Smoke Evacuation Research Articles

Aerosol mitigation in upper airway surgery

BackgroundAerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room. MethodsUtilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5–10 μm in diameter were measured. Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations. ResultsSES was effective compared to controls, but inferior to intraoral mitigation strategies (p < 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p < 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles. ConclusionsIntraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.

Ten questions concerning particle exposure in open electrosurgery and its control strategies

The increasing use of high-frequency electrosurgical pencils in open surgeries has heightened concerns about the adverse implications of electrosurgical smoke (ES) on perioperative personnel. Since 2015, there has been an increasing amount of research on electrosurgical smoke particles annually. Despite data discrepancies, nanoparticles (core particle size <200 nm) generally dominate in number distributions. Particulate matter (PM) concentration is closely related to the type of target tissue. Most studies show that ultrafine particle (UFP) concentrations near the main surgeon’s breathing zone inversely correlate with operating room air changes and positively correlate with the power of the electrosurgical pencil. Local smoke evacuation devices with negative ions, specialized filters and N95 respirators are more effective in protecting perioperative staff health, particularly against UFPs. The objective is to summarize particle exposure knowledge in open electrosurgery and establish a research agenda to protect medical personnel from ES exposure.

Smoke control and temperature distribution of tunnel fires under longitudinal ventilation combined with shaft exhaust

Longitudinal segmental smoke exhaust is often used for fire tunnels longer than 5 km. With the combined effect of longitudinal ventilation in the main tunnel and fan suction in the exhaust shaft, the smoke exhaust path is different from that of a traditional single-tube tunnel. Findings reported in the literature is insufficient to support the rapid development of extra-long road tunnels. In this paper, a numerical model was established by FDS (Fire Dynamics Simulator), and a 1:15 model test platform was built for verification. The effects of different longitudinal velocities, exhaust velocities, bifurcation angles, and exhaust shaft slopes on tunnel fires were analyzed for the longitudinal ventilation combined with shaft exhaust smoke evacuation mode (LVSE). The results show that when the exhaust velocity is greater than 4.5m/s, increasing the exhaust velocity has a limited effect on reducing the smoke length downstream of the exhaust shaft. The bifurcation angle has a significant effect on the velocity distribution in the ventilation shaft and the main tunnel. When the bifurcation angle is less than 45°, the airflow in the main tunnel is more likely to enter the exhaust shaft, and the velocity in the exhaust shaft is more than 5m/s. It is more favorable to reduce the smoke length when the slope of the exhaust shaft is not less than 7%. The high-temperature flue gas collects and forms a vortex near the vent under the LVSE mode, which makes the temperature decay rate slower than that when only longitudinal ventilation is used. The temperature decay model for the LVSE mode is obtained. This study is intended to provide a reference basis for the fire safety design of extra-long road tunnels under the LVSE mode.

A surgeon-modified device for the evacuation of diathermy smoke.

A surgeon-modified device for the evacuation of diathermy smoke.

Enhancing smoke management in underground parking areas using jet fan systems with a focus on dead-end areas

This study delves into the utilization of jet fans in underground parking structures for smoke management during fires, with a specific focus on enhancing smoke control near critical areas adjacent to dead-end sections through innovative jet fan designs. Through the analysis of airflow patterns and computational fluid dynamic simulations, the research aims to effectively contain smoke and prevent its dispersion to unaffected zones. Findings underscore the significance of parking layout designs in ventilation strategies and soot dispersion rates. Altering the downward orientation of the jet fan outlet results in a notable portion of smoke being confined within the parking facility. Additionally, widening the jet fan outlet, as proposed in the design, can enhance smoke evacuation in all directions. Two hazard detection scenarios were executed within the parking structure following the British standard (BS), with one scenario simulated as a fire ignition source. The chosen scenario considers all escape routes and evacuation procedures within the underground parking area based on architectural specifications. By employing OpenFOAM software with the buoyantBoussinesqPimpleFOAM solver, the study assesses the efficacy of this approach, achieving a reduction in airflow irregularities of over 30%. It also provides valuable insights for designers to refine their comprehension of jet fan design, recommending tailored designs for specific zones. This research offers practical guidance for designers to optimize jet fan configurations for effective smoke control in underground parking facilities.

