Introduction The risks to surgeons of carrying out aerosol generating procedures during the COVID pandemic are unknown. To define these risks in a systematic manner we investigated the presence of SARS-CoV-2 virus in the peritoneal fluid and lower genital tract of patients undergoing surgery at a time when COVID infection remained steady in the population.

Methods We carried out a prospective cross sectional observational study of patients undergoing abdominal surgery or instrumentation of the lower genital tract at a single large institution in the UK. We took COVID swabs from the peritoneal cavity and from the vagina from all eligible patients. All patients underwent preoperative nasopharyngeal testing and results were stratified by pre operative COVID status.

Results To date we have recruited 74 patients undergoing surgery. The commonest procedure undertaken was caesarean section but patients undergoing laparotomy and cancer surgery were also included. No patients had faecal or amniotic contamination of the abdomen or vagina at the time of sampling. All patients had negative nasopharyngeal COVID swabs within 48 hours of recruitment although 4/74 (5%) had the presence of antibodies suggesting previous infection. SARS-CoV-2 virus RNA was detected in 0/63 peritoneal samples and 0/68 lower genital tract samples.

Conclusions The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed COVID negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic and gynaecologic surgery at a time when COVID19 is endemic in the population.