Laparoscopic versus open surgery: aerosols and their implications for surgery during the COVID-19 pandemic

In the past weeks, surgical guidelines in response to the COVID-19 pandemic have been read, disseminated and compared with gravitas. These include guidelines of the American College of Surgeons (ACS) [1], the four surgical royal colleges of the United Kingdom and Ireland (Royal College of Surgeons, RCS) [2], the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) [3], the Royal Australasian College of Surgeons (RACS) [4] and the European Society of Surgical Oncology (ESSO) [5]. The first three bodies cautioned regarding the potential for viral transmission during the use of laparoscopy, but based this recommendation on caution, not data. The RACS, in contrast, has advised that there is no evidence to suggest that laparoscopy puts surgical staff at a higher risk of viral transmission than open surgery. ESSO has not taken a specific stance on this issue. The recommendations cautioning against laparoscopy have significant implications for the practice of modern abdominal surgery, where laparoscopy is often an established, preferred and superior modality for operating. This is particularly the case for emergency gastrointestinal (GI) surgery and surgical oncology, domains which surgeons around the world are attempting to preserve despite the COVID-19 pandemic. In the authors’ centres in the United Kingdom, there has been anecdotal avoidance of laparoscopy surgery based on the above guidelines. …