Surgical smoke knowledge and practices before and after onset of COVID-19: A national survey of OR personnel

BackgroundAt the start of the COVID-19 pandemic, new recommendations to evacuate surgical smoke were made due to unknown viral hazards. We evaluated perioperative registered nurses’ and surgical technicians/technologists’ knowledge of surgical smoke and determined smoke evacuation practices before and after the onset of COVID. MethodsAn electronic survey was developed, validated, and distributed nationally. Means and percentages were used for analysis of descriptive data. For comparison analyses, repeated measures were conducted on continuous variables with paired t-tests and mixed factor ANOVAs. ResultsWe found gaps in knowledge regarding surgical smoke hazards, low evacuation device usage, lack of smoke evacuation policies, and little to no air quality or exposure monitoring in ORs. Smoke evacuation practices did not change significantly following the onset of COVID-19. ConclusionsImplications for leadership, education, and research may provide perioperative personnel with improved work environments without surgical smoke hazards.

Do Surgical Smoke Evacuators Increase the Risk of Hearing Loss for Operative Personnel During Routine Adenotonsillectomy Surgery?

Aerosol mitigation equipment implemented due to COVID-19has increased noise levels in the operating room (OR) during otolaryngological procedures. Intraoperative sound levels may potentially place personnel at risk for occupational hearing loss. This study hypothesized that cumulative intraoperative noise exposures with aerosol mitigation equipment exceed recommended occupational noise exposure levels. Sound levels generated by the surgical smoke evacuator (SSE) during adenotonsillectomy were measured using a sound level meter and compared to surgery without SSE. Thirteen adenotonsillectomy surgeries were recorded. Mean sound levels with the SSE were greater than the control (72 ± 3 A-weighted decibels (dBA) vs. 68 ± 2 dBA; p=0.015). Maximum noise levels during surgery with SSE reached 82 ± 3 dBA. Surgeons performing adenotonsillectomy with aerosol mitigation equipment are exposed to significant noise levels. Intraoperative sound levels exceeded international standards for work requiring concentration. Innovation is needed to reduce cumulative OR noise exposures.

The Impact of Electrocautery Smoke on Surgical Staff and the Efficacy of Normal Surgical Masks Versus N95 Masks.

Electrocautery is a commonly used technique in surgical procedures, generating smoke that poses health risks to surgical staff. This study investigates the comparative efficacy of normal surgical masks versus N95 masks in mitigating the harmful effects of electrocautery smoke. Through a systematic review of literature spanning two decades, we explore the causes and effects of electrocautery smoke exposure, including potential long-term inhalation effects. Our findings highlight significant disparities in the protection offered by different masks and underscore the importance of adequate respiratory protection in surgical settings. In addition, we examine the factors influencing the generation and composition of electrocautery smoke, such as the power settings used, the type of tissue being cauterized, and the duration of the procedure. Furthermore, we discuss the potential health risks associated with long-term exposure to electrocautery smoke, including the possibility of respiratory conditions, cardiovascular effects, and carcinogenicity. Our analysis also addresses the importance of implementing appropriate smoke evacuation systems and optimizing operating room ventilation to minimize the concentration of smoke particles in the surgical environment. Overall, this comprehensive analysis provides valuable insights into the impact of electrocautery smoke in surgical settings and the varying levels of protection offered by different masks.

Use of current automatic smoke evacuation system in flexible gastrointestinal endoscopy: Its feasibility and potential usefulness.

Flexible endoscopy does not have a system that can automatically evacuate surgical smoke generated in the gastrointestinal lumen. We aimed to investigate the feasibility and potential usefulness of automatic smoke evacuation systems in flexible endoscopy. [Bench] After surgical smoke generated in the stomach was evacuated by the evacuator, the degree of residual smoke and gastric luminal collapse were evaluated to optimize the evacuator settings. [Animal] Insufflation, suction, and total operation time to complete the protocol of 10 cauterizations of the gastric mucosa were measured in three groups: "manual suction only," "manual suction with automatic evacuation (50% force)," and "manual suction with automatic evacuation (70% force)." The stability of endoscopic visualization and operability was evaluated by 10 endoscopists blinded to those suction settings, and the number of manual suctions, insufflations, and total operation time were measured. [Bench] The degree of residual smoke and gastric luminal collapse were inversely correlated. [Animal] When the automatic evacuator was partially used, there was no difference in the insufflation time, but the suction time (vs 50%; p = 0.011, vs. 70%; p = 0.011) and total operation time (vs. 50%; p = 0.012, vs. 70%; p = 0.036) were significantly reduced compared to manual operation only. Furthermore, manual suction with automatic evacuation (50% force) significantly improved the stability of endoscopic visualization and operability compared to manual operation only (p = 0.041, p = 0.0085). The automatic smoke evacuation in flexible gastrointestinal endoscopy was potentially feasible and useful by improving the device setting.

