Updates

June 29, 2020

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Dear Colleagues,

As we emerge from the pandemic and are slowly creating our "new normal," we have all come to appreciate the importance of social connection and support. As a profession, we also realize that we are unlikely to return soon to the conference / classroom style of continuing medical education that we were accustomed to.

 

We hope that CanSAGE's "In Covid Times" webinars have facilitated keeping our community connected and resourced to help our patients and ourselves. The next webinar (Wednesday, July 8) will be the last free webinar open to non-members.

 

Now CanSAGE needs your support!
Please renew your membership, or join as a new member to help us continue to fulfill our educational and advocacy mission. 

As part of your membership, we have decided to include FREE REGISTRATION to our upcoming virtual meeting – CanSAGE at home / ScanPEG chez nous – which will be held live on September 25-26. We will have top-notch National and International faculty discussing issues highly relevant to Canadian gynecologists. 

Please click here to see all the benefits that membership will provide and to find the Application / Renewal Form. There is also a discount if you sign up before August 1, 2020!

Be a member of CanSAGE, the voice of gynecology in Canada.

Warm regards,

Catherine

Dr. Catherine Allaire

President, CanSAGE

Le 29 juin 2020

Chers collègues,

Alors que nous sortons de la pandémie et créons lentement notre « nouveau normal », nous en sommes tous venus à apprécier l'importance des liens sociaux et du soutien. En tant que profession, nous nous rendons également compte qu'il est peu probable que nous revenions bientôt au style de formation médicale continue de conférence / classe auquel nous étions habitués.

 

Nous espérons que les webinaires « au temps de la Covid » de SCanPEG ont facilité le maintien de notre communauté et procure des ressources utiles pour aider nos patients et nous-mêmes. Le prochain webinaire (mercredi le 8 juillet) sera le dernier webinaire gratuit ouvert aux non-membres.

 

SCanPEG a maintenant besoin de votre soutien!

Veuillez renouveler votre adhésion ou adhérer en tant que nouveau membre pour nous assurer que nous pouvons remplir notre mission éducative et de plaidoyer.

En ce qui concerne votre adhésion, nous avons décidé d'inclure une INSCRIPTION GRATUITE à notre prochaine réunion virtuelle – ScanPEG chez nous / CanSAGE at home – qui se tiendra en direct du 25 au 26 septembre. Des professeurs de renommée nationale et internationale discuteront de sujets très pertinents pour les gynécologues canadiens. 

Veuillez cliquer ici pour voir tous les avantages que l'adhésion fournira et pour trouver le formulaire de demande / renouvellement. Il y a aussi un rabais si vous vous inscrivez avant le 1er août 2020!

Soyez membre de la SCanPEG, la voix de la gynécologie au Canada.

Sincèrement vôtre,

Catherine

Dre Catherine Allaire
Présidente de la SCanPEG

May 7, 2020

 

Dear Colleagues,

As we all continue to adapt to the COVID pandemic, we can breathe a sigh of relief that the first wave seems to have flattened thanks to everyone’s efforts, but there remains great uncertainty about the immediate future. Our governmental leaders are still advising against gatherings of over 50 people. Travel for health care professionals is still restricted in many provinces, and we are expecting a slow but steady ramp up of our usual activities with much delayed clinical care to deliver.

Considering all these factors, the Executive Board has made the difficult decision to cancel this year’s CanSAGE annual conference that was to be held in Saskatoon in September 2020.

Considerable time and effort had gone into preparing for this meeting, and we are grateful to the planning committee, our administrative support team and our sponsors for their commitment. This is disappointing to all of us who have come to appreciate this conference as a unique opportunity to exchange ideas, further our clinical knowledge, share our research and connect with colleagues and friends.  However we feel that this is the best choice to keep our members safe and available to the communities that we service.

But all is not lost!

Our planning committee is currently working on converting the meeting to a virtual format so that we can still meet and learn from each other, as well as share our research findings. Please stay tuned for further announcements about the Virtual CanSAGE Conference.

We want to thank you for your continued involvement and engagement with CanSAGE as we navigate these difficult times. 

