• Sami A Chadi, Keegan Guidolin, Antonio Caycedo-Marulanda, Abdu Sharkawy, Antonino Spinelli, Fayez A Quereshy, and Allan Okrainec.
• Department of Surgery, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada.
• Ann. Surg. 2020 Aug 1; 272 (2): e118e124e118-e124.

ObjectiveOur objective was to review the literature surrounding the risks of viral transmission during laparoscopic surgery and propose mitigation measures to address these risks.Summary Background DataThe SARS-CoV-2 pandemic has caused surgeons the world over to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. International society guidelines advise against the use of laparoscopy; however, the evidence on this topic is scant and recommendations are based on the perceived most cautious course of action.MethodsWe conducted a narrative review of the existing literature surrounding the risks of viral transmission during laparoscopic surgery and balance these risks against the benefits of minimally invasive approaches. We also propose mitigation measures to address these risks that we have adopted in our institution.Results And ConclusionWhile it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present.

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