Surgical Smoke Research Articles

Occupational Hazards of Surgical Smoke and Achieving a Smoke Free Operating Room Environment: Asia-Pacific Consensus Statement on Practice Recommendations.

Background:Surgical smoke generated through energy devices may present detrimental effects on individuals present in the operating room (OR). Despite the concerns possibly associated with surgical smoke, there may be no mandatory policies that suggest protective measures and limited firm standards are committed yet to address the same.AimThe aim of this paper is to present recommendations for surgeons and OR personnel by taking a consensus approach based on available literature and its interpretation by a multi-national panel of experts.MethodsThe Asia-Pacific (APAC) group was established with the aims of reviewing literature evidence, discussing key issues regarding surgical smoke and its hazards, and offering a summary of statements in achieving a smoke-free OR environment. Eleven expert surgeons from the international APAC region were gathered with the purpose of coming to a consensus on engineering, best work-practices, and administrative controls in minimizing surgical smoke exposure. A two-phase consensus method was used to obtain opinions from the expert panel of specialists. Statements with an agreement of more than 80% were accepted.FindingsFor twenty-one statements, the panel achieved consensus on 17 statements; another 5 were dropped due to lack of consensus. The consensus was obtained on statements that address the need for the implementation of administrative policies, training and awareness, standard procedure for the continued use of engineering controls, stringent work practice controls and preventive controls.ConclusionThe statements presented may guide surgeons and OR personnel in the practical management of surgical smoke safety, mitigating the risks associated with it. The consensus statement also provides a series of recommendations that can be used with other stakeholders, such as policymakers, hospital administrators and professional societies, to highlight and motivate the implementation of meaningful policies.

Clinical Issues-June 2022.

Electrostatic precipitator device use during laparoscopic surgery Key words: electrostatic precipitation (ESP), surgical smoke precipitator, anions, visual field, medical device reporting (MDR). Removal of used flammable skin antisepsis materials Key words: flammable liquid antiseptics, National Fire Protection Association (NFPA), fire prevention, fire risk, patient care vicinity. Ocular protection for patients with eyelash extensions Key words: ocular injury, eyelash extensions, eye protection, lagophthalmos, intraocular pressure. Perioperative nursing care of the patient with Raynaud's phenomenon Key words: ischemia, vasospasm, comfort measures, hypothermia, complementary care.

Factors Associated with Surgical Smoke Self-Protection Behavior of Operating Room Nurses.

Surgical smoke has been proven to be harmful and carcinogenic to humans as well as increasing the risk of acquiring infectious diseases. The operating room nurses’ willingness to use protective equipment against surgical smoke was low. The factors associated with personal protective behavior in the operating room against surgical smoke were sparsely explored. The purpose of this study is to determine factors associated with surgical smoke self-protection behavior of the operating room nurses. This was a descriptive correlational study using a convenience sample from a medical center in northern Taiwan. The self-designed questionnaires included personal characteristics and perceived attributes. The data were analyzed by descriptive and linear regression. Attendance at in-service education with regard to surgical smoke, the attitude to surgical smoke, and surgical smoke self-protection barriers were significant factors found in multivariate linear regression after controlling the covariates. The overall model was significant and accounted for 14.2% of variances. In summary, attending in-service education, attitude and barriers in executing self-protective behaviors were significant factors. It is important to promote operating room nurses’ health through providing correct surgical smoke knowledge, self-protection strategies to improve attitudes toward surgical smoke, improving the hospital’s environment by adding surgical smoke evacuation equipment, and standardizing the operating procedures.

The Nursing Effect of PRECEDE Management on Occupational Exposure to Surgical Smoke: Based on a Randomized Controlled Study.

