The Changing Face of Surgery Throughout the Covid-19 Pandemic

The pressures felt by healthcare providers around the globe through the Covid-19 pandemic have been unprecedented and – to some degree – unpredictable. Already-stretched services were impacted not only by the volume of seriously unwell people coming through the door, but by the sheer time and resources needed for enhanced cleaning and extra single-use PPE. Elective procedures have been postponed in readiness for the expected onslaught.


The effect on waiting lists for essential elective surgery in the future and the long-term effects of the pandemic on health services are yet to be seen. In addition, the altered array of training opportunities for pre- and post-registration medics and the redeployment of surgical trainees to fill gaps in general medical specialties during Covid is bound to impact on the emerging generation of practitioners.(ᶦ)


Time is of the essence in a medical emergency


The time restraints inherent to ensuring that new infection control precautions are observed between each patient irrespective of need or circumstance have been summed up by a new adage; ‘there is no emergency in a pandemic’. Even in the most critical emergencies, staff safety must come first. However, for doctors and nurses whose training has ingrained the value of a quick response it feels unnatural – even unethical – to stop and fit gowns, masks, and visors before attending a cardiac arrest or a hemorrhaging patient. Assessing personal risk before responding to an emergency does not come easily to healthcare professionals, and there are few settings as time-critical as the operating theatre. Managing risk to the patient has always been a primary concern – the potential threat to the operating room staff should also be paramountᶦᶦ. Widespread staff absence due to occupational exposure to Covid is unacceptable.


The recent uptick in Covid cases as lockdown restrictions were lifted around the world has reinforced the need for continuous review and refinement of infection control practice. Amid the challenges and tragedies of the Covid pandemic there has been a welcome rise in public understanding of safety and infection risk.


Staying clinically clean through Covid


Although we are living through a pandemic, operating theatres should already be near-aseptic environments, and so patient care – in theory – should only be minimally affected by external contaminants, however novel or prominent. However, surgical practices are not always supported by ergonomic or intuitive technology, creating openings for risks of delay or contamination. For example, diathermy in theatre is usually controlled by a foot pedal, which either significantly restricts a surgeon’s position, or needs to be moved around the floor by an assistant as the surgeon moves around the patient. Surgical energy devices are aerosol-generatingᶦᶦᶦ and should require particular protective measures for proximal staff.ᶦᵛ


A recent survey of practicing surgeons found that nurses have to actually crawl under the table an average of 2.4 times per surgery to move foot pedals. Having members of operating theatre staff crawling on the floor beneath the operating table to ensure that the surgeon has full flexibility is clearly hazardous and faintly ridiculous in the modern medical age. Any shortfall in usability creates scope for error, wasted time, and poor infection control practices. Just as there is no possibility for social distancing in theatre, there is no scope for outmoded and inefficient technology, particularly when infection risk is so high and morale is so low.

ᶦAl-Jabir, A., Kerwan, A., Nicola, M., Alsafi, Z., Khan, M., Sohrabi, C., O'Neill, N., Iosifidis, C., Griffin, M., Mathew, G., & Agha, R. (2020). Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1. International journal of surgery https://doi.org/10.1016/j.ijsu.2020.05.022

ᶦᶦPrakash, L., Dhar, S. A., & Mushtaq, M. (2020). COVID-19 in the operating room: a review of evolving safety protocols. Patient safety in surgery, 14, 30. https://doi.org/10.1186/s13037-020-00254-6

ᶦᶦᶦKaruppal, R., Surendran, S., Patinharayil, G., Muhammed Fazil, V. V., & Marthya, A. (2020). It is time for a more cautious approach to surgical diathermy, especially in COVID-19 outbreak: A schematic review. Journal of orthopaedics https://doi.org/10.1016/j.jor.2020.05.013

ᶦᵛ K, Erridge S, Chidambaram S, et al. (2020) Electrocautery, Diathermy, and Surgical Energy Devices: Are Surgical Teams at Risk During the COVID-19 Pandemic? Annals of Surgery. https://doi.org/10.1097/sla.0000000000004112




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