Engineering controls for surgical smoke in laser medical handpieces

Abstract

The hazard of surgical smoke is often overlooked when considering the safety of medical laser procedures but can present a high level of occupational risk. Administrative procedures for operating external extraction devices and the reliance on personal protective equipment are not sufficient for reducing the risk. This paper aims to quantify the hazard of laser-generated surgical smoke and demonstrate how effective engineering control solutions can reduce the risk. A new design solution is presented with engineering controls for surgical smoke extraction and optical radiation integrated into the laser handpiece. A fibre delivered diode laser is used to simulate laser vaporisation procedures on porcine skin tissue. Conventional external extraction conditions are compared to the new design solution. Fine particulate mass concentrations (PM2.5) from the simulated procedures, under different extraction conditions, are measured using optical particle size measurements. Peak concentrations of 55.86 ± 2.79 µg/m 3 were measured without extraction;showing the hazard of laser-generated surgical smoke is five times greater than the World Health Organisation guideline of 10 µg/m 3 . A typical medical extraction setup only achieved a 16% reduction in peak concentration values, 47.07 ± 2.35 µg/m 3 ; demonstrating that conventional, external, methods of extraction are ineffective. The new solution was able to capture all particulate material, reducing particulate concentrations to background levels, 2.19 ± 0.68 µg/m 3 , safely below the current recommended guidelines. The design and results present evidence that it is not only more effective to use engineering control methods but that it is practicable to do so.

Occupational Hazards of Surgical Smoke and Achieving a Smoke Free Operating Room Environment: Asia-Pacific Consensus Statement on Practice Recommendations

“…Many of the compounds found in surgical smoke are considered hazardous to human health and have been found at levels above recommended acute exposure limits set by national health organizations. The latest evidence suggests that surgical smoke generated by laser procedures is found to be five times higher (55.86 ± 2.79 μg/m 3 ) than the recommended limit of 10 μg/m 3 set by the World Health Organization ( 17 ). Based on existing literature, there appears to be no safe level of surgical smoke and evidence is lacking on the hazardous levels of exposure for surgeons and OR personnel.…”

Analysis of laser-generated plume concentration during in vivo laser hair reduction procedures in a tertiary referral laser dermatology unit

“…The air was sampled near the treatment region at approximately the operator's head height, without causing any interference with the procedure. An Optical Particle Sizer (OPS) (3330, TSI, USA), sample rate of 1 s at 1.0 L/min (±5%), was used and particulate mass concentration with aerodynamic diameter < 2.5 µm (PM 2.5 ) was calculated for analysis, following a previously established method 5 . Particulates are assumed to be spherical with an average density of 1.2 g/cm 3 6 .…”

“…Assessment of the suitability of recommended Personal Protective Equipment (PPE) for plume hazard should be conducted (HSG53) as increasing reliance on PPE is not practicable where engineering controls, e.g. integrated handpiece extraction, to remove the plume at source would be more appropriate 2,5 .…”