Table 1.

Measures during cardiothoracic robot assisted surgery (Adapted and

modified from Table 3 in Kimmig et al. (2019) J Gynecol Oncol. 31(3):e59)

All surgery during the COVID-19 pandemic should be regarded as high-risk, and, therefore, adequate preventive measures should be taken even in patients who tested negative or who have not been tested for COVID-19

During cardiothoracic robotic assisted 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 filter (ULPA or similar) 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 thorax with a suction device before entering or removing the material into or from the thorax 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 thorax 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

One-lung ventilation should not be used in patients with COVD-19 diseased lungs and PEEP should not be lowered in an attempt to improve surgical visualisation

COVID-19 coronavirus disease 2019, PEEP positive end-expiratory pressure, ULPA Ultra-Low Penetrating Air