Abstract
The hazard of surgical smoke is often overlooked when considering the safety of medical laser procedures but can present a high level of occupational risk. Administrative procedures for operating external extraction devices and the reliance on personal protective equipment are not sufficient for reducing the risk. This paper aims to quantify the hazard of laser-generated surgical smoke and demonstrate how effective engineering control solutions can reduce the risk. A new design solution is presented with engineering controls for surgical smoke extraction and optical radiation integrated into the laser handpiece. A fiber delivered diode laser is used to simulate laser vaporization procedures on porcine skin tissue. Conventional external extraction conditions are compared to the new design solution. Fine particulate mass concentrations (PM2.5) from the simulated procedures, under different extraction conditions, are measured using optical particle size measurements. Peak concentrations of 55.86 ± 2.79 μg/m3 were measured without extraction; showing that the hazard of laser-generated surgical smoke is five times greater than the World Health Organization guideline of 10 μg/m3. A typical medical extraction setup only achieved a 16% reduction in peak concentration values, 47.07 ± 2.35 μg/m3; demonstrating that conventional, external, methods of extraction are ineffective. The new solution was able to capture all particulate materials, reducing particulate concentrations to background levels, 2.19 ± 0.68 μg/m3, safely below the current recommended guidelines. The design and results present evidence that it is not only more effective to use engineering control methods but that it is practicable to do so.
Highlights
Laser-material interactions in surgical, medical and cosmetic procedures generate unique hazards through surgical smoke, and these risks are not adequately understood or controlled [1]–[3]
Based on the assumption that there is a potential risk from laser-generated surgical smoke, and that exposure should be reduced, this paper aims to quantify the hazard of laser-generated surgical smoke and demonstrate how effective engineering control solutions can reduce these risks
Hazards of Surgical Smoke The key finding of the results has shown that an Integrated Handpiece Extraction is significantly more effective at surgical smoke extraction than the use of external extraction methods
Summary
Laser-material interactions in surgical, medical and cosmetic procedures generate unique hazards through surgical smoke (laser-generated plume), and these risks are not adequately understood or controlled [1]–[3]. The acute and long-term risk to staff of surgical smoke is still unproven [3], but should be treated with caution It has, been observed that infectious materials can be present in laser plumes [13], and pathologic longterm effects have been demonstrated in rats [14]. Due to the identified uncertainty in particulate density, the paper recommends that future work on surgical smoke characterisation be conducted into a more accurate density measurement of different tissues from the 0.1 to 10 μm particle diameter range. This would provide more useful data to the field of environmental pollution and increase understanding of the respirable hazard of these materials. The online version of record will be different from this version once it has been copyedited and typeset.
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