Surgical Implications of COVID-19

We stopped elective surgery for all the right reasons.

Surgical Implications of COVID-19

We stopped elective surgery for all the right reasons.


We are triaging resources to the patients overwhelming our Emergency Departments. The Personal Protective Equipment (PPE), oxygen, ventilators, etc.. are being appropriately prioritized to the frontline. At the same time, however, a vulnerable population will continue to need essential healthcare services — those needing surgery.

The American College of Surgeons (ACS) released guidelines this week on the triage of surgical cases during the COVID-19 pandemic. They first recommended that surgeons curtail the performance of elective surgical procedures in the upcoming weeks.

  Other recommendations included the importance of waiting on results of COVID-19 testing and avoiding emergency surgeries, particularly at night when possible due to limited team staffing. As a surgeon, I realized the risk of intubation/extubation, bag masking, and bronchoscopic procedures, but had to pause and think of the implication of electrocautery of blood, gastrointestinal tissue, any body fluids. The ACS reminded us all of the risk to healthcare workers associated with the use of electrocautery because this process can aerosolize fluids, thus releasing potential virus into the air.

“The popularization of the use of surgical electrocautery is often attributed to William T Bovie (1882–1958), who had a doctorate in plant physiology, but whom we might nowadays regard as a biophysicist. Between 1914 and 1927, Bovie discovered that high frequency alternating current in the range 250,000–2,000,000 Hz could be used to incise coagulated tissue and obtain haemostasis, and developed the first commercial electrosurgical device at Harvard University. Harvey Cushing (1869–1939) popularized the device in neurosurgery; he first used it in an operating theatre in 1926 and went on to use it in over 500 neurosurgical operations. It was later adopted by other surgeons.”1

Needless to say, this has been a mainstay of the art of surgery. Having been trained during the era prior to laparoscopic surgery, I had to again pause and realize the potential danger of any laparoscopic or endoscopic procedure. “There is insufficient evidence to recommend for/against an open versus laparoscopic approach; however, the surgical team should choose an approach that minimizes OR time and maximizes safety for both patients and healthcare staff.”2

The recommendations also include guidelines for the care of some of the most vulnerable — oncology patients.

This is significant. According to the “Guidelines for Opening America Again,” even in Phase I, all vulnerable individuals must shelter in place. Vulnerable people include “those whose immune system is compromised such as by chemotherapy for cancer.”3

While Phase 1 of opening America allows surgery in Ambulatory Surgical Centers (ASC), which will have a positive economic impact, there are expectations that COVID-19 testing and supplies will be at levels as to not impact acute care facilities.


1 John Marshall’s first description of surgical electrocautery

2 COVID-19: Elective Case Triage Guidelines for Surgical Care

3 Opening Up America Again


Mark S. Kestner, MD, MBA

Chief Medical Officer

Mark is a surgeon with deep leadership experience in military, university, integrated delivery, and especially community-based healthcare systems.


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