Smoke analysis of a new surgical system that applies low-temperature plasma

Abstract

Background: The high-frequency electrotome (ES), which is widely used in surgical procedures, generates surgical smoke that is potentially hazardous to operating personnel. Previous research shows that the PlasmaBlade (PB) may be able to overcome this problem. The present study set out to analyze potentially hazardous surgical smoke generated during electrosurgery by the ES, the PB, and. a new surgical system that applies low-temperature plasma, the NTS-100.Methods: In vitro and in vivo healthy porcine models were used to compare volatile organic compounds (VOCs) and particulate matter (PM) in smoke generated by the NTS-100, the PB, and the conventional ES when cutting liver, muscle, and skin and subcutaneous tissues. The detected indexes included the VOCs in surgical smoke, the concentration and percentage of each part, the PM2.5 concentration, the mass of particles, and the diameter distribution of particles. Results:The smoke generated by the NTS-100 contained fewer hazardous components than that generated by the ES (P<0.05) and a comparable amount to that generated by the PB (P>0.05). The PM2.5 concentration and mass of particles in the smoke generated by the NTS-100 were lower than those with the ES (P<0.05 and P<0.01, respectively) and similar to those with the PB (P>0.05). The NTS-100 generated larger particles than did the ES and the PB (P<0.05).Conclusions: Surgical smoke contains harmful VOCs and PM, but the NTS-100 generated less hazardous surgical smoke than did the conventional ES and performed comparably to the PB. Therefore, using the NTS-100 may reduce the potential hazard of surgical smoke to operating room personnel.

Surgical smoke and occupational health

“…In Taiwan, for example, more than 10,000 nurses are exposed to these hazards each year ( 3 ). Also, if a large amount of surgical smoke is present in the environment, it can obstruct the surgeon’s view and make surgery last longer ( 4 , 5 ). Since the 1960s, the dangers of exposure to surgical smoke constituents and their presence of bioaerosols have been investigated ( 4 ).…”

“…During the coronavirus disease 2019 (COVID-19) pandemic, perioperative teams and nurse leaders were faced with a new and unknown issue: the possible dangers found in surgical smoke when electrosurgery and laparoscopic devices were used in surgical procedures on COVID-19 patients in the operating room ( 4 ).…”

“…The PlasmaBlade (PB), for example, was developed for this purpose. This device is known for working by delivering brief (40-µs range), high-frequency pulses of radiofrequency energy along the edge of a 12.5-µm-thin insulated electrode, using fewer energy to obtain a lower temperature while reducing the concentration of surgical smoke in the operating room ( 4 , 16 ).…”

“…In this context, a new surgical system named NTS-100, which applies low-temperature plasma, has been developed and a study by Zhang et al aimed to analyze and compare the surgical smoke produced by the conventional high-frequency electrotome (ES), the PB, and the NTS-100 when electrosurgery were used. The models used were in vitro and in vivo porcine tissues (liver, muscle, skin, and subcutaneous tissues), because pig’s genetic sequence simulate humans’ ( 4 ).…”

“…In this study they could analyze and detect the volatile organic compounds (VOCs), which includes benzene, methane, and many others, and also estimate the accumulation and percentage of each part of those, the PM2.5 concentration (particulate matter), the mass of particles and the diameter distribution of these particles. These analyses are important as these compounds are known as carcinogens present in surgical smoke ( 4 ).…”