Peritonectomy with high voltage electrocautery generates higher levels of ultrafine smoke particles

Andréasson, Sara Näslund; Anundi, Helena; Sahlberg, Bo; Ericsson, Claes-Gunnar; Wålinder, Robert; Enlund, Gunnar; Påhlman, Lars; Mahteme, Haile

doi:10.1016/j.ejso.2008.09.002

Cited by 33 publications

(42 citation statements)

References 17 publications

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“…Surgeries that are now often performed laparoscopically are of concern because they allow smoke buildup inside a patients' abdominal cavity, resulting in a high exposure risk. Many previous studies have investigated particle characterization in surgical smoke and its infection risks (DesCoteaux et al, 1996;Kunachak et al, 1996;Capizzi et al, 1998;Hughes and Hughes, 1998;BruskeHohfeld et al, 2008;Andreasson et al, 2009;Mowbray et al, 2013). However, chemical pollutants such as VOCs in surgical smoke have been addressed by only a few studies (Al Sahaf et al, 2007;Weston et al, 2009;Hill et al, 2012;Mellor and Hutchinson, 2013;Choi et al, 2014) and their impact on the indoor air is rarely discussed.…”

Section: Surgical Smoke As Voc Sourcementioning

confidence: 99%

“…Many previous studies have focused on particle characterization in surgical smoke and its infection risks. Mowbray et al (2013) systematically reviewed 20 full-text articles addressing surgical smoke and found that common end points were particle size (DesCoteaux et al, 1996;Bruske-Hohfeld et al, 2008;Andreasson et al, 2009) and infection risk (Kunachak et al, 1996;Capizzi et al, 1998;Hughes and Hughes, 1998). It is in relatively recent years that the chemical composition in surgical smoke such as volatile organic compounds (VOCs) has been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Surgical Smoke on Indoor Air Quality in Hospital Operating Rooms

Choi

Kang

2017

Aerosol Air Qual. Res.

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The objective of this study is to analyze the volatile organic compounds (VOCs) in the surgical smoke generated during laparoscopic surgery, and determine their influence on the indoor air quality in hospital operating rooms (ORs). Field measurements were carried out during eight surgeries in conventional and robotic ORs in which an electrosurgery system was being used, thus continuously generating surgical smoke. The VOCs were measured at three different locations, in the patients' abdominal cavities, beside the surgical table, and at the exhaust vent. Other indoor pollutants including carbon monoxide (CO), carbon dioxide (CO 2 ), and total airborne bacteria (TAB) in the indoor air were measured at the exhaust to assess the general indoor air quality in the ORs. The results from the patients' abdominal cavities confirmed that the surgical smoke contained abundant VOCs, with the levels of benzene and toluene exceeding the health guidelines. Compared to the results obtained in the abdominal cavity, the measurements obtained at the surgical table and exhaust vent exhibited low levels of VOCs, indicating that the actual exposure to these compounds was minimized in a highlyventilated operating room. However, the benzene concentration in the operating room approached a level that threatens the health of the occupants. Therefore, the results of this study suggest that there is a potential health risk to the surgeon who is closest to the point of origin of the surgical gas, as well as a need for further attention to identify the local pollutant dispersion near the surgical table while the ventilation system is operating.

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Section: Surgical Smoke As Voc Sourcementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Surgical Smoke on Indoor Air Quality in Hospital Operating Rooms

Choi

Kang

2017

Aerosol Air Qual. Res.

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“…All of these compounds were cross referenced against the COSHH list of approved workplace exposure limits as defined by the HSE (2007) of which 9 were identified as being hazardous to health, four of which are carcinogens, none of the compounds found exceeded the PEL's outlined by the HSE (2007). Andreasson et al (2009) found that the size of particles found in diathermy smoke was small enough to reach alveoli in the lungs and move into the cardiovascular system, and can cause inflammatory changes in the respiratory tract, nausea, carcinoma, dermatitis and cardiovascular dysfunction. He also discovered that surgical facemasks do not adequately filter particles and as such are not a suitable barrier and advise the use of an extractor.…”

mentioning

confidence: 99%

Diathermy smoke: a risk to perioperative practitioners?

