COVID‐19: Impact on Colorectal Surgery

7 May, 2020
The rapid spread of the COVID‐19 pandemic created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery including colorectal cancer surgeries, several questions pertaining to the operating room (OR) utilization and techniques needed to be rapidly addressed. Although patient safety is of paramount importance, caregiver safety is also a critical consideration. During the COVID‐19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local COVID‐19 testing availability and the incidence of known COVID‐19 infection in the respective community. In addition to standard COVID‐19 PPE precautions, a negative pressure environment, including an OR, has been recommended especially for use of the performance of aerosol generating procedures (AGPs). Hospital spaces ranging from patient to operating to endoscopy rooms have been successfully converted from the standard positive pressure to negative pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centers around whether it should be avoided in known COVID‐19 infected patients or whether it can be performed under precautions with safety measures in place to minimize exposure to the aerosolized virus particles. Several important lessons learned from PIPAC procedures are demonstrated to help improve our understanding and management. This document evaluates the issues surrounding these challenges including the operating room environment and AGPs which are germane to surgical practices around the world.