key: cord-0954283-jaosu2u5
authors: Wightman, Sean C.; David, Elizabeth A.
title: Commentary: A Breath of Fresh Air for Thoracic Surgeons in the Covid Era
date: 2020-06-20
journal: JTCVS techniques
DOI: 10.1016/j.xjtc.2020.06.014
sha: 35afd27b4fec3914876b05be17afc04289e410e4
doc_id: 954283
cord_uid: jaosu2u5

nan

With the increased prevalence of the novel coronavirus, the authors have creatively developed a solution to minimize the risk of increased susceptibility to the virus during thoracic surgical procedures due to prolonged airway and lung parenchymal exposure. Using the Da Vinci Xi robotic system (Intuitive, California, United States), flow of carbon dioxide was filtered during insufflation and desufflation of the operative space. These ultra-low particulate filters capture and remove the vast majority of organisms contained within any aerosolized particle 3 .

The authors advocate for cumbersome insufflation and desufflation each instrument change and advocate for removing all specimens at the end of the procedure rather than as they are separated from the patient. Although it is recognized this technique was not yet employed on any COVID-Risk of infection with COVID-19 increases with exposure time. 4 . Although risk of COVID-19 cannot be eradicated during a thoracic operation, it can be diminished. The method Dr. Seco and colleagues advocate for is only safely filtering when the chest is completely contained by ports and instruments. This does not aid during times of port insertion, specimen retrieval, and thoracostomy tube placement where exposure still exists. With the expansion of the isolated contralateral chest -causing movement of the mediastinum -there is likely a small but present air volume influx and egress on the operative side. Therefore, were a patient to be COVID-19 positive, there is still sufficient time for exposure to those present in the operating room even with insufflation and desufflation filters in place. Additionally, port-based chest operations are not always routine for thoracic surgeons which limits this technique's broad applicability. In the included video, no n95 particulate respirator masks were visibly utilized and this addition would likely further decrease viral exposure during thoracic surgery by providing protection during periods of imperfect circuit containment. 5 Although the technique demonstrates clear potential benefit, the obvious next step in this technique is the inclusion of real-world data demonstrating its efficacy.

In the video, the demonstrated insufflation and desufflation is a rhythmic dance between the scrub nurse and the bedside assistant occurring with every instrument change and specimen retrieval. The authors should be commended on devising a technique to minimize viral transmission during robotic operations. This novel technique on minimizing the likelihood of viral aerosolization is truly a breath of fresh air for thoracic surgeons in this era.

Thoracic Surgery Outcomes Research Network, Inc. COVID-19 Guidance for Triage of Operations for Thoracic Malignancies: A Consensus Statement from Thoracic Surgery Outcomes Research Network

Hemodynamic effects of carbon dioxide insufflation during thoracoscopy

COVIDSafe Thoracic Surgery: Minimising Intraoperative Exposure to Aerosols

Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient

Association between 2019-nCoV transmission and N95 respirator use