World Journal of Laparoscopic Surgery

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VOLUME 17 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Laparoscopic Surgery Practice in the Era of COVID-19: The Pakistani Perspective

Syed Ali Haider, Muhammad Zubair, Sumera Qazi

Keywords : Coronavirus disease-19, Health care professionals, Laparoscopic surgery, Minimally invasive surgery, Surgical smoke

Citation Information : Haider SA, Zubair M, Qazi S. Laparoscopic Surgery Practice in the Era of COVID-19: The Pakistani Perspective. World J Lap Surg 2024; 17 (1):44-51.

DOI: 10.5005/jp-journals-10033-1591

License: CC BY-NC 4.0

Published Online: 14-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aims: The SARS-CoV-2 coronavirus disease-19 (COVID-19) pandemic has wreaked havoc worldwide. Not only has it severely impacted the way of life, but also damaged global economies and worsened social disparities, including those in healthcare. The pandemic, having imposed an enormous burden on global healthcare infrastructure, has led to drastic changes in medical and surgical practices, including those of laparoscopic and minimally invasive surgery. This study aimed to explore the practice of laparoscopic surgeons during the COVID-19 era in Pakistan. Materials and methods: Surgeons involved in laparoscopic surgery (LS) were approached via e-mail practicing in different surgical setups and cities of Pakistan. After taking Institutional Review Board (IRB) approval and informed consent a questionnaire was filled out by all participating laparoscopic surgeons. The data was then analyzed in SPSS version 26. Results: A total of 168 surgeons involved in LS from different disciplines responded to the invitation and filled out the online questionnaire. The mean age of the surgeons was 48.72 ± 8.04 years and most of them were married and the majority belonged to the major cities of the country, i.e., Karachi, Lahore, Multan, Islamabad, and Rawalpindi. Surgeons who participated had a mean practice experience of 12.12 ± 6.88 years (minimum 3 and maximum 31 years). Most of the respondents were General Surgeons (GS), followed by minimal invasive surgeons (MIS) having advanced training in laparoscopy, Obstetricians and Gynecologists (OB-GYN), and Urologists. Conclusion: The LS practice in Pakistan during the COVID-19 era is widely variable. There is a dire need to formulate apt local guidelines, that are practical and implementable in developing countries.

  1. Worldometer. COVID-19 Coronavirus Pandemic. Worldometer. Available from:
  2. Pakistan Scientific and Technological Information Centre (PASTIC). COVID-19 S and T information resource portal. Available from:
  3. Gupta N, Agrawal H. COVID 19 and laparoscopic surgeons, the Indian scenario-perspective. Int J Surg 2020;79:165–167. DOI: 10.1016/j.ijsu.2020.05.076.
  4. Ng K, Poon BH, Kiat Puar TH, et al. COVID-19 and the risk to health care workers: A case report. Ann Intern Med 2020;172(11):766–767. DOI: 10.7326/L20-0175.
  5. Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: Lessons learned in China and Italy. Ann Surg 2020;272(1):e5–e6. DOI: 10.1097/SLA.0000000000003924.
  6. Francis N, Dort J, Cho E, et al. SAGES and EAES recommendations for minimally invasive surgery during COVID-19 pandemic. Surg Endosc 2020;34(6):2327–2331. DOI: 10.1007/s00464-020-07565-w.
  7. Li CI, Pai JY, Chen CH. Characterization of smoke generated during the use of surgical knife in laparotomy surgeries. J Air Waste Manag Assoc 2020;70(3):324–332. DOI: 10.1080/10962247.2020.1717675.
  8. DesCoteaux JG, Picard P, Poulin EC, et al. Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc 1996;10(2):152–158. DOI: 10.1007/BF00188362.
  9. Mowbray NG, Ansell J, Horwood J, et al. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020;107(11):1406–1413. DOI: 10.1002/bjs.11679.
  10. Barrett WL, Garber SM. Surgical smoke: A review of the literature. Is this just a lot of hot air? Surg Endosc 2003;17(6):979–987. DOI: 10.1007/s00464-002-8584-5.
  11. Dobrogowski M, Wesołowski W, Kucharska M, et al. Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient. Int J Occup Med Environ Health 2014;27(2):314–325. DOI: 10.2478/s13382-014-0250-3.
  12. American Society of Anesthesiologists. ASA-APSF joint statement on non-urgent care during the COVID-19 outbreak. American Society of Anesthesiologists. Available from:
  13. Tivey DR, Davis SS, Kovoor JG, et al. Safe surgery during the coronavirus disease 2019 crisis. ANZ J Surg 2020;90(9):1553–1557. DOI: 10.1111/ans.16089.
  14. Joseph JP, Joseph AO, Oomman S, et al. Laparoscopic versus open surgery: Aerosols and their implications for surgery during the COVID-19 pandemic. Eur Surg 2020 52(4):188–189. DOI: 10.1007/s10353-020-00644-1.
  15. Guraya SY. Transforming laparoendoscopic surgical protocols during the COVID-19 pandemic; Big data analytics, resource allocation and operational considerations. Int J Surg 2020;80:21–25. DOI: 10.1016/j.ijsu.2020.06.027.
  16. Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020;67(6):732–745. DOI: 10.1007/s12630-020-01620-9.
  17. Repici A, Aragona G, Cengia G, et al. Low risk of COVID-19 transmission in GI endoscopy. Gut 2020;69(11):1925–1927. DOI: 10.1136/gutjnl-2020-321341.
  18. Liang T. Handbook of COVID-19 prevention and treatment. The First Affiliated Hospital, Zhejiang University School of Medicine, 2020. pp. 1–68.
  19. ASGE Quality Assurance in Endoscopy Committee; Calderwood AH, Day LW, et al. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc 2018;87(5):1167–1179. DOI: 10.1016/j.gie.2017.12.009.
  20. American Society for Gastrointestinal Endoscopy. Joint GI Society Message: COVID-19 clinical insights for our community of gastroenterologists and gastroenterology care providers. Available from:
  21. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020;67(5):568–576. DOI: 10.1007/s12630-020-01591-x.
  22. Alp E, Bijl D, Bleichrodt RP, et al. Surgical smoke and infection control. J Hosp Infect 2006;62(1):1–5. DOI: 10.1016/j.jhin.2005.01.014.
  23. Shabbir A, Menon RK, Somani J, et al. ELSA recommendations for minimally invasive surgery during a community spread pandemic: A centered approach in Asia from widespread to recovery phases. Surg Endosc 2020;34(8):3292–3297. DOI: 10.1007/s00464-020-07618-0.
  24. Moletta L, Pierobon ES, Capovilla G, et al. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg 2020;79:180–188. DOI: 10.1016/j.ijsu.2020.05.061.
  25. Campanile FC, Podda M, Arezzo A, et al. Acute cholecystitis during COVID-19 pandemic: A multisocietary position statement. World J Emerg Surg 2020;15(1):38. DOI: 10.1186/s13017-020-00317-0.
  26. Porter J, Blau E, Gharagozloo F, et al. Society of robotic surgery review: Recommendations regarding the risk of COVID-19 transmission during minimally invasive surgery. BJU Int 2020;126(2):225–234. DOI: 10.1111/bju.15105.
  27. Royal College of Surgeons of England. Updated Intercollegiate General Surgery Guidance on COVID-19. Available from:
  28. El Boghdady M, Ewalds-Kvist BM. Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations. Surgeon 2021;19(2):e29–e39. DOI: 10.1016/j.surge.2020.07.005.
  29. American College of Surgeons. COVID-19: Elective case triage guidelines for surgical care. Available from:
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