Background“Surgical smoke” is a hazardous vapor produced during surgical dissection with electrocautery or high-speed drills. Prior literature has evaluated smoke exposure during spine surgery, but no study to-date has compared open and minimally-invasive spine surgery (MISS). This study aimed to determine whether the use of MISS techniques reduces operating room staff exposure to surgical smoke.MethodsAmbient surgical smoke was measured for MISS and open spine cases over a two-month period, using industrial particle detectors in standardized positions at the head and foot of the operating table. Ambient smoke was measured as particulate matter (PM) in mg/m3. Measurements were normalized for time (mg/m3/min) and number of surgical levels per case. Operative periods were defined as “exposure” (principal electrocautery phase) and “drilling” (principal drilling phase). PM measurements were compared between MISS and open cases.ResultsWe collected PM data for 81 cases: 40 MISS and 41 open. Most cases were thoracolumbar, with a higher predominance in the MISS cohort. MISS cases had lower overall PM and average PM per minute (P<0.01). During the exposure phase, MISS cases had lower PM overall, per minute, and per level operated (P<0.01). During the drilling phase, MISS cases had lower overall PM (P<0.01).ConclusionsOccupational particulate exposure is significantly reduced during MISS as compared to conventional open surgery. This effect is most pronounced during primary exposure with electrocautery.

Electrocautery remains one of the most ubiquitous and indispensable instruments in the contemporary operating theatre, enabling surgeons to achieve precise tissue dissection and reliable haemostasis across virtually every subspeciality of general surgery. The two principal modalities — monopolar and bipolar electrocautery — operate on fundamentally distinct electrophysical principles and confer different clinical profiles with respect to cutting efficiency, haemostatic capacity, lateral thermal spread, and safety. Despite their widespread adoption, a significant proportion of surgical practitioners retain incomplete knowledge of the underlying biophysical mechanisms and the associated complication profiles of these devices. Simultaneously, the combustion by-products generated during electrocautery — collectively termed surgical smoke — represent an underappreciated occupational health hazard for surgeons, theatre nurses, anaesthetists, and other perioperative personnel. Surgical smoke contains ultrafine particulate matter, volatile organic compounds, polycyclic aromatic hydrocarbons, and viable biological material including bacterial and viral fragments, all of which carry carcinogenic, mutagenic, and infective potential. This narrative review synthesises the current published evidence on the biophysical principles and comparative clinical performance of monopolar and bipolar electrocautery systems in general surgical practice, and critically evaluates the chemical composition, health implications, and mitigation strategies associated with surgical smoke. The review identifies that monopolar devices offer superior cutting versatility but produce greater lateral thermal spread and substantially higher volumes of surgical smoke than bipolar counterparts. Advanced bipolar vessel-sealing platforms provide safer haemostasis in proximity-sensitive anatomical regions. Smoke evacuation using high-efficiency local exhaust ventilation represents the primary recommended protective strategy, yet compliance remains globally suboptimal. Formal training programmes in surgical energy safety are essential but inconsistently implemented. This review underscores the urgent need for standardised institutional protocols, enhanced educational curricula, and updated regulatory frameworks to protect both patients and operating theatre personnel.

Multi-frequency shared-feature-learning based diffusion model for removing surgical smoke

Differences in the Effectiveness of Smoke Evacuator Types for Reducing Surgical Smoke: A Randomized Controlled Trial

Surgical power devices generate surgical smoke that may contain infectious components. Various technologies have been developed to improve surgical smoke management, but comparative performance data from human studies are limited. A prospective, single-centre study was performed for evaluating three smoke management technologies - continuous passive filtration (CPF), electrostatic precipitation (ESP), and continuous active filtration (CAF) - during laparoscopic sleeve gastrectomy in 15 bariatric patients. Surgical smoke concentration was monitored by condensation particle counting and single particle light scattering. Efficiency of intraoperative smoke clearance was assessed by the concentration half-life (T1/2). Secondary outcomes included total CO2 consumption, intraoperative pressure stability, and intraoperative visibility. ESP showed the highest smoke clearance efficiency (T1/2 = 7.2 s), followed by CAF (18.3 s) and CPF (20.6 s) with significant differences. Total CO2 consumption was highest for CAF (452.0 L) compared CPF (242.0 L) and ESP (80.1 L). All groups maintained a stable capnoperitoneal pressure and a good/very good intraoperative visibility. Electrostatic precipitation showed the lowest CO2 consumption and significantly higher smoke particle removal efficiency compared to continuous active/passive filtration. All technologies provided good/very good intraoperative visibility and capnoperitoneal pressure stability.

