Technical requirements for a safe performance of TAMIS during COVID-19 pandemic: The role of spinal anaesthesia and AirSeal®-a case report

Abstract

Coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems. Surgical care during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but also the safety of physicians and operating room (OR) staff. In the OR, general anaesthesia poses a risk of aerosolization during the intubation process. There is also concern about minimally invasive surgery due to aerosol formation. The SARS-CoV-2 virus was also identified in the faeces, so this is a possible pathway for transmission. This article presents the role of spinal anaesthesia (SA) and AirSeal® device in reducing the risk of COVID-19 contamination while performing transanal minimally invasive surgery (TAMIS). A 59-year-old patient, diagnosed with a T1 rectal adenocarcinoma, was submitted to TAMIS. The surgery was done during COVID-19 pandemic due to the risk of oncological progression with delayed treatment, under SA and using the AirSeal® system and adequate personnel protective equipment (PPE). Laparoscopic smoke evacuation systems with appropriate filters, like AirSeal®, minimize the aerosol formation and may reduce the risk associated with surgical smoke exposure. This case is unique because the patient was safely submitted to TAMIS using proper PPE and AirSeal® under SA, in order to minimize aerosol formation which is crucial during COVID-19 pandemic.