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.