Aim: This study was conducted to investigate the effects of five different methods for protecting against surgical smoke. Methods: This experimental study was carried out in the operating room of XXX University Hospital. To reduce exposure to surgical smoke, five different protective methods were implemented in practice. A total of 140 samples (including blood and urine) were collected from operating room personnel both before and after surgery. The samples were categorized as preoperative and postoperative and analyzed using the Wilcoxon signed-rank test. Results: In surgeries where a combination of N95 masks, protective goggles, and a wall-mounted aspirator was used, the levels of volatile organic compounds (VOCs) in the blood of the operating room team decreased postoperatively; however, this reduction was not statistically significant (p &amp;gt; 0.05). In contrast, when smoke evacuation was performed using a smoke tubing and a smoke evacuation pencil, an increase in blood VOC levels was observed after surgery, although this increase was also not statistically significant (p &amp;gt; 0.05). Conclusions: The use of N95 masks, protective goggles, and a wall-mounted aspirator was associated with a reduction in postoperative blood VOC levels in the operating room team, although the change was not statistically significant. Conversely, surgeries employing smoke tubing and a smoke evacuation pencil resulted in increased VOC levels, but the difference was not statistically significant.

Respiratory Protection Is Recommended for Procedures That Generate Surgical Smoke.

Reducing Surgical Smoke Exposure in Rhinologic Electrosurgery: A Pilot Evaluation of A Novel Evacuation Device

A Survey-Based Investigation of the Barriers in the Use of Surgical Smoke Evacuation in the Operating Room at Michigan Medicine to Inform Future Design

Protective effect of a novel smoke evacuation device during laparoscopic surgery: An experimental proof-of-concept study.

Abstract: Pressurized intrathoracic aerosol chemotherapy (PITAC) is a new therapeutic option in patients with malignant pleural effusion (MPE) and/or pleural metastasis (PM) which could provide an effective pleurodesis combined to an anti-neoplastic effect. Among the tumors that cause MPE, lung cancer is the most common cause, followed by breast cancer, malignant mesothelioma, ovarian neoplasm and lymphoma. The procedure is indicated for patients with an Eastern Cooperative Oncology Group (ECOG) performance status ≤2, without extra-thoracic metastases and is performed in video-assisted thoracoscopy surgery (VATS); general anesthesia is required with a double-lumen endotracheal tube and the chemotherapy (solutions of cisplatin and doxorubicin) is nebulized using a special device in the pleural cavity. After the nebulization, the system is left in steady-state and after 30 minutes staff provides to removes the remaining aerosol using a closed surgical smoke evacuation system. Our initial experience is based on six procedures, which appeared to be safe and feasible with no recurrence of MPE (computed tomography scan). We don’t report intraoperative and postoperative complications (no systemic absorption of drug with normal creatinine levels). In this article, we described PITAC as a repeatable technique for controlling MPE recurrence. However, although this technique is promising for PM, further studies, in which patients are evaluated in the same way as those receiving pressurized intraperitoneal aerosol chemotherapy, are needed to assess its oncological benefits.

Background/Objectives: Persistent human papillomavirus (HPV) infection can lead to malignancies of the cervix, vulva, vagina, penis, anus, and oropharynx. The increasing incidence of HPV-related head and neck cancers has raised concerns regarding potential occupational exposure and transmission risks among healthcare workers. This study aimed to systematically evaluate the evidence on occupational HPV transmission in healthcare settings. Methods: A systematic review of the literature was conducted using three electronic databases (PubMed, Scopus, and Web of Science) from inception to August 2025, following PRISMA 2020 guidelines. A total of 34 studies met the inclusion criteria and were included in the review. Expert opinions and practical recommendations from members of the European Society of Gynaecological Oncology (ESGO) Prevention Committee were included to support interpretation of the results. Results: The available literature on occupational HPV transmission was limited, with a paucity of high-quality studies. Nevertheless, existing data suggest a potential occupational risk, particularly during aerosol or smoke-generating procedures performed for cervical intraepithelial neoplasia or cervical cancer. Several studies reported the detection of HPV DNA in surgical smoke or on instruments used during such procedures, indicating possible exposure among healthcare workers. Conclusions: Although current evidence is insufficient to definitively classify HPV infection as an occupational disease, available data indicate a potential exposure risk for healthcare workers involved in HPV-related procedures. Preventive measures, like personal protective equipment, should be emphasized. HPV vaccination has been recommended by some professional societies for healthcare workers performing gynecological procedures, though further research is needed to evaluate vaccine efficacy beyond the standard age range and its cost-effectiveness in this context.

Is surgical smoke carcinogenic for operating room staff?

