Spectroscopic investigation of volatile compounds produced during thermal and radiofrequency bipolar cautery on porcine liver

Abstract

The potential risks associated with the emission of by-products emitted by surgical cautery are of concern. Various investigations—mostly based on gas chromatography—have been performed to analyse the so-called surgical smoke but controversies remain in terms of composition and concentrations of compounds present in the smoke and hence the associated risk to human health. This quantitative model study uses for the first time CO2-laser-based photoacoustic spectroscopy and focuses on the analysis of volatile organic compounds produced during thermal- and radiofrequency bipolar cautery on porcine liver. The latter instrument is employed in actual human surgery. Concentrations in the ppm to sub-ppm range and molar fractions could be determined for carbon dioxide, water vapour, ammonia, ethanol and methanol. Distinct differences particularly in the methanol and ethanol contents were found between the two cautery devices employed.

Gas emission during laparoscopic colorectal surgery using a bipolar vessel sealing device: A pilot study on four patients

“…Further similar studies at this stage are in our opinion not only unnecessary but also unethical. Ongoing studies of our group are currently trying to answer the open questions with a modified experimental set-up based on the experience of this pilot study [ 11 ].…”

“…First, the smoke composition and quantity depends largely on the combusted tissue and the employed instrument [ 4 , 11 ]. Hensman et al produced surgical smoke in their in vitro study on porcine liver, while Hollmann et al sampled gas emission during open reduction mammoplasty, both using conventional electrocautery [ 5 , 6 ].…”

“…Furthermore, our gas samples were produced in a CO 2 atmosphere and are therefore very likely to be different to samples from other studies [ 4 - 6 ]. Several molecules were found by in vitro studies of our group under room air [ 11 ]. Due to relatively low concentrations in the samples of this study – reflecting however laparoscopic reality – sampling errors can not be excluded.…”

“…This method requires elaborate sample preparations delivering mainly qualitative results. We used therefore optical techniques that have the advantage of high sensitivity and specifity without need of sample preparation [ 5 , 11 ]. However, spectral range is limited and technical performance is highly dependent on appropriate laser and detection schemes.…”

Applications of Near Infrared Photoacoustic Spectroscopy for Analysis of Human Respiration: A Review

“…[181]. Ray et al reported a quantitative model study where they first used laser CO 2 LPAS and focused on analyzing VOCs produced thermal and radiofrequency bipolar cautery on porcine liver [184]. They detected carbon dioxide, water vapor, ammonia, ethanol and methanol in the ppm to sub-ppm range and molar fractions, and the concentrations of methanol and ethanol differed between the two cautery devices employed.…”