[Robotic and laparosocpic urological surgery during COVID-19 pandemia.]

OBJECTIVE: SARS-CoV-2 pandemic hashigh repercussion on urologic minimally invasive surgery (MIS) Controversy about safety of MIS procedures during COVID-19 pandemic has been published Nowadays, our priority should be create agreement in order to restart and organize MIS with safety conditions for patients and healthcare workers METHODS: Pubmed and web search was conducted with following terms: "SARS-CoV-2", "COVID19", "COVID19 Urology", COVID19 Surgery", "COVID19 transmission", "SARS-CoV-2 transmission", "COVID19 nd minimally invasive surgery", "SARS-CoV-2 and CO 2insuflation" A narrative review of available literature and scientific evidence summary was done A modify nominal group technique was used to achieve an expert consensus First draft was circulated amongst authors Definitive document was approved in May 26th RESULTS: Non evidence supports higher risk of SARSCoV-2 healthcare workers infection with MIS compared to open surgery MIS is associated with shorter hospital stay than open surgery Modify MIS indications to open surgery, with no scientific evidence, could spend valuable resources in detriment to COVID-19 patients MIS indications should be prioritized attending to available resources and pandemic intensity SARS-CoV-2screening 72 hours prior to surgery by clinical and epidemiological questionnaire and nasopharyngeal PCRis recommended, in order to prevent nosocomial transmission, professional infections and to minimize postoperative complications Intraoperative steps should be established to reduce professional exposure to surgical aerosols, including: surgical room reorganization, adequate personal protective equipment, surgical technique optimization and management of CO2 and surgical smoke CONCLUSIONS: In COVID-19 pandemic de-escalation, MIS carried out with optimal safety measurements, could contribute to reduce hospital resources utilization With current evidence, MIS should not be limited or reconverted to open surgery during COVID-19 pandemic OBJETIVO: La pandemia provocada por el nuevo coronavirus SARS-CoV-2 ha tenido una elevada repercusion sobre la cirugia minimamente invasiva (CMI) Ha surgido una importante controversia sobre la realizacion de CMI durante la pandemia COVID-19 Es prioritario, establecer un consenso sobre la organizacion y realizacion con seguridad de la CMI durante la pandemia MATERIAL Y METODOS: Se realizo una busqueda web y en PubMed con los terminos: SARS-CoV-2, COVID19,COVID19 Urology, COVID19 Surgery, COVID19 transmission, SARS-CoV-2 transmission, COVID19 and minimally invasive surgery, SARSCoV-2 and CO2 insuflation Se realizo una revision narrativa de la literatura y una sintesis de la evidencia disponible Se ha utilizado una tecnica de grupo nominal modificada, circulando un primer borrador a todos los autores y aprobandose la version definitiva el dia 26 de Mayo de 2020 RESULTADOS: No existe evidencia sobre una mayor exposicion a SARS-CoV-2 en CMI respecto a cirugia abierta La CMI se asocia a una menor estancia hospitalaria por lo que cambiar, sin justificacion, la indicacionde CMI puede retrotraer recursos que podrian ser utilizados para la pandemia COVID-19 Se debepriorizar la CMI segun los recursos disponibles y la intensidad de la pandemia en cada momento Se recomienda realizar despistaje de SARS-CoV-2 mediante cuestionario clinico-epidemiologico y PCR nasofaringea 72 horas antes de la CMI electiva, para minimizar las complicaciones postoperatorias, evitar la transmisioncruzada entre pacientes y la posible exposicion de los profesionales sanitarios Se recomienda establecer medidas de organizacion en quirofano, de proteccion personal, tecnica quirurgica y manejo del CO2 y aerosoles generados para reducir la exposicion y riesgos del personal sanitario CONCLUSIONES: La CMI realizada con las medidasd e seguridad adecuadas para el paciente y profesionales, puede contribuir durante la desescalada a una menor utilizacion de recursos sanitarios y por tanto, no debe limitarse su utilizacion o cambiar sus indicaciones