Surgical smoke produced by the use of an electrosurgical unit may have a negative effect to patients and healthcare workers in the operating room, but studies on this problem are insufficient. In 100 situations in which patients were undergoing four types of surgery under general anesthesia, the count of airborne particles (in 1.415 L) was measured using a particle counter to see possible differences at the patients and at the anesthesiologists, during different types of surgery, and at several locations. The airborne particles during the use of an electrosurgical unit were significantly higher than before its use, both at the patient's head (median: 56/L vs 3,514/L; 95%CI for the median difference: 769-7,699/L) and at the anesthesiologist's position (230/L vs 6,907/L; 95%CI for the median difference: 2,945-13,196/L) (p < 0.0001). The airborne particles were significantly higher during cardiovascular surgery than during open abdominal surgery (median difference in increase: 8,439/L), significantly higher during open abdominal surgery than during head and neck surgery (2,654/L), and significantly higher during head and neck surgery than during laparoscopic surgery (1,442/L) (all p < 0.0001), and were high anywhere in the operating room and even outside the operating room door (always > 2,000/L). During the use of an electrosurgical unit, both the patients and healthcare workers are at increased risk of being exposed to high concentrations of airborne particles derived from surgical smoke.

(1) Background: Energy-based transurethral resection of bladder tumor (TURBT) generates surgical smoke that may contain hazardous volatile organic compounds (VOCs), yet surgeon breathing-zone exposure during transurethral surgery remains insufficiently characterized. (2) Methods: We conducted a prospective paired-exposure study during 28 TURBT procedures over 10 operating days using personal sampling at the surgeon's breathing zone and simultaneous intraoperative background sampling at three predefined locations (~1.5 m from the surgeon). VOCs were measured by active sampling onto Tenax TA sorbent tubes followed by thermal desorption Gas Chromatography-Mass Spectrometry (GC-MS), and formaldehyde was measured by 2,4-dinitrophenylhydrazine (DNPH) cartridges with high-performance liquid chromatography/ultraviolet detection (HPLC/UV). Breathing-zone versus background contrasts were summarized as paired geometric mean ratios (GMRs), and a dose index was calculated as concentration × operative time (µg·h/m3). (3) Results: Breathing-zone concentrations consistently exceeded background levels, including total VOCs (GMR 4.31; 95% CI 2.92-6.38), ΣBTEXS (sum of benzene, toluene, ethylbenzene, xylenes, and styrene; GMR 2.10; 1.69-2.60), and styrene (GMR 8.51; 6.25-11.60); formaldehyde showed a smaller but significant elevation (GMR 1.20; 1.07-1.35). ΣBTEXS dose increased with operative time (Spearman ρ = 0.80, p < 0.001) and resection mass where available (ρ = 0.62, p = 0.0038; n = 20) and scaled with operative time (β = 0.86; R2 = 0.69; n = 28). (4) Conclusions: TURBT is associated with marked enrichment of aromatic VOCs in the surgeon's breathing zone, supporting routine implementation of effective source-level smoke evacuation and filtration to reduce occupational exposure.

Depending on the use of electrocautery device in surgical procedures, the distribution of small particles oath the formation of surgery smoke occurs. Surgical smoke is as mutagenic as cigarette smoke oath contains many harmful oath carcinogenic polycyclic aromatic hydrocarbon compounds. of addition, viruses, bacteria oath live cells can be released during electrocauterization of tissues oath carried by surgical smoke. Inhalation of this smoke by the operating theater staff poses a danger. Despite the use of surgery masks oath operating theater ventilation, this danger is not completely eliminated. therefore, additional measurements oath safety measures are needed _ Of the COVID-19 pandemic, the risk of transmission from surgical smoke increases during the surgical processes of patients carrying this virus. There is the same risk in terms of similar airborne diseases of this study, it was investigated whether the surgical smoke generated due to cauterization used during the procedure in patients diagnosed with COVID-19 and going through surgical procedures contains COVID-19 virus RNA fragments (RTqPCR) and the chemicals contents of the surgical smoke were investigated by GC-MS.

Surgical smoke generated during energy-based operations is a known hazard containing particulate matter (PM), volatile organic compounds (VOCs), and biological debris, with insufficient adoption of commercial smoke evacuators due to cost and complexity. This study aimed to develop a cost-effective, modular and passive smoke evacuator and evaluate its efficacy in reducing PM and VOC levels during simulated laparoscopic procedures. A prototype smoke evacuator incorporating a distilled water bubbling trap, activated carbon filter, and ULPA filter was tested in a sealed chamber simulating laparoscopic surgery using porcine liver tissue. The system was connected to a laparoscopic port through a three-way valve, allowing manual, on-demand smoke evacuation without continuous suction. Air quality metrics, including PM1.0, PM2.5, PM10, VOC, and CO₂, were measured continuously. Results were compared to baseline and performance benchmarks from commercial smoke evacuation systems. Statistical analysis was performed using paired t-tests. The prototype evacuator reduced PM2.5 levels by >99.5% and VOC concentrations by >95% compared to no-evacuation control trials (p < 0.01). CO₂ concentrations returned to baseline following evacuation, indicating minimal disturbance of chamber atmosphere. PM2.5 and VOC levels were restored to near-baseline values. The developed modular passive smoke evacuator offers a promising and cost-effective solution to improve air quality and enhance occupational safety in operating rooms. The model represents an idealized simulation of laparoscopic smoke evacuation; further clinical validation in live surgical environments is warranted.

