Implications of COVID-19 on urological laparoscopic surgery

• Published in: Future oncology (London, England) Vol. 16; no. 26; pp. 1941 - 1945
• Main Authors: Condon, Benjamin, Whish-Wilson, Thomas, Davis, Niall F, Lawrentschuk, Nathan
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01.09.2020
• Subjects: Aerosols; Betacoronavirus; Bladder; Bladder cancer; Blood clots; Cancer surgery; Cancer therapies; Chemotherapy; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; Coronavirus Infections - transmission; Coronaviruses; COVID-19; Delivery of Health Care; Disease transmission; Humans; Infection Control; Infections; Kidney cancer; Laparoscopy; Laparoscopy - standards; Pandemics; Pandemics - prevention & control; Patients; Personal protective equipment; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; Pneumonia, Viral - transmission; Practice Guidelines as Topic; Prostate cancer; Robotics; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Social distancing; Surveillance; Testicular cancer; Tumors; Urologic Surgical Procedures - standards; Urology; Viruses
• ISSN: 1479-6694; 1744-8301
• DOI: 10.2217/fon-2020-0533

[...]robotic surgery allows staff to be more remote from the patient and each other when compared with laparoscopic and open operations, facilitating better social distancing within the operating room (8). Minerva Urol Nefrol Uro-oncological procedures divided into four categories: nondeferrable/urgent; semi nondeferrable; deferrable cancer surgery; replicable cancer surgery (radical prostatectomy considered as semi nondeferrable ; for intermediate to high risk patients) All benign or nononcological diseases delayed until the end of the COVID-19 emergency All outpatient procedures including biopsies should be delayed until post-COVID-19 emergency All surgery to be performed by experienced surgeons with a halt to clinical trials and new technologies (10) Nowroozi A and Amini E Urol J Limit urological procedures to emergencies and life-threatening cases. MIS/Laparoscopic surgery should be limited to planned urgent and emergency procedures Pre-operative COVID testing of patients if feasible Limit healthcare workers in room to essential personnel Surgical training should be limited to reduce time in operating room Social distancing within OT if able to Reduce surgical plume and pressure of the pneumoperitoneum Also summarised the ERUS position statement of key points (above) (13) Sobel et al. Indian Journal of Cancer Recommendation of deferring treatment of renal cell carcinoma from 3 to 6 months, except for patients with ongoing haematuria and/or inferior vena cava thrombus, which warrant immediate surgery Metastatic renal cell cancers should be started on targeted therapy Low grade nonmuscle invasive bladder cancers can be kept on active surveillance while high risk nonmuscle invasive bladder cancers and muscle invasive bladder cancers should be treated within 3 months Neoadjuvant chemotherapy should be avoided Management of low and intermediate risk prostate cancer can be deferred for 3-6 months while high risk prostate cancer patients can be initiated on neoadjuvant androgen deprivation therapy Patients with testicular tumors should undergo high inguinal orchiectomy and be treated according to stage without delay, with stage I patients being offered surveillance.