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Journal of Occupational Medicine and Toxicology

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Open Access 01-12-2018 | Research

In vitro toxicological evaluation of surgical smoke from human tissue

Authors: Jennifer D. Sisler, Justine Shaffer, Jhy-Charm Soo, Ryan F. LeBouf, Martin Harper, Yong Qian, Taekhee Lee

Published in: Journal of Occupational Medicine and Toxicology | Issue 1/2018

Abstract

Background

Operating room personnel have the potential to be exposed to surgical smoke, the by-product of using electrocautery or laser surgical device, on a daily basis. Surgical smoke is made up of both biological by-products and chemical pollutants that have been shown to cause eye, skin and pulmonary irritation.

Methods

In this study, surgical smoke was collected in real time in cell culture media by using an electrocautery surgical device to cut and coagulate human breast tissues. Airborne particle number concentration and particle distribution were determined by direct reading instruments. Airborne concentration of selected volatile organic compounds (VOCs) were determined by evacuated canisters. Head space analysis was conducted to quantify dissolved VOCs in cell culture medium. Human small airway epithelial cells (SAEC) and RAW 264.7 mouse macrophages (RAW) were exposed to surgical smoke in culture media for 24 h and then assayed for cell viability, lactate dehydrogenase (LDH) and superoxide production.

Results

Our results demonstrated that surgical smoke-generated from human breast tissues induced cytotoxicity and LDH increases in both the SAEC and RAW. However, surgical smoke did not induce superoxide production in the SAEC or RAW.

Conclusion

These data suggest that the surgical smoke is cytotoxic in vitro and support the previously published data that the surgical smoke may be an occupational hazard to healthcare workers.

Roan S. Even when surgery is over, sedation's risks could linger. Death rates are higher for months afterward, studies find. Los Angeles Times: Doctors search for a reason; 2005.

Bigony L. Risks associated with exposure to surgical smoke plume: a review of the literature. AORN J. 2007;86(6):1013–20. quiz 1021-4CrossRefPubMed

Ragde SF, Jorgensen RB, Foreland S. Characterisation of exposure to ultrafine particles from surgical smoke by use of a fast mobility particle sizer. Ann Occup Hyg. 2016;60(7):860–74.CrossRefPubMed

Barrett WL, Garber SM. Surgical smoke: a review of the literature. Is this just a lot of hot air. Surg Endosc. 2003;17(6):979–87.CrossRefPubMed

Gonzalez-Bayon L, Gonzalez-Moreno S, Ortega-Perez G. Safety considerations for operating room personnel during hyperthermic intraoperative intraperitoneal chemotherapy perfusion. Eur J Surg Oncol. 2006;32(6):619–24.CrossRefPubMed

Al Sahaf OS, Vega-Carrascal I, Cunningham FO, McGrath JP, Bloomfield FJ. Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci. 2007;176(3):229–32.CrossRefPubMed

Hill DS, O'Neill JK, Powell RJ, Oliver DW. Surgical smoke - a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. J Plast Reconstr Aesthet Surg. 2012;65(7):911–6.CrossRefPubMed

Ortolano GA, Cervia JS, Canonica FP. Surgical smoke- a concern for infection control practitioners., in managing. Infect Control. 2009:48–54.

Pierce JS, Lacey SE, Lippert JF, Lopez R, Franke JE. Laser-generated air contaminants from medical laser applications: a state-of-the-science review of exposure characterization, health effects, and control. J Occup Environ Hyg. 2011;8(7):447–66.CrossRefPubMed

10.

Pierce JS, Lacey SE, Lippert JF, Lopez R, Franke JE, Colvard MD. An assessment of the occupational hazards related to medical lasers. J Occup Environ Med. 2011;53(11):1302–9.CrossRefPubMed

11.

Ulmer BC. The hazards of surgical smoke. AORN J. 2008;87(4):721–34. quiz 735-8CrossRefPubMed

12.

Baggish MS, Elbakry M. The effects of laser smoke on the lungs of rats. Am J Obstet Gynecol. 1987;156(5):1260–5.CrossRefPubMed

13.

Freitag L, Chapman GA, Sielczak M, Ahmed A, Russin D. Laser smoke effect on the bronchial system. Lasers Surg Med. 1987;7(3):283–8.CrossRefPubMed

14.

Ball K. Compliance with surgical smoke evacuation guidelines: implications for practice. AORN J. 2010;92(2):142–9.CrossRefPubMed

15.

King B, McCullough J. Health hazard evaluation report HETA #2001-0066-3019. NIOSH. 2006;

16.

King B, McCullough J. Health hazard evaluation report HETA #2000-0402-3021. NIOSH. 2006;

17.

King B, McCullough J. Health hazard evaluation report HETA #2001-0030-3020. NIOSH. 2006;

18.

Moss EC, Bryant C, Stewart J, Whong WZ, Fleeger A, Gunter BJ. Health hazard evaluation report HETA 88-101-2008. NIOSH. 1990;

19.

Bryant CJ, Gorman R, Stewart J, Whong Z. Health hazard evaluation report HETA-85-126-1932. NIOSH. 1985;

20.