BackgroundSurgical smoke generated during energy-based operations is a known hazard containing particulate matter (PM), volatile organic compounds (VOCs), and biological debris, with insufficient adoption of commercial smoke evacuators due to cost and complexity.ObjectiveThis study aimed to develop a cost-effective, modular and passive smoke evacuator and evaluate its efficacy in reducing PM and VOC levels during simulated laparoscopic procedures.MethodsA prototype smoke evacuator incorporating a distilled water bubbling trap, activated carbon filter, and ULPA filter was tested in a sealed chamber simulating laparoscopic surgery using porcine liver tissue. The system was connected to a laparoscopic port through a three-way valve, allowing manual, on-demand smoke evacuation without continuous suction. Air quality metrics, including PM1.0, PM2.5, PM10, VOC, and CO₂, were measured continuously. Results were compared to baseline and performance benchmarks from commercial smoke evacuation systems. Statistical analysis was performed using paired t-tests.ResultsThe prototype evacuator reduced PM2.5 levels by >99.5% and VOC concentrations by >95% compared to no-evacuation control trials (p < 0.01). CO₂ concentrations returned to baseline following evacuation, indicating minimal disturbance of chamber atmosphere. PM2.5 and VOC levels were restored to near-baseline values.ConclusionThe developed modular passive smoke evacuator offers a promising and cost-effective solution to improve air quality and enhance occupational safety in operating rooms. The model represents an idealized simulation of laparoscopic smoke evacuation; further clinical validation in live surgical environments is warranted.

Background Electrosurgical procedures generate surgical smoke containing ultrafine particles (&lt; 100 nm) that can accumulate in the operating room atmosphere. The effectiveness of ventilation systems in controlling such emissions depends on airflow type and supply rate. This study quantified the concentration and size distribution of airborne particles in the surgeon′s breathing zone during ear, nose, and throat surgeries and evaluated the influence of operating room ventilation systems on exposure levels. Methods A prospective multicenter field study was conducted in six German hospitals with different ventilation designs. Two hospitals operated with unidirectional displacement flow systems (supply airflow rates: 8200 and 5100 m 3 /h), whereas four used mixing and dilution flow systems (1400–3000 m 3 /h). Particle number concentration and size distribution were continuously recorded using a nanoparticle sizer during 46 surgeries. Results Across all sites, mean particle number concentrations ranged from 2.3E + 6 to 4.8E + 14 P/m 3 , with maximum peaks up to 2.4E + 16 P/m 3 . Ultrafine particles represented 84.7 % ± 12.9 % of the total particle count. Operating rooms equipped with unidirectional displacement flow ventilation showed the lowest mean (2.3E + 6 P/m 3 ) and maximum particle number concentrations (8.8E + 6 P/m 3 ), up to 1 million times lower than those with mixing and dilution flow ventilation. Conclusion Surgical smoke generated during ear, nose, and throat operations represents a significant source of ultrafine particles in confined indoor environments. The results indicate that ventilation design is an important factor influencing exposure control, with unidirectional displacement flow systems being associated with substantially lower particle concentrations compared with mixing and dilution flow ventilation. These findings highlight the potential role of optimized airflow management for minimizing occupational exposure to ultrafine particles in healthcare environments.

Ventilation systems in operating rooms have high importance, as they simultaneously are important for patient and personnel safety. However, conventional ventilation systems laminar air flow and mixing ventilation show disadvantages, e.g., the first leads to discomfort of the staff because of high draught risks and the latter improves lateral transport of contaminations. In this study, a concept that introduces additional air inlets for local horizontal ventilation in the vicinity of the operation table combined with these conventional systems is tested in experiments. The impact on the removal of bacteria originating from the surgical staff and surgical smoke that is emitted during electrosurgical procedures with surrogate particles as well as thermal comfort of the staff and heat flux of the patient were experimentally assessed in a full-scale research operating room. It was shown that the concentrations of contaminations were reduced by more than one order of magnitude for surgical smoke and two orders of magnitude for airborne germs in the proximity of the local air inlet, compared to reference cases without local ventilation. Moreover, a risk of cross-contamination from the surgical micro-environment to the peripherical area was formed due to the horizontal airflow. The heating system of the patient simulators surface consumed 13 % more power for LAF and 29 % for TMV compared to the reference cases, increasing the risk of perioperative hypothermia. The thermal comfort of the surgical staff was not significantly affected by the local ventilation system.