Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization

Tomita, Yoshifumi; Mihashi, Shigenobu; Nagata, Kazuto; Setsuo, Ueda; Masakazu, Fujiki; Hirano, Minoru; Hirohata, Tomio

doi:10.1016/0165-1218(81)90120-8

Cited by 141 publications

(31 citation statements)

References 6 publications

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“…The risk of plume exposure generated by electrosurgical devices has been investigated since the 1980s [24]. It has been shown that as particle size increases, so does the risk for pathogen transmission.…”

Section: Discussionmentioning

confidence: 99%

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID‐19 Pandemic

et al. 2020

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Introduction The COVID‐19 pandemic requires us all to re‐evaluate aesthetic practices to ensure optimal patient safety during elective procedures. Specifically, energy‐based devices and lasers require special consideration, as they may emit plume which has been shown to contain tissue debris and aerosolized biological materials. Prior studies have shown transmission of viruses and bacteria via plume (i.e., HIV and papillomavirus). The purpose of this study was to evaluate plume characteristics of the Er:YAG resurfacing laser (Sciton; Palo Alto, CA) and compare it to the Morpheus8 fractional radiofrequency device (InMode; Lake Forest, CA). Methods Five patients who underwent aesthetic resurfacing and/or skin tightening of the face and neck were treated with the Er:YAG (Sciton Joule, Palo Alto, CA) and/or fractional radiofrequency (Morpheus8, Lake Forest, CA) between April 1 and May 11, 2020. Data collected included patient demographics, past medical history, treatment parameters, adverse events, particle counter data, as well as high magnification video equiptment. Patients were evaluated during treatment with a calibrated particle meter (PCE; Jupiter, FL). The particle meter was used at a consistent focal distance (612 inches) to sample the surrounding environment during treatment at 2.83 L/min to a counting efficiency of 50% at 0.3 µm and 100% at >0.45 µm. Recordings were obtained with and without a smoke evacuator. Results Of our cohort (n = 5), average age was 58 years old (STD ±7.2). Average Fitzpatrick type was between 2 and 3. Two patients received Er:YAG fractional resurfacing in addition to fractional radiofrequency during the same treatment session. Two patients had fractional radiofrequency only, and one patient had laser treatment with the Er:YAG only. There were no adverse events recorded. The particle counter demonstrated ambient baseline particles/second (pps) at 8 (STD ±6). During fractional radiofrequency treatment at 1‐mm depth, the mean recording was 8 pps (STD ±8). At the more superficial depth of 0.5 mm, recordings showed 10 pps (STD ±6). The Er:YAG laser resurfacing laser had mean readings of 44 pps (STD ±11). When the particle sizes were broken down by size, the fractional radiofrequency device had overall smaller particle sizes with a count of 251 for 0.3 µm (STD ±147) compared with Er:YAG laser with a count of 112 for 0.3 µm (STD ±84). The fractional radiofrequency did not appear to emit particles >5 µm throughout the treatment, however, the Er:YAG laser consistently recorded majority of particles in the range of 510 µm. The addition of the smoke evacuator demonstrated a 50% reduction in both particles per second recorded as well as all particle sizes. Conclusion Re‐evaluation of the plume effect from aesthetic devices has become important during the COVID‐19 pandemic. Further studies are required to characterize viability of COVID‐19 viability and transmissibility in plume specimens. Based on this pilot study, we recommend that devices that generate little to no plume such as fractional...

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Section: Discussionmentioning

confidence: 99%

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID‐19 Pandemic

et al. 2020

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“…Smelling the distinctive odor of surgical smoke indicates exposure to toxins and particulate matter that can cause respiratory problems and potentially clog suction lines. Inhaling the smoke produced by a gram of tissue that has been electrosurgically vaporized, which has particles as small as 0.07 μm, is equivalent to smoking six unfiltered cigarettes in 15 min . Inhaled particles of this size can easily be deposited in the alveoli, which can lead to respiratory problems.…”

Section: Smoke Evacuationmentioning

confidence: 99%

Advancement and benefit of energy sealing in minimally invasive surgery

Shabbir

Dargan

2014

Asian J Endoscop Surgery

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Energy sealing has advanced rapidly in the last decade with many new devices becoming available. The rate and variety of advances in technology facilitate new and existing techniques, with ultrasonic shears and electrothermal bipolar graspers forming a vital but changing part of the modern surgeon's armamentarium. Advances including the combination of ultrasonic and bipolar systems, the addition of cutting blades, tissue impedance sensors, and electrode configurations with reduced lateral thermal spread have heralded new opportunities in laparoscopic and minimally invasive surgery. Reduced operating times, lower postoperative pain scores, and shorter length of stay are offset by the additional cost of such instruments. Reduced instrument exchange, improved smoke evacuation, and shorter surgeries by trainees with some devices are benefits that set the scene for further innovation in this vibrant sector.

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“…It has, however, been observed that infectious materials can be present in laser plumes [13], and pathologic longterm effects have been demonstrated in rats [14]. One gram of laser-generated surgical smoke contains 40 mg of smoke condensates, with an equivalent mutagenic potential of 3 cigarettes [15].…”

Section: Introductionmentioning

confidence: 99%

Engineering controls for surgical smoke in laser medical handpieces

Jones

Parry

Britton

et al. 2021

Journal of Laser Applications

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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.

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Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization

Cited by 141 publications

References 6 publications

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID‐19 Pandemic

Plume Effect of Fractional Radiofrequency Verus Laser Resurfacing: Considerations in the COVID‐19 Pandemic

Advancement and benefit of energy sealing in minimally invasive surgery

Engineering controls for surgical smoke in laser medical handpieces

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