Published: 2022-08-29

Comparison of clinical safety of minimal access surgery/laparoscopy versus open surgery in terms of patient outcomes and risk to theatre staff during the COVID-19 pandemic

Owais-Ul-Umer Zargar, Ayat Albina, Ayat Albina, Nashrah Ashraf, Nashrah Ashraf, Javed Iqbal, Javed Iqbal, N. C. Dhingra, N. C. Dhingra


Background: The COVID-19 pandemic has greatly affected surgical practice in all parts of the world because the safety of minimal access surgery (MAS) was questioned during the COVID-19 pandemic due to increased concern with regard to disease spread. This study assessed the available evidence on the safety of laparoscopy as compared to open surgery during the COVID-19, explored the possible precautions to be taken to prevent exposure of the operating team to the viral infection. The objective of this study was to access the clinical safety of laparoscopy as compared to open surgery during the COVID-19 pandemic.

Methods: This study was a retrospective study conducted during the COVID-19 pandemic in the Department of Surgery, GMC, India, from January 2020 to January 2021. The various outcomes assessed included: burden of covid-19 infection among the patients, deaths due to COVID-19, infection acquired by staff, length of hospital stay and post-discharge symptomatology among patients.

Results: There was no statistically significant difference in terms of median age of patients (p=0.853), gender (p=0.835), American Society of Anesthesiologists (ASA) status (p=0.876), urgency of operation (p=0.074), total time in theatre complex (p=0.163) or total number of theatre staff involved (p=0.831). The length of stay in the hospital was significantly shorter in the laparoscopic as compared the open group (3.5 versus 9 days; p=0.011).

Conclusions: Based on our review, we concluded that if recommended guidelines are followed and proper precautions are taken, laparoscopic surgery is safe for patients and theatre staff during the COVID-19 pandemic. Only on the basis of COVID-19, laparoscopy should not be replaced by laparotomy. If laparoscopy is strongly indicated in patients, it can be used with precautions because of its benefits over open surgery.


Aerosols, American Society of Anesthesiologists, COVID-19 pandemic, Open surgery, Minimal access surgery

Full Text:



De Simone B, Chouillard E, Di Saverio S, Pagani L, Sartelli M, Biffl WL, ET AL. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann R Coll Surg Engl. 2020:1-10.

Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V. Laparoscopic versus open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum. 2005;48:2217-23.

Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: current status and implementation of the latest technological innovations. World J Gastroenterol. 2016;22:704-17.

Barberis A, Rutigliani M, Belli F, Ciferri E, Mori M, Filauro M. SARS-Cov-2 in peritoneal fluid: an important finding in the Covid-19 pandemic. Br J Surg. 2020;107(10):e376.

Champault G, Taffinder N, Ziol M, Riskalla H, Catheline JMC. Cells are present in the smoke created during laparoscopic surgery. Br J Surg. 1997;84(7):993-5

Colon Cancer Laparoscopic or Open Resection Study Group. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477-84.

Cohen SL, Liu G, Abrao M, Smart N, Heniford T. Perspectives on surgery in the time of COVID-19: safety first. J Minim Invasive Gynecol. 2020;27(4):792-3.

Public Health England. Guidance- COVID-19 personal protective equipment (PPE)- Updated 3 May 2020. 2020.

Di Saverio S, Khan M, Pata F, Ietto G, De Simone B, Zani E. Laparoscopy at all costs? Not now during COVID-19 and not for acute care surgery and emergency colorectal surgery: a practical algorithm from a Hub Tertiary teaching hospital in Northern Lombardy, Italy. J Trauma Acute Care Surg. 2020;88(6):715-8.

Alwan NA, Bhopal R, Burgess RA, Colburn T, Cuevas LE, Smith GD, et al. Evidence informing the UK's COVID-19 public health response must be transparent. Lancet. 2020;395:1036-7.

To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20(5):565-74.

Coccolini F, Tartaglia D, Puglisi A, Giordano C, Pistello M, Lodato M, et al. SARS-CoV-2 is present in peritoneal fluid in COVID-19 patients. Ann Surg. 2020;272(3):e240-2.

Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, et al. Safe management of surgical smoke in the age of COVID-19. Br J Surg. 2020;107:1406-13.

Al-Balas M, Al-Balas HI, Al-Balas H. Surgery during the COVID-19 pandemic: a comprehensive overview and perioperative care. Am J Surg. 2020;219(6):903-6.

Weissman DN, de Perio MA, Radonovich LJ Jr. COVID-19 and risks posed to personnel during endotracheal intubation. JAMA. 2020;10:2027-8.

Davies A, Thomson G, Walker J, Bennett A. A review of the risks and disease transmission associated with aerosol generating medical procedures. J Infect Prev. 2009;10:122-6.

Romero-Velez G, Pereira X, Zenilman A, Camacho D.. SARS-Cov-2 Was Not Found in the Peritoneal Fluid of an Asymptomatic Patient Undergoing Laparoscopic Appendectomy. Surg Laparosc Endosc Percutan Tech. 2020;30(6):e43-5.

Schwarz L, Tuech JJ. Is the use of laparoscopy in a COVID-19 epidemic free of risk? Br J Surg. 2020;107(7):e188.

Alp E, Bijl D, Bleichrodt RP, Hansson B, Voss A. Surgical smoke and infection control. J Hosp Infect. 2006;62(1):1-5.

Velanovich V. Laparoscopic vs open surgery. Surg Endosc. 2000;14(1):16-21.

Pryor A. SAGES and EAES recommendations regarding surgical response to COVID-19 crisis. SAGES. Available from: Accessed on 5 May 2020.

Veziant J, Bourdel N, Slim K. Risks of viral contamination in healthcare professionals during laparoscopy in the COVID-19 pandemic. J Visc Surg. 2020;157(3):59-68.