Prospective randomized study evaluating the usefulness of a surgical smoke evacuation system in operating rooms for breast surgery

Yutaka Tokuda,Miki Maruta,Takuho Okamura,Toshiyasu Suzuki,Miyuki Noguchi,Mutsuko Orita,Hideaki Matsuki

doi:10.1186/s12995-020-00259-y

Abstract

BackgroundNo prospective evaluation of surgical smoke evacuation systems has yet been conducted anywhere in the world. A prospective randomized study was conducted to clarify the usefulness of a surgical smoke evacuation system in terms of reducing the quantity of environmental pollutants found in operating room air and reducing the occupational exposure of doctors and nurses involved in surgical procedures to surgical smoke, volatile organic compounds, formaldehyde, etc.MethodsOperating room environment conditions with and without the use of a surgical smoke evacuation system were measured, and the personal exposure levels of doctors and nurses involved in surgical procedures were also surveyed. Use of the evacuation system was determined randomly, and the procedures involved were breast-conserving surgery and mastectomy, which were treated as stratification factors.ResultsThe average total volatile organic compound concentration in the operating room was significantly lower when the evacuation system was used compared with when it was not used. The findings were similar for formaldehyde concentration. Multiple regression analysis for healthcare professionals’ personal exposure levels showed that the evacuation system was a factor that significantly impacted their formaldehyde and acetaldehyde personal exposure levels, which were greatly reduced by the use of the system.ConclusionThis study’s findings demonstrate the effectiveness of the evacuation systems, which should increase awareness that their benefits take priority over the drawbacks.Trial registrationThe study was conducted after explaining to participants that it was a study of operating room environments in which their participation was voluntary and obtaining their consent. The study was also approved by the Tokai University Hospital clinical research review committee (no. 5R-022) and registered with the UMIN registry (UMIN000029092) on 13, September, 2017- retrospectively registered.

Highlights

The air environment in operating rooms contains many chemical substances, including anesthetic gas, volatile medical agents used for sterilization and other purposes, and surgical smoke
For this paper, a prospective randomized study was conducted to clarify the usefulness of a surgical smoke evacuation system in terms of reducing the quantity of environmental pollutants found in operating room air and reducing the occupational exposure of doctors and nurses involved in surgical procedures to surgical smoke, volatile organic compounds (VOC), formaldehyde, etc
Surgeries and operating rooms for which environment surveys were conducted Operating room environment surveys were conducted from June 30, 2015, until July 15, 2016, with environmental measurement and personal exposure level surveys conducted for 32 procedures where a surgical smoke evacuation system was used and 30 procedures where it was not used

Summary

Introduction

The air environment in operating rooms contains many chemical substances, including anesthetic gas, volatile medical agents used for sterilization and other purposes, and surgical smoke. In America, the National Institute for Occupational Safety and Health (NIOSH) [3] recommends the following as environmental exposure standards: 25 ppm or less for nitrous oxide (N2O) and 2 ppm or less for volatile anesthetic agent when used alone or 0.5 ppm or less if used in combination with N2O. It is mandatory for all anesthetic apparatus to be equipped with a waste anesthetic gas scavenging system. A prospective randomized study was conducted to clarify the usefulness of a surgical smoke evacuation system in terms of reducing the quantity of environmental pollutants found in operating room air and reducing the occupational exposure of doctors and nurses involved in surgical procedures to surgical smoke, volatile organic compounds, formaldehyde, etc

Methods

Results

Conclusion