The case for compulsory surgical smoke evacuation systems in the operating theatre

Abstract

Perioperative staff are frequently exposed to surgical smoke or plume created by using heat-generating devices like diathermy and lasers. This is a concern due to mounting evidence that this exposure can be harmful with no safe level of exposure yet identified. First, I briefly summarise the problem posed by surgical smoke exposure and highlight that many healthcare organisations are not sufficiently satisfying their legal and ethical responsibilities to protect their staff from potential harm. Second, I explore the ethical case for compulsory smoke evacuation systems using the principlist framework and its four ethical principles – autonomy, beneficence, nonmaleficence, and justice. I then consider some objections and argue that surgical smoke evacuation systems – when indicated – should be made compulsory.

Comparison of the Effects of Surgical Smoke on the Air Quality and on the Physical Symptoms of Operating Room Staff

“…Many previous studies have reported that surgical smoke affects employees adversely and causes them to have some physical complaints. (Aktas & Aksu, 2019; Ilce et al, 2017; King, 2018; Rodger, 2022). In this study, approximately 3/4 of the surgical team consisting of surgeons, assistants, anesthetists, nurses, and the auxiliary staff stated feeling uncomfortable with surgical smoke and reported similar physical complaints.…”

Promoting surgical smoke management in a pediatric operating room: a best practice implementation project

“…13 Denmark is one of the first countries in the world to implement surgical smoke management legislation and remains one of the few to have done so. 14 The European Union's directives on the protection of workers from risks related to exposure to biological agents, carcinogens, or mutagens at work establish minimum requirements for member nations to adopt; however, the directives stop short of mandating surgical smoke evacuation. 6 The translation of evidence into clinical practice in perioperative settings presents significant challenges across multiple disciplines.…”

“…The International Federation of Perioperative Nurses, which is composed of member associations representing 40 countries and regions from around the globe, acknowledges the significant risks of surgical smoke in the perioperative setting and recommends standardized smoke evacuation and filtration processes; however, it is unclear if or how these recommendations have been implemented in the international community 13 . Denmark is one of the first countries in the world to implement surgical smoke management legislation and remains one of the few to have done so 14 . The European Union's directives on the protection of workers from risks related to exposure to biological agents, carcinogens, or mutagens at work establish minimum requirements for member nations to adopt; however, the directives stop short of mandating surgical smoke evacuation 6…”