Table 2.

Steps enumerating precautions to be taken during Robotic surgery in Urological Cancer patients to prevent contamination from COVID-19 infection

Workflow	Action to be taken
1.Scheduling patients for surgery	Postpone all non-emergency/non urgent procedures (vide table 1) Avoid surgery on COVID-19 positive patients (if applicable)
2. Pre-operative office workup and screening of patients	Prefer telehealth consultation Screening for Covid-19 symptoms, travel history and exposure history. Covid-19 RT PCR/HRCT chest in all patients posted for surgery. Counselling for possible risk of contracting Covid-19 infection during hospital admission.
3.OR set up and Anesthesiology team	>20 air changes/hour HEPA filters for air filtration. Cleaning of Robotic console head support between each case. Entry and exit in OR to be restricted Use PPE Use Video laryngoscopy for intubation HEPA filter attached to the endotracheal tube before intubation Minimize risk of aerosol formation Only the anesthesia team members should be present during intubation and extubating
4.Robotic surgery team	All cases are to be done by experts Surgeon console can be kept outside OR Only single bedside assistant. Bedside assistant should use PPE. Keep pneumoperitoneum at minimum (5 mmHg) and use Air Seal device. Minimize instrument entry and exit and minimize air leak Avoid ultrasonic sealing devices and keep the diathermy setting at minimum Use Air Seal to suck all the CO2 at the end of the procedure. If Air Seal device is not available use a smoke evacuator connected to a HEPA filter/underwater seal using sodium hypochlorite solution.

HRCT: High resolution CT, HEPA: High efficiency particulate air, OR: Operating room