Air Pollution in the Operating Room - A Call to Embrace Smoke Evacuators.

Air Pollution in the Operating Room - A Call to Embrace Smoke Evacuators.

Clinical Issues - March 2024.

Exoskeleton use in the OR Key words: exoskeleton, exosuit, ergonomics, musculoskeletal injury, fatigue and pain. The Revised National Institute for Occupational Safety and Health Lifting Equation Key words: ergonomic risk, Revised NIOSH Lifting Equation (RNLE), lifting index (LI), load, lifting task. Surgical smoke safety during transurethral resection of the prostate procedures Key words: surgical smoke, smoke evacuation, transurethral resection of the prostate (TURP), vaporization, resectoscope. Preventing accidental dislodgement of tubes, drains, and catheters Key words: patient transfer, dislodgement, catheters, tubes, drains.

Examining Wind Flow's Impact on Multi-Storey Buildings: A Quest for Quality Improvement

Abstract This scientific article delves into the intricacies of wind flow's impact on multi-storey buildings, presenting results from a series of experimental investigations. The research encompasses an examination of wind interactions with buildings of varying heights and geometric profiles. Furthermore, it unveils the effects of tall structures on the natural ventilation and smoke evacuation systems of shorter edifices, considering different wind flow directions. The study leverages specialized wind tunnel and measurement techniques for a comprehensive analysis of wind-induced loads on buildings. The acquired insights furnish crucial input for the design of single-story temporary modular constructions within densely populated urban areas, subject to wind-induced stresses. Additionally, they hold potential applicability in the advancement of energy-efficient technologies and strategies within the realm of construction. The acquired dataset underscores the criticality of scrutinizing wind flow's impact on structures of varied typologies and dimensions and will allow to significantly improve the quality and efficiency of modern buildings in the future.

Prone Jack-Knife Transanal Minimally Invasive Surgery: A Safe and Effective Approach for Anterior Low Rectal GI Stromal Tumors.

Subepithelial rectal lesions, including gastrointestinal stromal tumours (GIST), leiomyomas, neuroendocrine tumours, lipomas, and schwannomas, are rare surgical conditions. 1 Surgical management in this region often entails radical surgical excisions with stoma creation. Radical surgical excisions with stoma creation are often required for surgical management in this region. In this video, we demonstrate a transanal minimally invasive surgery (TAMIS) approach to anterior low rectal GIST. Patient underwent neoadjuvant Imatinib Mesylate after multidisciplinary team discussion, and were evaluated preoperatively with colonoscopy, pelvis MRI, and endoscopic ultrasound-guided tissue biopsy. 2,3 The procedure was performed with the patient in the prone jack-knife position and using the GelPOINT® Path transanal access, providing an excellent surgical platform. 4 The access channel was chosen based on the lesion's location from the anal verge, and ports were placed in a triangular fashion onto the GelSeal Cap, including an apex 10 mm sleeve for the telescope connected to the insufflation stabilization bag, two lower 10 mm working ports, and an additional port if traction was necessary. The RapidVac TM smoke evacuator was used for smooth surgery without fluctuating the surgical field and to achieve optimal vision. Dissection was initiated over the lower margin of the mass into the subepithelial plane and then performed along and around the mass in the desired plane. This approach and positioning in prone jack-knife, allowed dissection under direct vision with excellent surgical ergonomics and avoided radical resection. Our video demonstrates the feasibility and safety of TAMIS for the management of anterior low rectal subepithelial lesion, providing an alternative to more radical surgical approaches. See Video Vignette.

