Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment

Hensman, Chris; Baty, D.; Willis, R. G.; Cuschieri, Alfred

doi:10.1007/s004649900771

Cited by 153 publications

(122 citation statements)

References 5 publications

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“…Previous authors have identified chemicals found in electrosurgical smoke. 8 One of the most worrisome is carbon monoxide. During laparoscopic procedures, high levels of CO are produced that can lead to slight elevations of carboxyhemoglobin.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

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,"Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility." Journal of Endourology.21,3. 347-351. (2007 ABSTRACT Purpose:We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility. Materials and Methods:The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles Ͼ500 nm and Ͻ500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.Results: The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components Conclusions: Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.

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Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

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“…In vitro studies analysing the chemical composition of surgical smoke have identified up to 80 chemicals, 8,9 including hydrocarbons, nitriles, fatty acids and phenols.…”

Section: Discussionmentioning

confidence: 99%

Current Attitudes and Practices Towards Diathermy Smoke

Spearman

Tsavellas

Nichols

2007

annals

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INTRODUCTION The hazards of surgical smoke are well documented and electrosurgical units (ESUs) are an integral part of surgical practice. The aim of this study was to gauge the opinions of general surgical consultants, specialist registrars and senior theatre nurses in the Wessex Region towards the hazards of ESU smoke.MATERIALS AND METHODS A literature search was carried out using Ovid Medline. A questionnaire was sent to 169 consultants, SpRs and nurses in the 14 hospitals across the Wessex Region, exploring current practices, perceived hazards and whether adequate precautions were currently in use. RESULTS Only 3 of 98 surgeons used dedicated smoke extractors, despite the fact the majority (72%) felt that, currently, inadequate precautions were taken to protect staff and patients from surgical smoke. There was also uncertainty about the hazards amongst the respondents.CONCLUSIONS The use of smoke extraction equipment is very limited. Greater awareness of the hazards and available technology to extract fumes from the theatre environment might lead to greater uptake.

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“…through peritoneum and their penetration into blood and other body fluids [1,2]. The proof of their absorption may be the presence of these compounds or their metabolites in blood and urine.…”

mentioning

confidence: 99%

“…Therefore, analysis of urine samples is an important source of information concerning functioning of the body, as well as its exposure to harmful substances. Whereas smoke production during laparoscopic surgeries is well documented in world literature [1][2][3][4][5][6][7], the analysis of urine samples of patients undergoing laparoscopic procedures in order to assess the potential exposure to such substances has not been performed yet. A number of studies, such as those conducted by Barrett et al [7], show the presence of chemical compounds of different structure and toxicity, which mostly occur in low to trace concentrations, in the smoke produced as a result of tissue thermocoagulation.…”

mentioning

confidence: 99%

Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

Dobrogowski¹,

Wesołowski²,

Kucharska³

et al. 2014

International Journal of Occupational Medicine and Environmental Health

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Objectives: The aim of this study was to assess the exposure of patients to organic substances produced and identified in surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy. Material and Methods: Identification of these substances in surgical smoke was performed by the use of gas chromatography-mass spectrometry (GC-MS) with selective ion monitoring (SIM). The selected biomarkers of exposure to surgical smoke included benzene, toluene, ethylbenzene and xylene. Their concentrations in the urine samples collected from each patient before and after the surgery were determined by SPME-GC/MS. Results: Qualitative analysis of the smoke produced during laparoscopic procedures revealed the presence of a wide variety of potentially toxic chemicals such as benzene, toluene, xylene, dioxins and other substances. The average concentrations of benzene and toluene in the urine of the patients who underwent laparoscopic cholecystectomy, in contrast to the other determined compounds, were significantly higher after the surgery than before it, which indicates that they were absorbed. Conclusions: The source of the compounds produced in the abdominal cavity during the surgery is tissue pyrolysis in the presence of carbon dioxide atmosphere. All patients undergoing laparoscopic procedures are at risk of absorbing and excreting smoke by-products. Exposure of the patient to emerging chemical compounds is usually a one-time and short-term incident, yet concentrations of benzene and toluene found in the urine were significantly higher after the surgery than before it.

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Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment

Cited by 153 publications

References 5 publications

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Current Attitudes and Practices Towards Diathermy Smoke

Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

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