Electrocautery Devices With Feedback Mode and Teflon-Coated Blades Create Less Surgical Smoke for a Quality Improvement in the Operating Theater

Abstract

Monopolar electrocautery is a fast and elegant cutting option. However, as it creates surgical smoke containing polycyclic aromatic hydrocarbons (PAHs), it may be hazardous to the health of the surgical team. Although new technologies, such as feedback mode (FM) and Teflon-coated blades (TBs), reduce tissue damage, their impact on surgical smoke creation has not yet been elucidated. Therefore, we analyzed the plume at its source.The aim of this study was to evaluate if electrocautery FM and TBs create less surgical smoke.Porcine tissue containing skin was cut in a standardized manner using sharp-edged Teflon-coated blades (SETBs), normal-shaped TBs, or stainless steel blades (SSBs). Experiments were performed using FM and pure-cut mode. Surgical smoke was sucked through filters or adsorption tubes. Subsequently, filters were scanned and analyzed using a spectrophotometer. A high-performance liquid chromatography (HPLC-UV) was performed to detect benzo[a]pyrene (BaP) and phenanthrene as 2 of the most critical PAHs. Temperature changes at the cutting site were measured by an infrared thermometer.In FM, more surgical smoke was created using SSB compared with TBs (P < 0.001). Furthermore, differences between FM and pure-cut mode were found for SSB and TB (P < 0.001), but not for SETB (P = 0.911). Photometric analysis revealed differences in the peak heights of the PAH spectrum. In HLPC-UV, the amount of BaP and phenanthrene detected was lower for TB compared with SSB. Tissue temperature variations increased when SSB was used in FM and pure-cut mode. Furthermore, different modes revealed higher temperature variations with the use of SETB (P = 0.004) and TB (P = 0.005) during cutting, but not SSB (P = 0.789).We found that the use of both TBs and FM was associated with reduced amounts of surgical smoke created during cutting. Thus, the surgical team may benefit from the adoption of such new technologies, which could contribute to the primary prevention of smoke-related diseases.

Hidrocarbonetos Policíclicos Aromáticos: Correlação Entre Tempo De Uso Do Eletrocautério E Tempo Cirúrgico

“…Atualmente, estudos têm sido publicados abordando não somente as consequências da queimadura da fumaça para o trabalhador e o risco de explosões nas salas operatórias (22) , mas também estudos que buscam mensurar os compostos da fumaça e os efeitos no organismo humano (5,7,13) . Entretanto, estes estudos ainda não são conclusivos, mas há forte evidência científica dos malefícios para o ser humano, incluindo a toxicidade na mucosa respiratória (1,23) .…”

“…Estudo afirmou que existe risco de câncer para os cirurgiões frente aos HPA gerados pela fumaça cirúrgica, e esse risco correspondeu a 0,1% (7) . Assim como neste estudo, HPA foram encontrados em estudos transversais realizados em diversos países como na Alemanha, Suécia, Reino Unido e na Suíça, incluindo cirurgias abertas e videolaparoscópicas (5,(13)(14)(15) .…”

“…O referido composto foi encontrado na fumaça do eletrocautério em estudos internacionais (5,(13)(14)(15) , entretanto ainda são escassos estudos, principalmente nacionais, que abordam a presença dos compostos químicos na fumaça cirúrgica (16) , além daqueles que correlacionem o tempo de uso do eletrocautério e o tempo cirúrgico.…”

Polycyclic aromatic hydrocarbons produced by electrocautery smoke and the use of personal protective equipment 1

“…These compounds are generated during incomplete combustion processes, such as those of coal, wood, garbage, tobacco, and grilled meat 8 , and are also formed during electrocautery. Studies developed in Lübeck (Germany) 3 , Changhua (Taiwan) 4 and in Uppsala (Sweden) 10 identified these compounds in the surgical smoke generated by this device.…”

“…This smoke may contain various chemical pollutants in the form of gases or particles 2 . Exploratory studies report that polycyclic aromatic hydrocarbons (PAHs) 3 - 4 , volatile organic compounds 5 , and carbon oxides are among such pollutants contained in the smoke combustion process 2 , 6 .…”