James Porter¹*, Elliot Blau¹ , Farid Gharagozloo² , Martin Martino³ , Robert Cerfolio⁴ , Umamaheswar Duvvuri⁵ , Aileen Caceres⁶ , Ketan Badani⁷ , Sam Bhayani⁸ , Justin Collins⁹ , Rafael Coelho¹⁰, Bernard Rocco¹¹, Peter Wiklund¹², Senthil Nathan13, Eduardo Parra-Davila¹⁴, Carlos Ortiz-Ortiz¹⁴, Kris Maes¹⁵, Prokar Dasgupta¹⁶ , Vipul Patel¹⁷*

• ¹ Department of Urology, Swedish Medical Center, Seattle, WA
• ² Center for Advanced Thoracic Surgery, Florida Hospital Celebration Health, University of Central Florida, Celebration, FL
• ³ Department of Gynecologic Oncology, Lehigh Valley Health Network, Allentown, PA
• ⁴ Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY
• ⁵ Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
• ⁶ Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, FL
• ⁷ Department of Urology, Mount Sinai Medical School, New York, NY
• ⁸ Division of Urology, Washington University School of Medicine, St Louis, MO
• ⁹ ORSI Academy, Melle, Belgium
• ¹⁰ Department of Urology, Instituto do Câncer do Estado de São Paulo (Icesp), SP, São Paulo, Brazil
• ¹¹ Urology Department, University of Modena & Reggio Emilia, Modena, Italy
• ¹² Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
• ¹³ University College London, Division of Surgery and Interventional Science, London, UK
• ¹⁴ Department of Surgery, Celebration Health, Celebration, FL
• ¹⁵ Center for Robotic and Minimally Invasive Surgery, Hospital da Luz Lisboa, Lisboa, PT
• ¹⁶ Guy’s Hospital, Kings College London, Urology, London, UK
• ¹⁷ Global Robotics Institute, Florida Hospital-Celebration Health Celebration, Orlando, FL

The COVID-19 pandemic has created uncertainty regarding the safety and appropriate utilization of minimally invasive surgery (MIS) during this current outbreak. Surgical governing bodies such as Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Royal Colleges of Surgery of Great Britain and Ireland have made statements regarding the possibility of COVID-19 release into CO2 insufflant during MIS. The basis for this concern is prior evidence in the literature of other viral pathogen release during laparoscopic surgery. The recommendations are correctly based on caution given the lack of understanding of how COVID-19 compares to other viruses with regard to transmission and presence in CO2 during MIS. In this review we have investigated the available literature on COVID-19 transmission during MIS, address the implications of current and previously published recommendations and discuss steps to mitigate COVID-19 transmission during MIS for staff and patient safety.

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