Commentary On: "Surgical Smoke - A Health Hazard in the Operating Theatre: A Study to Quantify Exposure and a Survey of the Use of Smoke Extractor Systems in UK Plastic Surgery Units".

Abstract

In this study, Hill et al. attempt to answer these questions through an intriguing preclinical study. 10 The investigators quantified the mass of tissue converted into a smoke plume over a period of 2 months by determining the duration of diathermy use and additionally attempted to determine the prevalence of surgical smoke evacuators in plastic surgery units in the United Kingdom. They utilised a novel method of determining the number of device activations and the total duration of activation of devices. This was achieved by accessing built-in service functions of the device. It gave very precise measurements of cutting and coagulation. However, it should be noted that the investigators did not evaluate desiccation and fulguration functions. Also, many plastic surgeons use bipolar electrocautery, which has not been evaluated in this paper. Regarding results, the authors used this experimental data along with the number and duration of activation to estimate the mass of tissue destroyed during the 44 operating days, and extrapolated that to provide descriptive analysis of the amount of tissue destroyed per day. If we extrapolate these findings, taking into consideration that 1 g of tissue creates a surgical smoke plume with the mutagenic effect of smoking 6 unfiltered cigarettes, 8,9 a total of approximately 27–30 unfiltered cigarettes would need to be smoked in the operating room per day to produce equivalent mutagenicity. This finding emphasises the importance of evacuation of smoke plumes. However, it should be noted that this finding is based on mea