Table 3. Measures during robot assisted surgery to prevent gas, aerosol and smoke leakage.

Description
• All surgery during the COVID-19 pandemic should be regarded as high-risk, and therefore no pre-operative testing of patients will be needed.
• During laparoscopic surgery take steps to minimize CO2 release.
• Close the taps of ports before inserting them to avoid escape of gas during insertion.
• Attach a CO2 (ULPA) filter or water lock to one of the ports for smoke evacuation. Do not open the tap of any ports unless they are attached to a CO2 filter or being used to deliver the gas.
• Minimize introduction and removal of instruments through the ports as much as possible. For introduction of material (such as bags, meshes) or specimen retrieval (such as biopsies), deflate the abdomen with a suction device before entering or removing the material into or from the abdomen or use an air-lock system. Re-insert the port before turning CO2 on again.
• At the end of the procedure turn CO2 off, deflate the abdomen with a suction device and via the port with CO2 filter, before removal of the ports.
• Avoid the use of ultrasonic sealing and use lowest possible electrocautery power. If possible use electrothermal bipolar vessel sealing.
• Minimize sudden gas dispersal during total laparoscopic hysterectomy when the specimen is removed, deflate the abdomen with a suction device before removal the uterus through the vagina.

COVID-19, coronavirus disease 2019; ULPA, Ultra Low Penetrating Air.