 

Best wishes and stay safe,

Catherine Allaire MD
President, CanSAGE

March 31, 2020

Joint RCOG, BSGE and BGCS guidance for the management of abnormal uterine bleeding in the evolving Coronavirus (COVID-19) pandemic 

March 27, 2020

Joint Society Statement on Minimally Invasive Gynecologic Surgery 
During the COVID-19 Pandemic

Issued:  3/27/2020 – by AAGL

 

The surgical care of gynecologic patients during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but that of the physicians and operating room personnel. Guidance around minimally invasive gynecologic surgery is a rapidly evolving topic, and the information presented below is subject to change as new data becomes available.

Urgency of Surgical Treatment:

The AAGL, along with many other surgical and women’s health professional societies, supports suspension of non-essential surgical care during the immediate phases of the COVID-19 pandemic. Please refer to AAGL’s Joint statement on elective surgeries dated March 16, 2020 (1)
 

Additionally, depending on the degree of urgency, COVID-19 positive patients may be best-served by delaying surgical procedures until their infection is resolved. However, in some instances, gynecologic surgical care may be deemed essential and unable to be delayed. We have outlined important safety information to consider when performing gynecologic surgery during this time


Universal Evaluation:

The COVID-19 status of every patient should be evaluated by pre-operative screening on the day of surgery including history, physical exam and patient questionnaire regarding flu-related symptoms (see Appendix 1) and exposures. When possible, COVID-19 testing should be undertaken for symptomatic and at-risk patients prior to surgery. As testing becomes more rapid and readily available, universal testing for COVID-19 may be recommended.


Considerations should be made based on the prevalence of disease on a local level regarding the interpretations of test results due to the risk of false negative results early in the course of disease; patients with unknown COVID-19 status may be considered “positive until proven otherwise” in terms of mobilizing appropriate protective gear for health care workers. Providers in some areas of the world affected early in the global pandemic have advocated for additional imaging evaluation (Computed Tomography (CT) of the Chest) prior to any surgical procedure due to suggestion of superior predictive ability in early disease (2).

Personal Protective Equipment (PPE) for Operating Room Personnel:

The COVID-19 virions are 50-200 nm in size, while N-95 masks are rated to filter, with 95% efficiency, particles that are greater than 300 nm in size (3, 4). There is evidence to suggest that conventional surgical masks may provide a similar level of protection as the N95 mask in general-use conditions (5), and providers should employ the equipment deemed appropriate by their respective institutions

It is recommended that anyone working in the operating room utilize full PPE, which includes shoe covers, impermeable gowns, surgical or N-95 masks, protective head covering, gloves and eye protection. In addition, movement of personnel in and out of the operating room should be strictly limited, with efforts made to limit staff breaks mid-case when possible. Trainee participation should be limited and include only personnel essential to the safe performance of the operation in order to avoid exposure and preserve PPE resources. 

Surgical Approach:

Potential concerns exist regarding aerosolization of viral particles by electrosurgical and ultrasonic device use at the time of surgery, which could then theoretically be transmitted to the operating room environment. Additionally, with laparoscopy or robot-assisted laparoscopy, sudden release of trocar valves, non-air-tight exchange of instruments or specimen extraction via abdominal or vaginal incisions may potentially expose the health care team to aerosolized viral particles. While it is important to acknowledge these concerns, at present, they remain theoretical in relation to risk of transmission of COVID-19 to operating room personnel. There is no available evidence from the COVID-19 pandemic, or from prior global influenza epidemics, to suggest definitively that respiratory viruses are transmitted through an abdominal route from patients to health care providers in the operating room.


Laparoscopic and Robot-assisted Approach to Gynecologic Surgery:
The following are recommendations for best practice when laparoscopy or robot-assisted laparoscopy is performed (Level 3 Evidence based on expert opinion):

  • Employ electrosurgical and ultrasonic devices in a manner that minimizes production of plume, with low power setting and avoidance of long desiccation times

  • When available, make use of a closed smoke evacuation/filtration system with Ultra Low Particulate Air Filtration (ULPA) capability 

  • In addition, a laparoscopic suction may be used to remove surgical plume and desufflate the abdominal cavity; do not vent pneumoperitoneum into the room

  • Use low intra-abdominal pressure (10-12mmHg) if feasible

  • Avoid rapid desufflation or loss of pneumoperitoneum, particularly at times of instrument exchange or specimen extraction

  • Tissue extraction should be performed with minimal CO2 escape (desufflate with closed smoke evacuation/filtration system or laparoscopic suction prior to minilaparotomy, making extraction incision, vaginal colpotomy, etc.)

