LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 137-138
Comment: Personal protective equipment use in laparoscopy during COVID-19
Aditya Baksi, Supreet Kaur
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||19-Sep-2020|
|Date of Acceptance||20-Sep-2020|
|Date of Web Publication||22-Dec-2020|
Dr. Aditya Baksi
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baksi A, Kaur S. Comment: Personal protective equipment use in laparoscopy during COVID-19. J Min Access Surg 2021;17:137-8
We read with interest the viewpoint on personal protective equipment (PPE) use in laparoscopy by Dr K. Bhattacharya. The author has very aptly pointed out the difficulties faced by laparoscopic surgeons while wearing PPE, and concluded that protocols and guidelines need to be formed on PPE use during laparoscopic surgery. The author has questioned whether PPE is needed in all cases. It is not clear whether 'all cases' refers to all SARS-CoV-2-positive patients or all patients undergoing laparoscopic surgery, irrespective of the COVID status. The Indian inter-society directives recommend pre-operative testing for SARS-CoV-2 for all patients undergoing surgery. PPE use is not required in case of patients who test negative. It should be worn only while operating on SARS-CoV-2-positive patients and during emergency surgery, when there is no time to wait for the test results.
The problems of sweating and dehydration are inevitable with PPE, but can be somewhat alleviated by adequate cooling of the operating room and by drinking water prior to donning. Tea and coffee cause diuresis, and should be avoided before an operation. Adequate time should be allotted to donning the PPE. A mental checklist of individual preferences of the technique of donning PPE (such as adding a cotton pad above the ears to lessen pain from the elastic band of the mask or taping the edges of the mask to secure it in place and lessen fogging) might be useful. When long operating time is anticipated, surgeons may consider dividing work with a colleague, who can scrub in after a certain interval of time. Such practices could become the 'new normal'.
Fogging is a frustrating problem with goggles, which can be avoided by simply replacing goggles with face shields. Many are sceptical of using face shield, as it does not air-seal the face as goggles do. However, there is no evidence of better efficacy of goggles compared to face shield, and the CDC and WHO recommend either goggles or face shield for healthcare workers involved in the care of COVID-19 patients. Online surveys show preference for face shield among healthcare workers due to less fogging, greater comfort and better visibility. Clarity and field of vision are of utmost importance in laparoscopic surgery, and both are compromised when using goggles. Use of anti-fogging solutions can provide some relief but cannot improve the field of vision. Face shield is also more comfortable for bespectacled surgeons. In addition, face shield does not cause pressure on the bridge of the nose and users are more comfortable due to air circulation. The risk of transmission of SARS-CoV-2 is much higher through the nostrils than through conjunctivae. Face shield provides an additional layer of protection to the N95 mask. In fact, it can allow the use of valved masks, which cause less discomfort than masks without valves. It is unreasonable to fear a risk of exposure with face shield due to lack of a sealing effect. Laparoscopic surgery can become a lot easier by modification of eye protection strategy.
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Conflicts of interest
There are no conflicts of interest.
| ¤ References|| |
Srivastava A, Nasta AM, Pathania BS, Sundaram E, Jani KV, Manickavasagam K, et al
. Surgical practice recommendations for minimal access surgeons during COVID 19 pandemic Indian inter-society directives. J Minim Access Surg 2020;16:195-200.
Den Boon S, World Health Organization, editors. Personal Protective Equipment for Use in a Filovirus Disease Outbreak: Rapid Advice Guideline. Geneva: World Health Organization; 2016. p. 53.