Perioperative Strategy to Minimize the Risk of Viral Transmission in a Severe Acute Respiratory Syndrome Coronavirus 2-Positive Patient Undergoing Laparoscopic Cholecystectomy: A Case Report

Abstract

Herein we present a case of laparoscopic cholecystectomy in a patient who was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient was a 56-year-old man with acute cholecystitis. During preoperative workup, he was revealed to be SARS-CoV-2-positive, but without any signs of pneumonia. As treatment of acute cholecystitis was complicated by asymptomatic coronavirus disease 2019 (COVID-19), nonoperative management with antibiotics was initiated. However, his condition deteriorated to gangrenous cholecystitis and obstructive cholangitis on the 8^th day of symptom onset. A multidisciplinary team discussed the treatment and perioperative risk mitigation strategy against viral transmission. After sharing information and simulation of preventive measures, laparoscopic cholecystectomy and C-tube drainage were performed on the 11^th day of symptom onset, when we thought that infectiousness should have declined significantly. During surgery, protective measures against surgical smoke were applied using pneumoperitoneum devices equipped with an ultralow particulate air filter. We report our experience of perioperative risk mitigation strategies in laparoscopic surgery for a patient who was positive for SARS-CoV-2.