  • Minimize blood/fluid droplet spray or spread

  • Minimize leakage of CO2 from trocars (check seals in reusable trocars or use disposable trocars)

 

Vaginal and Laparotomic Approach to Gynecologic Surgery: 

Similar concerns exist in relation to aerosolization of viral particles with use of hand-held electrosurgical devices and plume release directly into the operating room environment in an uncontrolled fashion; these concerns are also unproven in relation to COVID-19 disease transmission. Collaboration with Anesthesiology colleagues and discussion of performing vaginal and open procedures under regional anesthesia is appropriate to avoid the aerosol generating events of intubation and extubation. 
 

Considerations regarding choice of surgical route include patient comorbidities (such as but not limited to: obesity, diabetes, cardiovascular disease) which could result in higher morbidity from laparotomic procedures. Additionally, prolonged hospitalization for recovery after laparotomy could expose patients to higher risk of nosocomial infection including COVID-19, and could place a higher burden on the health-care system. 
 

The following are recommendations for best practice when a vaginal or laparotomic procedure is performed
(Level 3 Evidence based on expert opinion):

  • Perform dissection and vascular control using non-electrosurgical techniques where possible

  • Employ electrosurgical and ultrasonic devices in a manner that minimizes production of plume, with low power setting and avoidance of long desiccation times

  • Smoke evacuators should be used alongside ULPA filters where possible

  • Utilize a suction device to remove any surgical plume as it is produced

  • Minimize blood/fluid droplet spray or spread

 

Hysteroscopic and Other Procedures:

The risk of COVID-19 transmission at time of hysteroscopy with bipolar electrosurgical devices and normal saline as the infusion medium is unknown, but theoretically low. Standard droplet precautions are recommended for PPE. The risks related to laser vaporization and conization procedures are also undelineated, and the above recommendations about minimization and evacuation of surgical plume apply. 

 

Summary and Recommendations:

Surgery for gynecologic patients during the COVID-19 pandemic should be approached on a case-by-case basis, taking into account patient-level factors and local resources. Minimally invasive and vaginal approaches to surgery are associated with lower morbidity for the patient in many cases, as well as shorter hospitalization. The data on risk of surgical plume exposure and transmission of COVID-19 are limited. There are strategies for all surgical approaches that can help mitigate the risk of exposing operating room personnel.
 

Appendix: Symptoms associated with COVID-19 according to WHO and CDC:

 

Common symptoms: Fever, Dry cough, Fatigue, Shortness of breath

 

Other associated symptoms: Muscle aches, Sore throat, Diarrhea, Nausea/vomiting, Runny nose


https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
https://www.who.int/health-topics/coronavirus#tab=tab_3

 

References:

  1. AAGL – Elevating Gynecologic Surgery. Joint Society Statement on Elective Surgery during COVID-19 Pandemic. Available at: https://www.aagl.org/news/covid-19-joint-statement-on-elective-surgeries/. Published March 2020. Accessed March 25, 2020. 

  2. Ai T, Yang Z, Hou H, Zhan C, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Feb 26:200642. doi: 10.1148/radiol.2020200642. [Epub ahead of print]

  3. Chen N, Zhou M. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513.

  4. 3M. 3M Infection Prevention N95 Particulate Respirators, 1860/1860S and 1870. Frequently asked questions. Available at: http://multimedia.3m.com/mws/media/323208O/n95-particulate-respirators-1860-1860s-1870-faqs.pdf. Published 2008. Accessed March 25, 2020. 

  5. Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA. 2019;322(9):824–833. doi:10.1001/jama.2019.11645

March 19, 2020

 

Dear colleagues and friends,

On behalf of the Board of CanSAGE, I want to reach out in these trying times. We are all currently preparing for the worst, knowing that the next few weeks will bring unprecedented challenges for our medical community and all Canadians.

It is heartening to see the rapid uptake of social distancing measures and the early preparedness undertaken by all our hospitals. With a bit of luck, these measures may be successful at flattening the curve and providing adequate resources for those who get seriously affected by Covid-19. 

As this situation is rapidly evolving and unpredictable, we are not currently making any changes regarding our Annual Meeting in September in Saskatoon, though this will be evaluated continually in the coming weeks or months. 

As all your mailboxes are being bombarded with pressing information, we will try to minimize our communications from CanSAGE until we have a firm plan ahead. In the meantime, look out for each other and stay well. 

 

Best regards,

Catherine Allaire MD
President, CanSAGE