Background Occupational exposure seriously threatens the physical and mental health of professionals and has become an important public health problem. In clinical medical and nursing work, medical staff, especially nursing staff, are faced with the status quo of occupational exposure with high risk, serious harm, and severe situation. Therefore, a sound management system must be established to control the occupational exposure of nurses. Aims According to the PRECEDE management model, evaluate the operating room nurses' knowledge, belief, and behavior scores on the protection of surgical smoke, understand their awareness of surgical smoke and the current status of protection, improve the mastery rate and protection compliance of surgical smoke-related knowledge in the operating room, reduce the harm of surgical smoke to the human body, and provide a basis for smoke protection.Materials and methods. 125 doctors working in the operating room of our hospital were selected as the control group of this study, and 112 nonsmoke-exposed nurses working in the operating room of our hospital were selected as the observation group. The nurses' knowledge-belief behavior scores and self-evaluation scores of smoke influence were counted before and after the intervention in the operating room. SPSS25.0 was used to process the data. Tests and repeated measures analysis of variance were used to compare the effects before and after intervention. Results After one month of intervention, the knowledge scores of nurses in the operating room on the protection of surgical smoke increased significantly, and the difference was significant (P < 0.05); the scores of related concepts, physical properties, chemical properties, and authoritative protection standards increased significantly (P < 0.05). There was no significant increase in the scores of smoke hazards (P > 0.05); the attitude of smoke protection increased significantly, which was statistically significant (P < 0.05); and the behavior compliance of smoke protection was significantly increased, which was statistically significant (P < 0.05). After one month of intervention, the self-evaluation score of smoke effect of operating room nurses decreased significantly, and the difference was statistically significant (P < 0.05). The data was analyzed by repeated measure analysis of variance. The knowledge of surgical smoke (F = 65.570, P < 0.001), attitude (F = 78.307, P < 0.001), and behavior (F = 403.015, P < 0.001) scores gradually increased. The observation group's total cholesterol, low-density lipoprotein cholesterol, and the proportion of low-density lipoprotein cholesterol were higher than that of the control group, and the proportion of high-density lipoprotein cholesterol was lower than that of the control group. The difference was statistically significant P < 0.05. Conclusion After the intervention of operating room nurses under the guidance of PRECEDE management mode, the theoretical knowledge of operating room nurses is effectively improved, the operations are standardized, the self-evaluation scores of smoke influence are reduced, and the safety level of operating room is improved. More importantly, the health of nursing staff is fully guaranteed.

Dynamics of surgical smoke in the operating room during spinal surgery: Comparison of particulate matter 2.5-air concentration between the electric scalpel with and without a smoke evacuation pencil: A cross-sectional study

BackgroundSurgical smoke is a vaporous by-product generated during tissue incision and cauterization with an electric scalpel. This smoke contains tissue- and blood/vascular-derived substances, bacteria, viruses, and chemical substances. Among them, it contains many fine particles called particulate matter (PM) 2.5, which are harmful and hazardous to the human body. We aimed to investigate the occurrence of PM2.5 in surgical smoke produced during spinal surgery and to evaluate the efficacy of an electric scalpel with a smoke evacuation pencil. MethodsIn this retrospective observational study, 89 patients who underwent spinal surgery between June 2019 and May 2021 were included. A dust monitor was installed in the operating room to measure the PM2.5 air concentration during the surgery. During each surgery, the total amount of PM2.5, the maximum PM2.5 air concentration, the exposure time to PM2.5, and the average value of PM2.5 air concentration from the start to the end of the surgery were calculated. ResultsWe found that in 29 of the 89 cases (32.6%), the air concentration of PM2.5 increased to a level that could cause health damage during the surgery. Twelve cases (13.4%) reached the level that could cause serious health damage, and 8 cases (9%) reached an emergency warning level. The total amount and the maximum and average levels of PM2.5 were significantly suppressed in the surgery with a smoke evacuation pencil group than in the surgery without a smoke evacuation pencil group. ConclusionWe detected hazardous levels of PM2.5 in the air during spinal surgery, highlighting the importance of considering smoke control or reduction during spinal surgery. We recommend using an electric scalpel with a smoke evacuation pencil for regulating PM2.5 levels in the operating room.

Determination of Benzene, Toluene, Ethylbenzene and Xylene Compounds in Surgical Smoke and Its Relationship with Body Mass Index and Duration of Surgery

Determination of Benzene, Toluene, Ethylbenzene and Xylene Compounds in Surgical Smoke and Its Relationship with Body Mass Index and Duration of Surgery

Characterization of signal kinetics in real time surgical tissue classification system

Effective surgical margin assessment is paramount for good oncological outcomes and new methods are in active development. One emerging approach is the analysis of the chemical composition of surgical smoke from tissues. Surgical smoke is typically removed with a smoke evacuator to protect the operating room staff from its harmful effects to the respiratory system. Thus, analysis of the evacuated smoke without disturbing the operation is a feasible approach. Smoke transportation is subject to lags that affect system usability. We analyzed the smoke transportation delay and evaluated its effects to tissue classification with differential mobility spectrometry in a simulated setting using porcine tissues. With a typical smoke evacuator setting, the front of the surgical plume reaches the analysis system in 380 ms and the sensor within one second. For a typical surgical incision (duration 1.5 s), the measured signal reaches its maximum in 2.3 s and declines to under 10% of the maximum in 8.6 s from the start of the incision. Two-class tissue classification was tested with 2, 3, 5, and 11 s repetition rates resulting in no significant differences in classification accuracy, implicating that signal retention from previous samples is mitigated by the classification algorithm.

