIDSafe Thoracic Surgery: minimizing Intraoperative Exposure to Aerosols