Surgical smoke: a review of the literature

Abstract

Surgical smoke is omnipresent in the day-to-day life of the surgeon and other medical personnel who work in the operating room. In addition, patients are also exposed, especially and uniquely so in laparoscopic cases where smoke is created and trapped in a closed and absorptive space. Surgical smoke has typically been produced by electrocautery but is now ever more present in a new form with the burgeoning use of the laser and the harmonic scalpel. Several cases of transmission of human papillomavirus (HPV) from patient to treating professional via laser smoke have alerted us to the reality that surgical smoke in certain situations is far form benign. However, surgeons rarely take measures to protect themselves, their co-coworkers and patients from surgical smoke. Should we and, if so, how do we differentiate between different types of smoke and should we move toward increasing our efforts to protect ourselves, our co-workers, and patients from it? This article attempts to sort through the available data and draw some reasonable conclusions regarding surgical smoke. In general, surgical smoke is a biohazard and cannot be ignored. At a minimum, surgical smoke is a toxin similar to cigarette smoke. However, other dangers exist. This is especially true in specific circumstances such as when tissue infected with dangerous viruses is aerosolized by lasers. In addition, smoke generated by the harmonic scalpel, being a relatively cold vapor similar to laser smoke, should be further investigated for its potential ill effects and until then, looked upon with reasonable caution. Although not a high-priority in most surgical cases, surgeons should support efforts to minimize OR personnel, patients, and their own exposure to surgical smoke.

Safety considerations for Health care Workers involved in Cytoreductive Surgery and Perioperative chemotherapy

“…However, there is a risk and hence measures should be taken to minimize the exposure as much as is possible [37][38][39].…”

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

“…The generation of a surgical plume is harmful when it persists as it decreases visualization, often requiring the surgeon to remove the scope from the surgical field and remove the obstructing aerosol particles. Compromised visualization in endoscopic surgery could be dangerous and fatal [9,10]. There are a lot of studies on the effects on the composition of surgical smoke and its effects on the operating theater personnel [10].…”

“…Plume aerosol generated by ultrasonic dissectors can be identified up to 40 cm from the point of production and usually is composed of tissue, blood, and blood products. The surgical plume production from an ultrasonic scalpel was compared with that from electrocautery by Ott et al [13], which described large quantities of cellular debris ([1 9 107 particles/mL) in the plume generated by the ultrasonic scalpel but had approximately one-fourth the amount of particle concentration which was further substantiated in the review exclusively on surgical smoke wherein the instrument and its effect on different types of tissue was also described [9,13]. Fatty tissue was found to generate 17-23 times more particles than lean tissue did [13].…”

“…This minimizes tissue charring, desiccation, and the zone of thermal injury [1,4,6,8]. Disadvantages of this technology are the formation of aerosolized fatty droplets from the tissue being treated, which can significantly interfere with visualization through a laparoscope [9,16,20].…”

Is It Time for a More Systematic Approach to the Hazards of Surgical Smoke?: Reconsidering the Evidence

“…Furthermore, research has also demonstrated that the temperatures produced by electrosurgical techniques can also create various end products. For example, higher cautery temperatures produce greater amounts of hazardous chemical components in the smoke; lower temperatures produce more cell particles (Barrett & Garber, 2003). Research has also revealed that different electrosurgical techniques produce different amounts of surgical smoke.…”