Gatti JE, Bryant CJ, Noone RB, Murphy JB. The mutagenicity of electrocautery smoke. Plast Reconstr Surg. 1992;89(5):781–4. discussion 785-6CrossRefPubMed

21.

Eshleman EJ, LeBlanc M, Rokoff LB, Xu Y, Hu R, Lee K, et al. Occupational exposures and determinants of ultrafine particle concentrations during laser hair removal procedures. Environ Health. 2017;16(1):30.CrossRefPubMedPubMedCentral

22.

Daigle CC, Chalupa DC, Gibb FR, Morrow PE, Oberdorster G, Utell MJ, et al. Ultrafine particle deposition in humans during rest and exercise. Inhal Toxicol. 2003;15(6):539–52.CrossRefPubMed

23.

Chalupa DC, Morrow PE, Oberdorster G, Utell MJ, Frampton MW. Ultrafine particle deposition in subjects with asthma. Environ Health Perspect. 2004;112(8):879–82.CrossRefPubMedPubMedCentral

24.

Hensman C, Newman EL, Shimi SM, Cuschieri A. Cytotoxicity of electro-surgical smoke produced in an anoxic environment. Am J Surg. 1998;175(3):240–1.CrossRefPubMed

25.

Ziegler BL, Thomas CA, Meier T, Muller R, Fliedner TM, Weber L. Generation of infectious retrovirus aerosol through medical laser irradiation. Lasers Surg Med. 1998;22(1):37–41.CrossRefPubMed

26.

Fletcher JN, Mew D, DesCoteaux JG. Dissemination of melanoma cells within electrocautery plume. Am J Surg. 1999;178(1):57–9.CrossRefPubMed

27.

Nduka CC, Poland N, Kennedy M, Dye J, Darzi A. Does the ultrasonically activated scalpel release viable airborne cancer cells. Surg Endosc. 1998;12(8):1031–4.CrossRefPubMed

28.

Steege AL, Boiano JM, Sweeney MH. Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke. Am J Ind Med. 2016;59(11):1020–31.CrossRefPubMedPubMedCentral

29.

LeBouf RF, Stefaniak AB, Virji MA. Validation of evacuated canisters for sampling volatile organic compounds in healthcare settings. J Environ Monit. 2012;14(3):977–83.CrossRefPubMed

30.

LeBouf RF, Virji MA, Saito R, Henneberger PK, Simcox N, Stefaniak AB. Exposure to volatile organic compounds in healthcare settings. Occup Environ Med. 2014;71(9):642–50.CrossRefPubMedPubMedCentral

31.

Piao CQ, Liu L, Zhao YL, Balajee AS, Suzuki M, Hei TK. Immortalization of human small airway epithelial cells by ectopic expression of telomerase. Carcinogenesis. 2005;26(4):725–31.CrossRefPubMed

32.

Lu S, Zhang W, Zhang R, Liu P, Wang Q, Shang Y, et al. Comparison of cellular toxicity caused by ambient ultrafine particles and engineered metal oxide nanoparticles. Part Fibre Toxicol. 2015;12:5.CrossRefPubMedPubMedCentral

33.

Thomson EM, Breznan D, Karthikeyan S, MacKinnon-Roy C, Charland JP, Dabek-Zlotorzynska E, et al. Cytotoxic and inflammatory potential of size-fractionated particulate matter collected repeatedly within a small urban area. Part Fibre Toxicol. 2015;12:24.CrossRefPubMedPubMedCentral

34.

Qian Y, Castranova V, Shi X. New perspectives in arsenic-induced cell signal transduction. J Inorg Biochem. 2003;96(2–3):271–8.CrossRefPubMed

35.

Xia T, Kovochich M, Nel A. The role of reactive oxygen species and oxidative stress in mediating particulate matter injury. Clin Occup Environ Med. 2006;5(4):817–36.PubMed

36.

Bruske-Hohlfeld I, Preissler G, Jauch KW, Pitz M, Nowak D, Peters A, et al. Surgical smoke and ultrafine particles. J Occup Med Toxicol. 2008;3:31.CrossRefPubMedPubMedCentral

37.

Elmashae Y, Richard HK, Yermakov M, Reponen T, Grinshpun SA. Surgical smoke simulation study: physical characterization and respiratory protection. Aerosol Sci Technol. 2018;52(1):38–45.CrossRef

38.

Lee T, Soo JC, LeBouf RF, Burns D, Schwegler-Berry D, Kashon M et al. Surgical smoke control with local exhaust ventilation: Experimental study. J Occup Environ Hyg. 2018;15(4):341–50.

39.

Kunachak S, Sobhon P. The potential alveolar hazard of carbon dioxide laser-induced smoke. J Med Assoc Thail. 1998;81(4):278–82.

Title: In vitro toxicological evaluation of surgical smoke from human tissue
Authors: Jennifer D. Sisler
Justine Shaffer
Jhy-Charm Soo
Ryan F. LeBouf
Martin Harper
Yong Qian
Taekhee Lee
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Occupational Medicine and Toxicology / Issue 1/2018
Electronic ISSN: 1745-6673
DOI: https://doi.org/10.1186/s12995-018-0193-x

At a glance: The STEP trials

Springer Medicine

In vitro toxicological evaluation of surgical smoke from human tissue

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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