A surgeon at Chulalongkorn Hospital has shared, via Facebook, his first nerve-racking experience of operating on a patient infected with COVID-19.

Dr. Phuphat Vongwattanakit said, while it was the first operation of its kind at Chulalongkorn Hospital, and he was not sure whether it was the first of its kind in Thailand.

He gave a detailed account of the necessary pre-operation preparations, starting with the powered, air-purifying respirator (PAPR) which, he suggested, surgeons get used to wearing.

Since the headgear was equipped with positive air pressure, there was no need to wear an N95 surgical mask as well, but the anaesthesiology team wore them, because they are more convenient than the full PAPR, especially during removal of the gown.

The next steps were to cleanse hands with sanitizer gel and then put on a disposable sterile gown and gloves before the patient was brought into the operating theatre.

Dr. Phuphat said the operation was quick, adding that he felt comfortable in the PAPR, although, on several occasions, his surgical teammates’ headgear bumped against each other. Another drawback of wearing the PAPR was some difficulty in communicating but, luckily, the team understood what the surgeon needed, he added.

There was another issue, he recalled, namely which topical antimicrobial should be used on the patient and povidone iodine was recommended, rather than the more usual chlorhexidine, as it was not proven against the virus.

After the operation and the patient’s transfer to the recovery area, it was time to remove the used PPE. “This is the most difficult part for those without experience in removing the gown, and it is done after removal of the PAPR,” said Dr. Phuphat.

The team then changed shoes, left the theatre’s anteroom for a shower and took a second shower at home.

He said the operation went well and he thanked all the medical personnel for their help in ensuring this nerve-racking endeavour went “as smooth as silk”.