Cardiothoracic robotic assisted surgery in times of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic poses an immense threat to healthcare systems worldwide. At a time when elective surgeries are being suspended and questions are being raised about how the remaining procedures on COVID-19 positive patients can be performed safely, it is important to consider the potential role of robotic assisted surgery within the current pandemic. Recently, several robotic assisted surgery societies have issued their recommendations. To date, however, no specific recommendations are available for cardiothoracic robotic assisted surgery in COVID-19 positive patients. It is suggested that robotic assisted surgery might have various advantages such as early recovery after surgery, shorter hospital stay, and reduced loss of blood and fluids as well as smaller incisions. However, electrosurgical and ultrasonic devices, as well as CO2 insufflation should be managed with caution to prevent the risk of aerosolization of viral particles. It has to be noted that most guidelines recommend to suspend all elective procedures, first to create capacity for the care of victims of the pandemic but second to prevent exacerbation of the cytokine storm associated with COVID-19 infection. As all surgical procedures induce a considerable amount of inflammation, this should always be weighed against the benefits of timely intervention. As pointed out by ERUS and AAGL, electrosurgical and ultrasonic devices can produce large amounts of smoke. To decrease the production of surgical smoke, the power setting of the electrocautery should, therefore, be as low as possible and long dissecting times at the same spot should be avoided. Furthermore, it has been demonstrated that 10 min of electrocautery creates smoke with higher particle concentrations during laparoscopic surgery when compared to open surgery. Moreover, the increased intracavitary pressures associated with pneumoperitoneum might represent an additional risk for aerosolization of viral particles with potential exposure of the operating staff. Because similar principles are applied for CO2 insufflation of the thorax, it is important to also be aware of this theoretical risk of viral spread in cardiothoracic RAS. Finally, general measures recommended by surgical societies such as personal protective equipment, optimal patient selection, and limitation of operating room staff evidently remain applicable in RAS and should be adhered to strictly. To read more-


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