Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

Abstract

Background and Objectives:Surgical smoke contains various malodorous and hazardous combustion byproducts. We aimed to analyze hydrocarbons accumulated in the abdominal cavity during laparoscopic gynecologic surgery and determine the efficiency of a built-in-filter port.Methods:We prospectively followed seven patients with benign uterine pathology. Surgical smoke was generated using laparoscopic or robotic electrocautery. The smoke was collected twice for each patient using a built-in-filter port and a conventional port. The concentrations of volatile organic compounds and aldehydes were determined using gas chromatography with mass spectrometry and high-performance liquid chromatography with ultraviolet visible light detection and compared using the paired-sample Wilcoxon signed-rank test.Results:Five volatile organic compounds and five aldehydes had toxic effects or unpleasant odors. The median concentration of formaldehyde before filtration (0.870 ppm) exceeded the time-weighted average concentration (0.75 ppm) of the Occupational Safety and Health Administration. Built-in-filter ports significantly reduced the concentration of five volatile organic compounds and two aldehydes but not that of formaldehyde, acetaldehyde, and propionaldehyde. Formaldehyde concentration decreased by 50% after filtration but remained above the recommended exposure limit (0.016 ppm) of the National Institute of Occupational Safety and Health.Conclusions:Surgical smoke in minimally invasive gynecologic procedures contains several hazardous hydrocarbons including formaldehyde. Built-in-filter ports have the potential to reduce the exposure of surgical smoke to surgeons and operating room personnel; nevertheless, development of built-in-filter ports is necessary to improve the filtering efficiency for highly concentrated formaldehydes.

Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery

“…8 The nature of surgical smoke varies with the type of energy device and tissue, although data are incomplete and sometimes conflicting. 3,6,7,[24][25][26] As a general principle, energy may not be relied upon for the destruction of infectious agents, and tissue charring is more likely to release smaller particles and aerosolized pathogens. 5,7,27 For this reason, it has been previously recommended that energy devices should be used sparingly and at low intensity, and advanced bipolar cautery or ultrasonic devices should be preferred over standard cautery.…”

“…5,7,27 Smoke from an open surgical field may be evacuated using dedicated, commercially available suction devices. 3,7,[24][25][26] During minimally invasive surgery, accumulation within a closed space may lead to a high concentration of smoke with pressurization and the potential for sudden discharge. 4,28 This can be mitigated by periodically venting the surgical field, ensuring complete paralysis to avoid cough and forceful abdominal contractions, 4,28 and, if applicable, using airtight laparoscopic trocars or trocars with built-in or add-on filters.…”

“…4,28 This can be mitigated by periodically venting the surgical field, ensuring complete paralysis to avoid cough and forceful abdominal contractions, 4,28 and, if applicable, using airtight laparoscopic trocars or trocars with built-in or add-on filters. 4,25,26 Laparoscopy guidelines also suggest minimizing CO 2 insufflation pressure, so in the case of lung surgery, CO 2 insufflation is likely best avoided. Because minimally invasive surgery does afford some possibility of smoke containment and more control over smoke evacuation compared to open surgery, 4,24 the net effect of surgical approach (open or minimally invasive), at least in the case of laparoscopy, is unresolved.…”

Smoke and particulate filters in endoscopic surgery reviewed during COVID-19 pandemic

“…Two groups reported the use of a Tropian trocar (Tropian Tech., Gunpo, Korea) that has a built-in filter made of two layers of processed and refined charcoal [10,11]. Each layer has 1200 m 2 /g surface to absorb a large amounts of smoke.…”

“…The space between the two charcoal layers is occupied by innumerable 1-50 μm micropores designed to trap liquid and aerosolized substances. These studies evaluated smoke generated by (1) laparoscopic nephrectomies using electrocautery and Harmonic Generator 300 (Ethicon Endo-Surgery Inc., Cincinnati, OH); [9] and by (2) laparoscopic or robot assisted procedures for benign uterine diseases using electrocautery, SurgiwandTM (Medtronic, Minneapolis, MN, USA) or HotShears™ EndoWrist cautery (Intuitive Surgical, Sunnyvale, CA, USA) [11]. The smoke filtered through the Tropian trocar was processed by ultra-performance liquid chromatography.…”