Table 1.

Multi-modal requirements for a safe laparoscopy : tips and tricks [[1], [2], [3], [4], [5],[10], [11], [12],18,19].

Preparation of the material before the intervention in order to keep the operating room closed during the intervention

Specific Personal Protective Equipment (FFP3/ FFP2 / N95 masksa, goggles and appropriate clothing)

Closer collaboration necessary with the anaesthesiologist (rapid sequence intubation, curarization, pneumoperitoneum pressure)

Small skin incisions and use of balloon trocars (better sealing) to avoid untimely removal of the trocars and the occurrence of CO2 leaks during the procedure

Reduction of the pressure of the pneumoperitoneum (10 to 8 mm Hg) and reduction of the Trendelenburg position (10 to 15°) in order to limit the ventilatory and circulatory constraints

Limitation of instrument changes to avoid leaks

Promotion of bipolar energy (with the lower power) rather than ultrasonic energy b

Use of smoke filtration systems (see Fig. 1A–C).

Preference for intra-corporeal nodes (gas leak in case of extra-corporeal nodes)

Removing the operator trocars once the pneumoperitoneum is completely evacuatedc

Port-site closure once the pneumoperitoneum is completely evacuated

^aFFP3 masks may filter 99 % of all particles above 0.3 μm. FFP2 masks (European classification) or N95 masks (American classification) ensure the filtration of at least 95 % of the particles in suspension measuring more than 0.3 μm.

^bUltrasonic energy could theoretically be more dangerous than bipolar energy because it leads to a low temperature aerosol which does not allow the cellular components of the virus to be destroyed.

^cIn order to avoid the possible incarceration of an intestinal loop or the omentum, we introduce a blunt-tipped probe (type aspiration probe) to repel the intestinal handles and at the same time remove the trocar. The optical trocar is removed under visual control.