Safety of Endoscopic Transsphenoidal Pituitary Surgery during the COVID-19 Pandemic and Comparison to the Pre-Pandemic Era

Objectives: Safe provision of transsphenoidal surgery for pituitary tumors (TSS) has been significantly disrupted by theCOVID-19 pandemic. We assess whether there was any compromise to patient and staff safety from COVID-19 fromundertaking TSS during the COVID-19 pandemic in our institution. Methods: We retrospectively review all the cases performed between the March 1 and September 11, 2020 and comparedour findings to the cases performed between March 1 and September 11, 2019. In doing so, we aim to assess the impact ofthe COVID-19 pandemic on our service. We review individual patient records to identify any COVID-19 relatedcomplications during or after their inpatient stay and evaluate any COVID-19 confirmed cases among staff involved in theseoperations. Results: Twenty-seven patients had TSS since March 2020 versus 39 during the same period in 2019. Of the patientstreated during the COVID-19 pandemic, 10 required urgent TSS for apoplexy or visual compromise, 10 needed expeditedsurgery and seven had elective procedures. Average duration of GA was 43 minutes (vs. 25 minutes in 2019), surgery 78minutes (vs. 79 minutes in 2019). The length of stay postsurgery was 2 days on average ([range: 1-9 days] vs. 3.6 days in2019 [range: 1-27 days]). No COVID-19 related complications were seen, no new infections developed and no staffinvolved contracted COVID-19. Measures taken to minimize risk included patients self-isolating prior to surgery andpreoperative COVID-19 testing with all patients operated on after April 2020 having received a COVID-19 antigen test at 1to 4 days before the date of their surgery. Theater and anesthetic process followed Trust COVID-19 guidance and physicalmeasures to reduce the spread of aerosols generated were used (clear sheet applied over the patient with small openingsfor instruments and endoscope ([ Fig. 1 ]), nasal latex slits ([ Fig. 2 ]), and full PPE (whenever necessary). Conclusion: We did not see any patient or staff COVID-19 complications or have any new COVID-19 cases contracted byundertaking transphenoidal surgery during the COVID-19 pandemic for pituitary tumors (TSS), with appropriate testing andprecautions in place. Anesthetic time did increase for these cases but there again were no compromises to patient safety orrecovery from this.