Automatic Smoke Analysis in Minimally Invasive Surgery by Image-Based Machine Learning

IntroductionMinimally Invasive Surgery uses electrosurgical tools that generate smoke. This smoke reduces the visibility of the surgical site and spreads harmful substances with potential hazards for the surgical staff. Automatic image analysis may provide assistance. However, the existing studies are restricted to simple clear versus smoky image classification. Materials and methodsWe propose a novel approach using surgical image analysis with machine learning, including deep neural networks. We address three tasks: 1) smoke quantification, which estimates the visual level of smoke, 2) smoke evacuation confidence, which estimates the level of confidence to evacuate smoke, and 3) smoke evacuation recommendation, which estimates the evacuation decision. We collected three datasets with expert annotations. We trained end-to-end neural networks for the three tasks. We also created indirect predictors using task 1 followed by linear regression to solve task 2 and using task 2 followed by binary classification to solve task 3. ResultsWe observe a reasonable inter-expert variability for tasks 1 and a large one for tasks 2 and 3. For task 1, the expert error is 17.61 percentage points (pp) and the neural network error is 18.45 pp. For tasks 2, the best results are obtained from the indirect predictor based on task 1. For this task, the expert error is 27.35 pp and the predictor error is 23.60 pp. For task 3, the expert accuracy is 76.78% and the predictor accuracy is 81.30%. ConclusionsSmoke quantification, evacuation confidence, and evaluation recommendation can be achieved by automatic surgical image analysis with similar or better accuracy as the experts.

Surgical smoke: a matter of hygiene, toxicology, and occupational health.

The use of devices for tissue dissection and hemostasis during surgery is almost unavoidable. Electrically powered devices such as electrocautery, ultrasonic and laser units produce surgical smoke containing more than a thousand different products of combustion. These include large amounts of carcinogenic, mutagenic and potentially teratogenic noxae. The smoke contains particles that range widely in size, even as small as 0.007 µm. Most of the particles (90%) in electrocautery smoke are ≤6.27 µm in size, but surgical masks cannot filter particles smaller than 5 µm. In this situation, 95% of the smoke particles which pass through the mask reach deep into the respiratory tract and frequently cause various symptoms, such as headache, dizziness, nausea, eye and respiratory tract irritation, weakness, and abdominal pain in the acute period. The smoke can transport bacteria and viruses that are mostly between 0.02 µm and 3 µm in size and there is a risk of contamination. Among these viruses, SARS-CoV-2, influenza virus, HIV, HPV, HBV must be considered. The smoke may also carry malignant cells. The long-term effects of the surgical smoke are always ignored, because causality can hardly be clarified in individual cases. The quantity of the smoke changes with the technique of the surgeon, the room ventilation system, the characteristics of the power device used, the energy level at which it is set, and the characteristics of the tissue processed. The surgical team is highly exposed to the smoke, with the surgeon experiencing the highest exposure. However, the severity of exposure differs according to certain factors, e.g., ventilation by laminar or turbulent mixed airflow or smoke evacuation system. In any case, the surgical smoke must be removed from the operation area. The most effective method is to collect the smoke from the source through an aspiration system and to evacuate it outside. Awareness and legal regulations in terms of hygiene, toxicology, as well as occupational health and safety should increase.

Nanoparticle Concentration in Surgical Plume During Tonsillectomy: A Comparison of Four Techniques.

Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures. This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups. The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels. Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel. 3 Laryngoscope, 134:2444-2448, 2024.

A CROSS-SECTIONAL STUDY OF SURGICAL SMOKE INHALATION, ITS HAZARDS AND PREVENTION AMONG PAEDIATRIC SURGICAL RESIDENTS IN PAKISTAN