Smoke removal and image enhancement of laparoscopic images by an artificial multi-exposure image fusion method

In laparoscopic surgery, image quality is often degraded by surgical smoke or by side effects of the illumination system, such as reflections, specularities, and non-uniform illumination. The degraded images complicate the work of the surgeons and may lead to errors in image-guided surgery. Existing enhancement algorithms mainly focus on enhancing global image contrast, overlooking local contrast. Here, we propose a new Patch Adaptive Structure Decomposition utilizing the Multi-Exposure Fusion technique to enhance the local contrast of laparoscopic images for better visualization. The set of under-exposure level images is obtained from a single input blurred image by using gamma correction. Spatial linear saturation is applied to enhance image contrast and to adjust the image saturation. The Multi-Exposure Fusion (MEF) is used on a series of multi-exposure images to obtain a single clear and smoke-free fused image. MEF is applied by using adaptive structure decomposition on all image patches. Image entropy based on the texture energy is used to calculate image energy strength. The texture entropy energy determined the patch size that is useful in the decomposition of image structure. The proposed method effectively eliminate smoke and enhance the degraded laparoscopic images. The qualitative results showed that the visual quality of the resultant images is improved and smoke-free. Furthermore, the quantitative scores computed of the metrics: FADE, Blur, JNBM, and Edge Intensity are significantly improved as compared to other existing methods.

Influence of two different operating room ventilation systems on the surgical smoke exposure of surgeons

The intraoperative use of electrosurgical devices leads to the emission of surgical smoke, which is a proven health risk for operating room personnel. According to guidelines, either a unidirectional displacement flow system or mixed turbulent flow ventilation are recommended to reduce the surgical smoke exposure. However, the impact of the ventilation system on the particle concentration in clinical practice remains unclear. We performed a multicenter study and first investigated the turbulence intensity (for unidirectional displacement flow) and the recovery time (for mixed turbulent flow) in 15 operating rooms. Then, particle concentrations sized ≥0.3 μm were measured in the surgeons’ breathing zones and the 5th percentile, the mean, the 95th percentile, and the maximum concentration were determined. The average particle concentrations during 179 surgical procedures (unidirectional displacement flow: n = 87 surgeries; mixed turbulent flow: n = 92 surgeries; median time from skin incision to suture: 70 min; median electrocautery time: 24%/16.8 min) were 1.5 E+05/m³ (5th percentile), 1.7 E+06/m³ (mean), 2.5 E+07/m³ (95th percentile), and 2.1 E+08/m³ (maximum). Unidirectional displacement flow ventilation systems with turbulence intensities ≤5% decreased the particle concentration by a factor of 5.3 for the 5th percentile, 2.1 for the mean, 5.7 for the 95th percentile, and 6.6 for the maximum concentration compared to unidirectional displacement flow systems with turbulence intensities ≥20%. Furthermore, a turbulence intensity ≤5% reduced particles 15.5-times (5th percentile), 8.6-times (mean), 8.4-times (95th percentile), and 6.4-times (maximum) more effective than mixed turbulent flow ventilation. We concluded that the ventilation system has a relevant quantitative effect on the particle concentration, especially if electrocautery devices are used. A unidirectional displacement flow system with a turbulence intensity ≤5% reduced particles best, while mixed turbulent flow ventilation is not optimal for surgeries with surgical smoke release. Operating room personnel should be aware that even a short period of electrocautery application can cause high concentrations of surgical smoke particles. Thus, electrocautery devices should always be used with caution.

Polarization-based smoke removal method for surgical images.

Smoke generated during surgery affects tissue visibility and degrades image quality, affecting surgical decisions and limiting further image processing and analysis. Polarization is a fundamental property of light and polarization-resolved imaging has been studied and applied to general visibility restoration scenarios such as for smog or mist removal or in underwater environments. However, there is no related research or application for surgical smoke removal. Due to differences between surgical smoke and general haze scenarios, we propose an alternative imaging degradation model by redefining the form of the transmission parameters. The analysis of the propagation of polarized light interacting with the mixed medium of smoke and tissue is proposed to realize polarization-based smoke removal (visibility restoration). Theoretical analysis and observation of experimental data shows that the cross-polarized channel data generated by multiple scattering is less affected by smoke compared to the co-polarized channel. The polarization difference calculation for different color channels can estimate the model transmission parameters and reconstruct the image with restored visibility. Qualitative and quantitative comparison with alternative methods show that the polarization-based image smoke-removal method can effectively reduce the degradation of biomedical images caused by surgical smoke and partially restore the original degree of polarization of the samples.

