key: cord-1053773-hhjrnfac
authors: Sarrió-Sanz, Pau; Martínez-Cayuelas, Laura; Valencia-Guadalajara, Victor José; Villada-Warrington, Tatiana; Sánchez-Caballero, Laura; Nakdali-Kassab, Baraa; Gómez-Pérez, Luis
title: An accessible and economical evacuation system for surgical fumes and pneumoperitoneum in laparoscopy during the SARS-CoV-2 pandemic
date: 2020-08-31
journal: Br J Surg
DOI: 10.1002/bjs.11824
sha: 20d078cef7912846db7a3c5fd3b91e25a2c43e6f
doc_id: 1053773
cord_uid: hhjrnfac

nan

The global pandemic produced by SARS-CoV-2 started in the Chinese province of Wuhan in December 2019. 1 It has caused more than four million cases and almost 320.000 deaths. In Spain there are more than 230.000 people infected by the virus and 27.700 deaths have been reported, with an estimate of around 20% of the cases affecting health care professionals according to the reports of the European Center for Disease Prevention and Control 2 .

There is enough evidence on the elevated propagation of this microorganism during procedures that generate aerosols, because of wich the control of this situation on the operating room is mandatory 3,4 . This risk does not only take place during the anesthetic process; laparoscopic surgery is one of procedures that generates aerosols 5 , in an even higher concentration than the observed during open surgery 6 . For this reason, the scientific associations recommend to be careful and the use of devices that filter surgical fumes to minimize the possibility of dissemination of particles generated during the surgery [7] [8] [9] [10] .

Although there are different fume evacuation systems to use during laparoscopy on the market 8 , these are not always available in every center due to different reasons.

A closed system has been designed for the extraction of surgical fumes, by adapting a generic passive heat and moisture exchange (HME) filter.

The system that we present, (Figure 1 ) consists in an HME type filter connected with two adapters in L shape and two connectors to the operating room vacuum device with two hollow silicone tubes. This way, the aerosol aspiration is carried out directly from the laparoscopic port by opening the key. In the other ports we place a lid to prevent an accidental opening during the surgery.

There is currently about the possibility of infection during surgery due to exposure to surgical fumes, although harmful effects have been known for years 5 . The lack of this specific evacuation systems during laparoscopy in some centers and the need to perform an urgent surgery or simply maintain surgical activity, the developed system based on HME filters offers an accessible and economical alternative 8, 10 . This type of filters has demonstrated a pathogen filter capacity close to 100% 11 .

The designed system has been adopted in routine surgical in our hospital since the beginning of the pandemic, along with the rest protection measures 12 with great adaptation and satisfaction of the entire surgical team. The fume evacuation system based on an adapted HME filter is an easily accessible and economical alternative that should be implanted in all laparoscopic procedures in case of not having any specific fume evacuation systems.

The authors declare no conflict of interest. 

Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy

European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era

Safe management of surgical smoke in the age of COVID-19

COVID-19 pandemic: perspectives on an unfolding crisis

Clearing the air: an accessible system for suction and safe evacuation of pneumoperitoneum during laparoscopy in patients with COVID-19

Can breathing circuit filters help prevent the spread of influenza A (H1N1) virus from intubated patients?

Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2)