PSGE Statement on Minimally Invasive Gynecologic Surgeries during the COVID-19 Pandemic in the Philippines. March 30, 2020

To the Editor:

During this time, the Philippine Society for Gynecologic Endoscopy supports the suspension of elective surgeries on review of the available literature and current guidelines.

However, there may be occasions when surgery may be deemed urgent [1,2] and cannot be delayed, and the following recommendations must be considered in decision making. These are subject to change as new data become available.

• (1)
  All minimally invasive gynecologic surgeries (laparoscopy and hysteroscopy) are not recommended as the first choice of surgical route at this time for the following reasons:

  • a.
    Routine coronavirus disease 2019 (COVID-19) testing as part of the preoperative assessment of the patient is not feasible.
  • b.
    There is a potential for viral aerosolization with carbon dioxide use to achieve pneumoperitoneum [3,4].
  • c.
    COVID-19 virus shedding in the peritoneum and female reproductive tract is still unknown [3,4].
  • d.
    There is a limited supply of the proper protective equipment (PPE) for the surgical team (surgeons, anesthesiologists, nurses, and allied medical profession). The use of PPE is important to prevent virus transmission, which occurs through inhalation of infected droplets [3,4].
• (2)
  For urgent cases [1,2], minimally invasive gynecologic surgeries may be done as long as

  • a.
    The institution is capable of providing full PPE for the surgical team 3, 4, 5.
  • b.
    All patients undergo the necessary preoperative assessment to rule out COVID-19 [3,4].
  • c.
    Proper measures are taken to contain carbon dioxide release during procedures [3,4].
  • d.
    The use of nonelectrosurgical or ultrasonic measures for hemostasis is maximized [3,4].
  • e.
    Disposable equipment is used.