Means to protect HCPs
Means to protect HCPs must be implemented whenever the laparoscopy is performed in a patent infected with SARS-CoV-2, or in the context of the Covid-19 epidemic in a patient with fever or a recent cough, or who has spent time in the last two weeks in a location where the epidemic is active, or who has been in contact with infected persons [17]. Some authors even advocate extending testing for SARS-CoV-2 to all patients awaiting surgery whether or not they have Covid-19 symptoms [8], [18]. Measures must include personal protection equipment (PPE) for HCPs, laparoscopy equipment, surgical technique and operating room organisation.

Personal protection equipment for HCPs
The surgery team (surgeon, assistant, scrub nurse or circulating nurse) seem to be less exposed than the anaesthesia team (anaesthetist and anaesthetist's nurse), who are in direct contact with the patient's upper airways, which are the main source of contamination [19]. PPE is only one component of the protection measures. It must be used by every member of the HCP team according to the World Health Organisation (WHO) guidelines [20]. PPE includes long-sleeved fluid protection gowns, lined gloves, goggles (or visors, especially for the anaesthesia teams) [19], and masks.
Conventional surgical masks do not provide sufficient protection in an operating room with a risk of aerosols rich in viral droplets. The N95 respirator masks regulated by the US National Institute for Occupational Safety and Health (NIOSH) are not EC-approved. The FFP2 and FFP3 filtering facepiece masks are more efficient as regards the filtration of aerosols (of saline solution or paraffin oils), with an efficiency of 94% for FFP2 and 99% for FFP3. FFP2 masks meet the filter efficiency criteria of the NIOSH [21]. To be effective, these masks must, however, be used correctly and be properly fitted.

Laparoscopy equipment and surgical technique
The risk of contamination of HCPs is highest during the insertion of trocars, extraction of the excised tissues and removal of trocars at the end of the operation. Technical measures are summarised in Table 1 .
Table 1 Technical measures for preventing contamination of HCPs by SARS-CoV-2.
Prefer the “closed” technique for obtaining pneumoperitoneum
Reduce the pneumoperitoneum pressure as much as possible (without compromising safety)
Reduce the power of electrosurgery and ultrasonic dissection
Systematically use laparoscopic smoke aspiration systems
Systematically use particle filters
Prefer intracorporeal anastomosis
Extract excised tissue after complete emptying of the pneumoperitoneum
Fully aspirate the pneumoperitoneum before removing the last trocar
As the virus can be present in the digestive tract [22], intracorporeal anastomosis (particularly in colorectal surgery) is to be preferred because it reduces the risk of contamination of the HCPs.
Lastly, there is no data in the literature suggesting that laparoscopy should be systematically replaced by laparotomy during the Covid-19 epidemic.

Organisational measures
The first measure is to raise awareness among HCPs of the risk of contamination and train them in implementing prevention measures. We need not dwell on the now well-known general sanitising measures: frequent hand-washing, permanent wearing of masks, and frequent washing of furniture and floors according to the general rules of hospital hygiene.
The main organisational measures are summarised in Table 2 . These measures are to be implemented jointly with the hygiene and administration departments of each hospital.
Table 2 Organisational measures for preventing contamination of HCPs by SRAS-CoV-2.
Train HCPs in protection measures
Set up separate circuits for patients with Covid-19 or suspected of having Covid-19 and for certainly non-Covid-19 patients
Have as few HCPs as possible in operating rooms
Avoid movement or changing of HCPs during laparoscopy
Ventilate the operating room
Manage waste appropriately during and after laparoscopy
Encourage the surgical team to leave the operating room during the intubation and extubation phases
Take general hygiene measures (hand-washing, cleaning of furniture and instruments, etc.)