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Study to track if COVID can spread during minimally invasive surgery

Aug. 27, 2020, 10:42 AM

 

by Bill Snyder

Physician-scientists at Vanderbilt University Medical Center are investigating whether SARS-CoV-2, the virus that causes COVID-19, can be spread through aerosolized emissions (microscopic droplets and particles) during minimally invasive surgery in children.

Recent studies suggest that many children infected with the SARS-CoV-2 virus do not show symptoms of COVID-19. If correct, they pose a significant risk of spreading the virus while undergoing common minimally invasive surgical procedures such as removal of lung nodes, hernia repair and laparoscopic appendectomy.

Yet no report to date has described the transmission of respiratory viruses, including SARS-CoV-2, in aerosolized surgical emissions during operations performed on patients of any age, said Harold “Bo” Lovvorn III, MD, associate professor of Pediatric Surgery at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Supported by a $15,000 grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the study is the first to examine whether SARS-CoV-2 viral particles can be detected in surgical emissions and whether they remain structurally intact and capable of infecting others.

The findings from this study, which can be applied to adults undergoing surgery, will be of immediate value to surgeons seeking to further shield their teams, other health care providers and hospitalized patients from COVID-19, said Lovvorn, who is the study’s co-principal investigator with Natasha Halasa, MD, MPH, associate professor of Pediatrics.

Gretchen Jackson, MD, PhD, associate professor of Pediatric Surgery and a member of SAGES, sponsored the grant. Zaid Haddadin, MD, postdoctoral research fellow in the Division of Pediatric Infectious Diseases, also is participating in the study.

Since the COVID-19 pandemic began, surgeons have been warned by their professional societies to wear the highest rated personal protective equipment (PPE) including N95 masks while performing surgical procedures that generate aerosols, and to use emission and smoke evacuation systems during laparoscopy to reduce transmission of the virus.

In many hospitals with heavy surgical volumes, however, PPEs and filter-evacuation systems have been depleted because of high use of these vital supplies. Better determination of risk through studies like this, and allocation of resources to COVID-19 hotspots could help hospitals preserve adequate supplies, Halasa said.

In the study, nasal swabs will be obtained for rapid testing from patients immediately after induction of general anesthesia. Samples that are positive for SARS-CoV-2 will be tested further to confirm the presence of viral RNA using the polymerase chain reaction (PCR) technique.

In patients who test positive for the SARS-CoV-2 virus, swabs will be collected during the procedure from condensation in the surgical port that is connected to a commercially available evacuation system, and from the evacuation tubing, fluid collection chamber and filter.

Additional PCR testing of these samples will be conducted in Halasa’s lab to quickly confirm the presence of the SARS-CoV-2 virus.

Samples that are confirmed to have viral RNA will be tested in cell cultures in the laboratory of Mark Denison, MD, director of the Division of Pediatric Infectious Diseases, to determine the viability and infectivity of the virus.

Denison, the Edward Claiborne Stahlman Professor of Pediatric Physiology and Cell Metabolism, is internationally known for his studies of coronaviruses. Halasa is an expert in the detection of pathogenic viruses.

“Partnering with these two outstanding virologists will maximize the chance to detect and understand the potential virulence of SARS-CoV-2 in aerosols emitted during minimally invasive surgery,” Lovvorn said.

The study will be continued for a year. VUMC’s pediatric surgeons perform more than 700 minimally invasive surgeries annually.

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