Clinical significance of lipid droplets formed in the peritoneal fluid after laparoscopic surgery for gastric cancer.

Several studies have previously reported that laparoscopic surgery using an energy sealing device generates hazardous surgical smoke. However, the droplets appearing on the surface of peritoneal fluid irrigated with saline, after dissection phase of laparoscopic gastrectomy were ignored for a long time. This study aimed to investigate the composition and clinical significance of these droplet particles. This study prospectively enrolled 15 patients with early gastric cancer (cT1NanyM0) who were scheduled for laparoscopic gastrectomy. Floating phases of peritoneal irrigation fluid containing droplets in dissected area were retrieved before and after surgical dissection. Using gas chromatography analysis, the areas under the peak were compared between the samples retrieved before and after surgical dissection. We also analyzed if the area value with significant change was related to the inflammatory response. In gas chromatography, the area values after laparoscopic surgical dissection were significantly increased in 10 out of 37 kinds of fatty acids, compared to those before surgical dissection. The significant increase in area value of α-linoleic and eicosadienoic acids were positively correlated with the elevated level of C-reactive protein at postoperative day 2 (Spearman's ρ = 0.843, P < 0.001; Spearman's ρ = 0.785, P = 0.001). The lipid droplets, generated after laparoscopic lymphadenectomy during gastric cancer surgery, contained various types of fatty acids, and some of them have been found to be associated with inflammatory response.

Occupational Hazards of Orthopedic Surgery Exposures: Infection, Smoke, and Noise

The orthopedic environment exposes surgeons and staff to infection, surgical smoke, and high levels of noise. It is helpful to understand how exposure increases the risk for adverse health consequences. Protective equipment, safety protocols, and instrument modification can reduce exposure to hazards. When modifications to practice are made, they must be evaluated to ensure they do not introduce new hazards or impede the use of instruments. Despite evidence of risk, protective measures are seldom employed in orthopedic practice. Wider implementation of protection for clinicians may not occur unless the same hazards are shown to impact patient outcomes.

Introduction: Occupational Hazards to the Joint Replacement Surgeon

Introduction: Occupational Hazards to the Joint Replacement Surgeon

Simple smoke ventilation method for uniportal video-assisted thoracoscopic surgery.

Fogging of the thoracoscopic lens affects a surgeon’s ability to maintain a clear operating field. In uniportal video-assisted thoracoscopic surgery, the thoracoscopic lens tends to fog when the surgeon does not hold a suction instrument. Thus, a suction instrument needs to be held by the surgeon’s nondominant hand to remove surgical smoke, mist, and moisture. Here, we describe a simple, easy and cost-effective surgical smoke ventilation technique for uniportal video-assisted thoracoscopic surgery using a suction catheter to solve the problem. We present this technique and comment on its advantages, including decreased cost and improved surgical visualization.

How Do You Measure a Year?

How Do You Measure a Year?

Measurement of particulate matter 2.5 in surgical smoke and its health hazards.

PurposeSurgical smoke is generated during the cauterization, coagulation, and incision of biological tissues by electrocautery, ultrasonic coagulation, incising devices, and lasers. Surgical smoke comprises water, water vapor, steam, and some particulate matter, including bacteria, viruses, cell fragments, and volatile organic compounds, which can pose health risks to the operating room personnel. In this study, we measured the concentration of particulate matter 2.5 (particles with a diameter of ≤ 2.5 μm) in surgical smoke.MethodsWe used digital dust counters for real-time monitoring of particulate matter 2.5 generated intraoperatively in breast and gastrointestinal surgeries performed at our hospitals between 2019 and 2020.ResultsConcentrations of particulate matter 2.5 were measured in surgical smoke generated when performing 14 different surgeries. Immediately after electrocautery, the concentration of particulate matter 2.5 increased to 2258 μg/m3 and then, when we stopped using the devices, it decreased rapidly to the initial levels. Interestingly, the concentrations increased after each intermittent electrocautery procedure. Higher concentrations of particulate matter 2.5 were observed during breast surgeries than during laparoscopic procedures.ConclusionSurgical smoke poses potential health risks to operating room personnel by contaminating their breathing zone with high concentrations of particulate matter 2.5. A local exhaust ventilation system is needed to reduce exposure.

