Page 1 of 4 © Annals of Laparoscopic and Endoscopic Surgery. All rights reserved. Ann Laparosc Endosc Surg 2021;6:26 | http://dx.doi.org/10.21037/ales-20-103 Introduction Current coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, is challenging healthcare systems at a global level. All surgical procedures should be performed in highly selective cases (1). It is prudent to postpone non-oncological procedures and prioritize urgent cancer treatment. There should be an optimization of operating room and hospitalization time and complications minimized. The surgical care during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but also the safety of physicians and operating room (OR) staff. Aerosol generating procedures of respiratory secretions and procedures transmitting droplets can spread the virus. The principles should be to keep droplet spread to a minimum and avoid aerosolization as far as possible (2). In the OR, measures can be taken to reduce the risk of contamination, such as the use of adequate personal Case Report Technical requirements for a safe performance of TAMIS during COVID-19 pandemic: the role of spinal anaesthesia and AirSeal ® — a case report Maria João Amaral 1,2 , Mariana Vaz 3 , António Manso 1,2 , Manuel Rosete 1,2 , Nídia Gonçalves 3 , Marco Serôdio 1,2 , José Guilherme Tralhão 1,2,4 1 General Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal; 3 Anaesthesiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 4 Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal Correspondence to: Maria João Amaral (ORCID: 0000-0002-7494-3218). Department of General Surgery, Centro Hospitalar e Universitário de Coimbra - Praceta Prof. Mota Pinto, 3004-561 Coimbra, Portugal. Email: mariajoaoamaral@hotmail.com. Abstract: Coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems. Surgical care during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but also the safety of physicians and operating room (OR) staff. In the OR, general anaesthesia poses a risk of aerosolization during the intubation process. There is also concern about minimally invasive surgery due to aerosol formation. The SARS-CoV-2 virus was also identified in the faeces, so this is a possible pathway for transmission. This article presents the role of spinal anaesthesia (SA) and AirSeal ® device in reducing the risk of COVID-19 contamination while performing transanal minimally invasive surgery (TAMIS). A 59-year-old patient, diagnosed with a T1 rectal adenocarcinoma, was submitted to TAMIS. The surgery was done during COVID-19 pandemic due to the risk of oncological progression with delayed treatment, under SA and using the AirSeal ® system and adequate personnel protective equipment (PPE). Laparoscopic smoke evacuation systems with appropriate flters, like AirSeal ® , minimize the aerosol formation and may reduce the risk associated with surgical smoke exposure. This case is unique because the patient was safely submitted to TAMIS using proper PPE and AirSeal ® under SA, in order to minimize aerosol formation which is crucial during COVID-19 pandemic. Keywords: SARS-CoV-2; coronavirus disease 2019 (COVID-19); transanal minimally invasive surgery (TAMIS); spinal anaesthesia; AirSeal ® system; case report Received: 20 July 2020; Accepted: 17 December 2020; Published: 20 April 2021. doi: 10.21037/ales-20-103 View this article at: http://dx.doi.org/10.21037/ales-20-103