Table 1.
Suggestion to be employed during urological laparoscopic or robotic assisted surgical procedure in order to minimize the risk for the surgical team to contract Covid-19 virus
| General protection of the surgeons (Two-way protective apparel) | − Surgical balaclava instead of surgical cap |
| − Face shield | |
| − Mask (surgical or superior protection) | |
| − Waterproof gown | |
| − Double glow | |
| − Shoe cover | |
| − Learn properly how to dress and undress in order not to become self-contaminated | |
| Assume the entire OR will be contaminated | − Prefer negative pressure ORs |
| − In case of positive pressure ORs (the vast majority) allow for sufficient time between cases for complete room air exchange (around 30 minutes) | |
| − Leave outside the OR all not necessary items (cell phone – hospital charts/papers – etc) | |
| − Keep at minimum the number of personnel in the OR. | |
| Prevention and management of aerosol dispersal | − Hasson technique for pneumoperitoneum induction (with use of dedicated trocar that offers perfect sealing with the skin incision) |
| − Keep clean the skin from blood at incision sites | |
| − Keep clean the instruments from blood | |
| − Avoid sudden release of trocar valves | |
| − Check the airtightness of the trocars | |
| − Extensive use of suction device to remove smoke and aerosol | |
| − Avoid using two-way pneumoperitoneum insufflators | |
| Management of pneumoperitoneum | − Keep CO2 pressure at the lowest possible value |
| − Reduce the Trendellemburg position time as much as possible | |
| − Total evacuation of pneumoperitoneum via suction device or connecting one of the laparoscopic ports to a water seal created with a sealed container prior to trocar removal or specimen extraction. | |
| Operation technique | − Set the power of electrocautery as low as possible |
| − Avoid prolonged dissecting time on the same place with electrocautery or harmonic scalpel to avoid excessive smoke | |
| − In case of the use of bowel during surgery (urinary diversion during radical cystectomy) prefer the intracorporeal anastomoses and reconstruction since Covid-19 has been detected in the stools of positive patients | |
| Postoperative operating room and equipment management | − Respect the governmental or scientific societies protocols for OR cleaning and disinfection |
| − Devices used for suspected or proven infected patients should undergo separate disinfection | |
| − Dispose clinical wastes separately |
Derived from: a) Zheng MN. Ann Surg 2020 Mar 26. doi:10.1097/SLA.0000000000003924; b) Di Saverio S, Pata F, Gallo G, Carrano F, Scorza A, Sileri P, Smart N, Spinelli A, Pellino G. Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience. Colorectal Dis. 2020 Mar 31. doi: 10.1111/codi.15056;22 c) Spinelli A, Pellino G. Covid-19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020 Mar 19. doi: 10.1002/bjs.11627.23