Background: For thousands of years human beings have been using heat as a source of ligature and to treat the wound either it’s from the trauma or fought in the wars. In 1854 an imminent surgeon Albrecht Theodor Middendorf published a paper on the application of electrocautery in surgical operations. The objective of the study was to analyze the hazards of surgical smoke inhalation in Paediatric Surgery residents and to create awareness of its signs and symptoms, risk factors and utilizing preventive measures. Methods: A Cross-sectional study was conducted involving all the Paediatric Surgery residents enrolled on a supervised training program in Pakistan between 1st July 2022 to 30th June 2023 at all the tertiary care hospitals in Pakistan. Their socio-demographic, academic data, signs and symptoms and risk factors were calculated. Data was analyzed with descriptive and comparative analysis using SPSS. A Pearson contingency coefficient is used to determine the association between categorical variables. Results: Our study included all the Paediatric Surgery residents in Pakistan n=155 over a span of one year starting from July 1st 2022 to June 30th 2023. N=75 (48.4%) were males and n=80 (52.6%) were female residents. Their mean age was 29.5 years±4 (SD). 41% of the residents were from Khyber Teaching Hospital, 32% from Children’s Hospital, 14% from National Institute of Child Health Karachi, 9.8% from Children’s Hospital Islamabad (PIMS) and 5.2% from Lady Reading Hospital Peshawar. N=135 (87.1%) of the residents used electrocautery while performing the surgery (p=0.006). N=121 (78.1%) were aware of its hazards (p=0.341). 90% think they are at an increased risk (p=0.032). Most of them (84.6%) wear a surgical mask while only (64%) wear protective equipment (p=0.321). Think they are at an increased risk of cancers (83.9%) (p=0.002) and should be screened (93.7%) (p=0.343). Conclusion: Paediatric surgery residents are at an increased risk of surgical smoke inhalation, pointing to the emerging need to adopt protective measures by creating awareness, and utilizing health safety checklists and smoke evacuation mechanisms in operation rooms. All residents should seek knowledge on the subject and use personal protective equipment for less harmful effects on their health.

Estimating Air Pollution in Operation Rooms Generated from Cautery, Drills, and Other Equipment, Utilizing a Particulate Counter and Gas Analyzer.

Air pollution, especially indoor air pollution, is increasingly recognized as a worldwide hazard that reduces life expectancy. Pollution caused by equipment such as surgical cautery is not just a nuisance but a workplace hazard that exposes the staff to respirable particulate matter and toxic chemical agents. It has not yet received much recognition in India, nor have mitigating measures like smoke evacuators and dedicated scavenging systems become prevalent. We aimed to do a prospective observational study of the extent of this hazard in the operation rooms in our tertiary care, Government-run hospital using a consumer-grade pollution measuring equipment (CAIR +™, Prana Air, New Delhi). We measured and compared the particulate pollutant matter (PM) levels, Total Volatile Organic Compounds (TVOC), formaldehyde, and carbon dioxide at multiple areas of interest at different time points. The particulate pollution level in PM 1.0, PM 2.5, and PM 10 and TVOCs rose many times the baseline near the surgical team during cautery use. It remained high near the anesthesia workstation. The median PM 2.5 level in µg/m3(micrograms/cubic meter) was 181 near the surgical team during cautery use, and it was 25 at the anesthesia workstation. This peak level was 30 times the basal level of 6 µg/m3 at the start of the day and was above the annual population-weighted mean PM 2·5 breakpoint of 40 μg/m3 recommended by the National Ambient Air Quality Standards in India. The pollution levels increase dramatically when surgical cautery is used, potentially exposing the team to large peak elevations in particulate matter and TVOCs. We recommend the mandatory use of smoke evacuators and optimization of the air conditioning.

Smoke simulation and emergency evacuation simulation under indoor fire scenario

According to relevant data, when a fire occurs in a large public building, human life and property will be greatly threatened. In order to solve the problem of personnel evacuation under fire conditions, this paper starts with ant colony algorithm and introduces heuristic function, node selection strategy, and pheromone update to improve ant colony algorithm, so as to provide a scientific basis for personnel evacuation after fire. Based on BIM technology, smoke simulation technology, and evacuation simulation technology, this paper studies the evacuation of people in fire scenarios. Simulation of fire smoke and personnel evacuation is carried out on the BIM model of the shopping mall. Using Pyrosim software to simulate the spread of smoke in the shopping mall after the fire, the smoke temperature, fire visibility and CO concentration of each node are obtained.

2023 Conference Poster Collection: Smoke Evacuation and Management and Staff Well-Being.

2023 Conference Poster Collection: Smoke Evacuation and Management and Staff Well-Being.