Surgical smoke: modern mobile smoke evacuation systems improve occupational safety in the operating theatre.

OBJECTIVESEvaluation of smoke capture efficiency of different mobile smoke evacuation devices with respect to volatile organic compounds and their noise emission.METHODSElectrosurgical incisions were performed on fresh porcine liver in an operating room with vertical laminar flow. The generated surgical smoke was analysed with proton-transfer-reaction mass spectrometry with and without the use of a mobile smoke evacuation system consisting of a smoke evacuator machine, a suction hose and a handpiece. The inlet of the mass spectrometer was positioned 40 cm above the specimen. Various devices were compared: a hard plastic funnel, a flexible foam funnel, an on-tip integrated aspirator of an electrosurgical knife and a standard secretion suction (Yankauer). Also, sound levels were measured at a distance of 40 cm from the handpieces’ inlet.RESULTSThe smoke capture efficiency of the secretion suction was only 53%, while foam funnel, plastic funnel and integrated aspirator were all significantly more effective with a clearance of 95%, 91% and 91%, respectively. The mean sound levels were 68 and 59 A-weighted decibels with the plastic and foam funnel, respectively, 66 A-weighted decibels with the integrated aspirator and 63 A-weighted decibels with the secretion suction.CONCLUSIONSCarcinogenic, mutagenic and reprotoxic volatile organic compounds in surgical smoke can be efficiently reduced by mobile smoke evacuation system, providing improved protection for medical personnel. Devices specifically designed for smoke evacuation are more efficient than standard suction tools. Noise exposure for the surgeon was lowest with the flexible foam funnel and higher with the other handpieces tested.

Investigating surgical smoke in otolaryngology operating rooms

Surgical smoke is a common chemical hazard produced from the use of electrocautery, laser, or ultrasonic scalpels during surgery. It has been proved harmful to medical personnel. Thus, it is important to monitor surgical smoke concentrations in the operating room. In the past decade, many researches regarding surgical smoke were discussed in different professional healthcare fields, but few showed the correlation between surgical smoke and otolaryngology surgery. In this study, the concentrations of particulate matter and formaldehyde were measured during thirty cases of several types of otolaryngology surgery in a regional research hospital in Taiwan. The concentrations of 0.3 µm and 0.5 µm particulate matter raised rapidly in the main knife range at the beginning of the electrocautery knife used, and then decreased by half after 5–10 min of use. The concentrations of formaldehyde were ranged from 1 to 2 ppm during the surgery, which is higher than the permissible exposure limit. While many medical staffs are working in the operating room and are exposed to the smoke hazard, effective strategies for collecting and eliminating the smoke should be taken in all medical facilities.

Eliminación de los efectos de humo en cirugía laparoscópica usando redes antagónicas generativas y el principio del canal oscuro

In laparoscopic surgery, image quality can be severely degraded by surgical smoke caused by the use of tissue dissection tools that reduce the visibility of the observed organs and tissues. Improve visibility in laparoscopic surgery by combining image processing techniques based on classical methods and artificial intelligence. Development of a hybrid approach to eliminating the effects of surgical smoke, based on the combination of the dark channel prior (DCP) method and a pixel-to-pixel neural network architecture known as a generative adversarial network (GAN). Experimental results have shown that the proposed method achieves better performance than individual DCP and GAN results in terms of restoration quality, obtaining (according to PSNR and SSIM index metrics) better results than some related state-of-the-art methods. The proposed approach decreases the risks and time of laparoscopic surgery because once the network is trained, the system can improve real-time visibility.

Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project.

Energy-generating surgical devices (eg, electrosurgical units, lasers) produce surgical smoke that can cause negative health effects in exposed individuals. In 2019, a review of nursing documentation at an urban teaching hospital revealed that personnel were properly evacuating surgical smoke during less than 0.5% of applicable procedures. To address the noncompliance and reduce exposure to surgical smoke, an interdisciplinary team initiated a quality improvement project to implement a surgical smoke evacuation policy for all smoke-generating procedures. The project included creation and implementation of a smoke evacuation policy, staff member education on the hazards of surgical smoke and proper evacuation device use, and acquisition of the proper smoke evacuation equipment. After instituting the policy in June 2020, results of a three-month chart audit showed that there was nursing documentation confirming personnel used energy-generating devices and the corresponding surgical smoke evacuation devices during 664 of 2,224 procedures, for a compliance rate of 30%.