Dunn

Brown

2014

Journal of Operating Department Practitioners

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“…The mutagenic effect created by thermal destruction of 1 g of tissue is equivalent to that of three cigarettes. In their study Andréasson et al 9 evaluated the amount of particles generated during extensive surgery. The average Topgül et al Hyperthermic Intraperitoneal Chemotherapy-Personnel Safety surgical duration of peritonectomy group, which consisted of patients with a mean score of 14 PCI, was 9.1 hours.…”

mentioning

confidence: 99%

“…Doors of surgery theatre should be hermetic and kept closed during the operation. 9 Those are the standard procedures for safe surgery that should be applied in all hospitals. A high standard air conditioning equipped in an operating room is very important, and much beneficial to surgical environment independent from the operation.…”

mentioning

confidence: 99%

Safety of Health Workers During Hyperthermic Intraperitoneal Chemotherapy Procedure

Topgül¹,

Malazgirt²,

Bişgin³

2018

TJCD

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ÖZPeritoneal karsinomatoz (PK) genellikle hastalığın son evresi olarak kabul edilir. Sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK), PK'nin potansiyel tedavi yöntemi olarak ortaya çıkmıştır. Bu multimodal prosedür, karın içinde makroskopik rezidüel tümör hacmi olmaksızın tam sitoredüksiyon elde etmeyi amaçlayan agresif multivisseral rezeksiyonları ve peritonektomiyi içerir. SRC'den sonra, ısıtılmış kemoterapi peroperatif olarak tüm periton yüzeylerini kaplayacak şekilde karın içine verilir. Böylece, yeterli intraabdominal kemoterapik ilaç konsantrasyonuna, sistemik yan etkiler olmadan ulaşılır. Hipertermi, periton kan akışını artırarak, direkt sitotoksik etkiyle ve tümör mikroçevresini değiştirerek intraperitoneal kemoterapinin etkisini artırır. Bu prosedürün uygulanması esnasında sağlık çalışanı çeşitli aşamalarda (hava yoluyla, doğrudan temasla, perfüzatlara veya kemoterapi çözeltilerine temasla ve kemoterapötiklere maruz bırakılan nesnelerin/dokuların temasıyla gibi) sitotoksik ajanlara maruz kalma riski altındadır. Ayrıca SRC sırasında hem peritoneal yüzeylerin çıkarılması hem de tümör depozitlerinin yok edilmesi esnasında yüksek voltajlı elektokoter kullanımı, sağlık çalışanını uzun saatler boyunca yüksek miktarda cerrahi dumana maruz bırakır. Bu dumanın solunması sağlık çalışanı için bir risk teşkil edebilir. SRC ve HİPEK'in güvenli bir şekilde uygulanması için kılavuz ilkeler henüz oluşturulmamıştır. Bu çalışma, SRC ve HİPEK yönetiminin güvenlik hususlarına ilişkin mevcut kanıtları özetlemektedir. Anahtar Kelimeler: Hipertermik intraperitoneal kemoterapi, sitoredüktif cerrahi, personel güvenliği Peritoneal carcinomatosis (PC) is often considered an end-stage condition. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as the only potentially curative treatment for PC. This multimodal procedure involves aggressive multivisceral resections and peritonectomy aimed at achieving a complete cytoreduction, with no macroscopic residual tumor volume within the abdomen. After surgery, a heated chemotherapy perfusate is administered intraoperatively into the abdomen to cover all peritoneal surfaces. Thus, sufficient intraabdominal chemotherapeutic drug concentration can be achieved without systemic side effects. Hyperthermia enhances the effect of intraperitoneal chemotherapy by increasing peritoneal blood flow, by direct cytotoxic effect, and by altering the tumor microenvironment. During this procedure, the health worker is at risk of exposure to cytotoxic agents at various stages (such as through air contamination or direct contact during manipulation of perfusates or chemotherapy solutions and manipulation of objects/tissues exposed to chemotherapeutics). In addition, the use of high-voltage electrocautery during the removal of both peritoneal surfaces and tumor deposits during CRS exposes the health worker to large amounts of surgical smoke for extended periods of time. Inhalation of this smoke may pose a risk to the health-care...

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Peritonectomy with high voltage electrocautery generates higher levels of ultrafine smoke particles

Cited by 33 publications

References 17 publications

Influence of Surgical Smoke on Indoor Air Quality in Hospital Operating Rooms

Influence of Surgical Smoke on Indoor Air Quality in Hospital Operating Rooms

Diathermy smoke: a risk to perioperative practitioners?

Safety of Health Workers During Hyperthermic Intraperitoneal Chemotherapy Procedure

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