What precautions need to be taken for patients with COVID-19 undergoing gynecologic surgery?

Bottom Line:

All patients undergoing gynecologic surgery during the pandemic need to have a health risk assessment performed before any type of surgery and patients with confirmed or suspected infections should postpone their surgeries until they have fully recovered from the active infection.

Reference:

Chiofalo, B. et al. Practical Recommendations for Gynecologic Surgery During the COVID-19 Pandemic. International Journal of Gyencology & Obstetrics (2020).  https://doi.org/10.1002/ijgo.13248

Date Published:

29 May 2020

Synopsis:

Many patients require treatment for severe gynecological diseases and some of these treatment options include surgery. Unfortunately, during the pandemic many elective surgeries have been postponed due to the risk of infection and lack of staff and resources available to perform these surgeries. This paper recommends that patients with gynecologic illnesses be treated with pharmacotherapy for conditions that are sensitive to hormones during the pandemic. Surgery in a patient with a potential COVID-19 infection poses high-risk challenges to both the patient and the surgical team. Since COVID-19 is spread through droplets, airborne transmission is possible when small droplet particles linger in the air. Droplets in the air are more likely to occur in surgeries where patients need to be intubated and have their airways manipulated. To make things more challenging, many patients also present with no symptoms. This paper recommends all surgeries to be avoided during the pandemic due to the likelihood of patients being asymptomatic. In particular, during vaginal surgeries many viral particles can be released uncontrollably into the air from the electrosurgical devices that are used. If a gynecologic surgery cannot be avoided, the researchers recommend using dissection (manual cutting) techniques instead of using electrosurgical tools to limit the spread of viral droplets in the air. For patients with endometriosis, recommendations include using pharmacotherapy when possible and only using surgery when the risk of transmitting the virus has decreased. In these patients, laparoscopic surgery is recommended. In gynecologic cancers, chemotherapy is recommended for extended cycles whenever possible except for early-stage vulvar cancer when surgery cannot be delayed. 

Summary by: Brintha Sivajohan