Surgical smoke

Surgical smoke is the gaseous by-product produced by electrosurgery, laser tissue ablation, ultrasonic scalpel dissection, high speed drilling or burring, or any procedure done by means of a surgical device that is used to ablate, cut, coagulate, desiccate, fulgurate, or vaporize tissue. Other names for surgical smoke are cautery smoke, plume, diathermy plume, or, sometimes, aerosols produced during surgery, vapor contaminants, or air contaminants.[1]

There is evidence, although the evidence is somewhat controversial, of the dangers from toxicity or possible infectivity of surgical smoke produced by electrosurgery or ultrasonic scalpel procedures; such surgical smoke contains carcinogenic or irritant chemicals and/or bio-aerosols capable of harming patients or operating room personnel upon inhalation.[2][3][4]

... Our investigation showed a very high exposure to ultrafine particles (> 100000 cm–3) for surgeons and close assisting operating personnel – alternating with longer periods of low exposure. Although peaks of ultrafine particles will occur in the majority of cases for only short time intervals, they will accumulate during a professional life. Nothing is known yet about the health effects of such very high and very short (seconds to minutes) exposures to ultrafine particles, but it should be kept in mind that without adequate ventilation the particles produced by electrocautery and laser techniques will probably not vanish quite as quickly.

Ultrafine particles in the surgical smoke have to be looked upon with caution, as they may also contain viable cellular material. ... Probably the most important safety measure in an operation theatre is a reliable air conditioning system that effectively filters out gases and all freshly produced particles. ... During endoscopic surgery smoke is accumulated and released at once in a relatively high velocity air flow. Surgeons should pay attention that the jet is not pointed at persons standing close. The preferred preventive measure would be to use a commercially available filter that can be attached to the Luer lock valve on the cannula and that removes cells, particulates, and chemical gases when desufflating.[5]

The presence of viable cells in surgical smoke is controversial. The issue is of concern because of the potential for viable aerosolized cancer cells to seed distance sites such as trocar incisions leading to port-site metastases through a method known as the chimney effect.[6]
A 44-year-old laser surgeon presented with laryngeal papillomatosis. In situ DNA hybridization of tissue from these tumors revealed human papillomavirus DNA types 6 and 11. Past history revealed that the surgeon had given laser therapy to patients with anogenital condylomas, which are known to harbor the same viral types. These findings suggest that the papillomas in our patient may have been caused by inhaled virus particles present in the laser plume.[7]
... Surgical smoke has been identified to carry viable bacteria that have been cultured from surgical smoke, including Bacillus subtilis and Staphylococcus aureus. In addition, mycobacteria have been isolated from smoke, including Mycobacterium tuberculosis ... The hazards of electrosurgical smoke are for the most part potential hazards without a large epidemiological database demonstrating their harmfulness to humans. In the presence of a scientifically verifiable hazard and the absence of definitive epidemiologic proof of health consequences, the most prudent course of action is to minimize exposure, which has virtually no downside risk.[8]

References

  1. ↑ Watson DS. "Surgical Smoke: What Do We Know" (PDF).
  2. ↑ Fitzgerald JEF, Malik M, Ahmed I. A single blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surgical Endoscopy 2012;26(2):337-342. PMID 21898022. DOI: 10.1007/s00464-011-1872-1
  3. ↑ Ball K (1995). "Surgical smoke: Is it safe to breathe?". Today's Surgical Nurse. 18 (5): 16–21.
  4. ↑ Novak DA; Benson SM (2010). "Understanding and controlling the hazards of surgical smoke". Prev Infect Ambul Care. 1: 3–5.
  5. ↑ Brüske-Hohlfeld I; Preissler G; Jauch KW; Pitz M; Nowak D; Peters A; Wichmann HE (2008). "Surgical smoke and ultrafine particles". Journal of Occupational Medicine and Toxicology. 3 (1): 1. doi:10.1186/1745-6673-3-31.
  6. ↑ Barrett WL; Garber SM (2003). "Surgical smoke: a review of the literature". Surgical Endoscopy. 17 (6): 979–987.
  7. ↑ Hallmo P; Naess O (1991). "Laryngeal papillomatosis with human papillomavirus DNA contracted by a laser surgeon". European Archives of Oto-rhino-laryngology. 248 (7): 425–427.
  8. ↑ McCormick PW (2008). "Bovie smoke. A perilous plume". AANS Neurosurg. 17 (1).
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