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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2013

01-09-2013 | Review

Is surgical smoke harmful to theater staff? a systematic review

Authors: Nicholas Mowbray, James Ansell, Neil Warren, Pete Wall, Jared Torkington

Published in: Surgical Endoscopy | Issue 9/2013

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Abstract

Background

Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff.

Methods

Cochrane Database, MEDLINE, PubMed, Embase classic and Embase, and the metaRegister of Controlled Trials were searched for studies reporting the constituents found in the smoke plume created during surgical procedures, the methods used to analyze the smoke, the implications of exposure, and the type of surgical instrument that generated the smoke. Studies were excluded if they were animal based, preclinical experimental work, or opinion-based reports. The common end points were particle size and characteristics, infection risk, malignant spread, and mutagenesis.

Results

The inclusion criteria were fulfilled by 20 studies. In terms of particle size, 5 (25 %) of the 20 studies showed that diathermy and laser can produce ultrafine particles (UFP) that are respirable in size. With regard to particle characterization, 7 (35 %) of the 20 studies demonstrated that a variety of volatile hydrocarbons are present in diathermy-, ultrasonic-, and laser-derived surgical smoke. These are potentially carcinogenic, but no evidence exists to support a cause–effect relationship for those exposed. In terms of infection risk, 6 (30 %) of the 20 studies assessed surgical smoke for the presence of viruses, with only 1 study (5 %) positively identifying viral DNA in laser-derived smoke. One study (5 %) demonstrated bacterial cell culture (Staphylococcus aureus) from a laser plume after surgery. Regarding mutagenesis and malignant spread, one study (5 %) reported the mutagenic effect of smoke, and one study (5 %) showed the presence of malignant cells in the smoke of a patient undergoing procedures for carcinomatosis.

Conclusions

The potentially carcinogenic components of surgical smoke are sufficiently small to be respirable. Infective and malignant cells are found in the smoke plume, but the full risk of this to the theater staff is unproven. Future work could focus on the long-term consequences of smoke exposure.
Literature
1.
Massarweh NN, Cosgriff N, Slakey P (2006) Electrosurgery: history, principles, and current and future uses. J Am Coll Surg 202:520–530PubMedCrossRef
2.
Lawrentschuk N, Fleshner NE, Bolton DM (2010) Laparoscopic lens fogging: a review of etiology and methods to maintain a clear visual field. J Endourol 24:905–913PubMedCrossRef
3.
Spruce L, Braswell ML (2012) Implementing AORN-recommended practises for electrosurgery. AORN J 96:373–388CrossRef
4.
5.
6.
7.
Edwards BE, Reiman RE (2008) Results of a survey on current surgical smoke control practices. AORN J 87:739–749PubMedCrossRef
8.
Edwards BE, Reiman RE (2012) Comparison of current and past surgical smoke control practices. AORN J 95:337–350PubMedCrossRef
9.
10.
11.
12.
Andreasson SN, Anundi H, Sahlberg B, Ericsson CG, Walinder R, Enlund G, Pahlman L, Mahteme H (2009) Peritonectomy with high-voltage electrocautery generates higher levels of ultrafine smoke particles. Eur J Surg Oncol 35:780–784PubMedCrossRef
13.
Bruske-Hohfeld I, Preissier G, Jauch KW, Pitz M, Nowak D, Peters A, Wichmann HE (2008) Surgical smoke and ultrafine particles. J Occup Med Toxicol 3:31CrossRef
14.
DesCoteaux JG, Picard P, Poulin E, Baril M (1996) Study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc 10:152–158PubMedCrossRef
15.
Nezhat C, Winer WK, Nezhat F, Nezhat C, Forrest D, Reeves WG (1987) Smoke from laser surgery: is there a health hazard? Lasers Surg Med 7:376–382PubMedCrossRef
16.
Smith J, Yeh HC, Muggenburg B, Guilmette R, Martin LS, Strine PW (1992) Study design for the characterization of aerosols during surgical procedures. J Scand J Work Environ Health 18(Suppl 2):106–109
17.
Fitzgerald JE, Malik M, Ahmed I (2012) A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc 26:337–342PubMedCrossRef
18.
Hollmann R, Hort CE, Kammer E, Naegele M, Sigrist MW, Meuli-Simmen C (2004) Smoke in the operating theatre: an unregarded source of danger. Plast Reconstr Surg 114:458–463PubMedCrossRef
19.
Lin YW, Fan SH, Chang KH, Huang CS, Tang CS (2010) A novel inspection protocol to detect volatile compounds in breast surgery electrocautery smoke. J Formos Med Assoc 109:511–516PubMedCrossRef
20.
Moot AR, Ledingham KM, Wilson PF, Senthilmohan ST, Lewis DR, Roake J, Allardyce R (2007) Composition of volatile organic compounds in diathermy plume as detected by selected ion flow tube mass spectrometry. Anz J Surg 77:20–23PubMedCrossRef
21.
Sagar PM, Meagher A, Sobczak S, Wolff BG (1996) Chemical composition and potential hazards of electrocautery smoke. Br J Surg 83:1792PubMedCrossRef
22.
Weston R, Stephenson RN, Kutarski PW, Parr NJ (2009) Chemical composition of gases surgeons are exposed to during endoscopic urological resections. Urology 74:1152–1155PubMedCrossRef
23.
Wu YC, Tang CS, Huang HY, Liu CH, Chen CH, Chen CR, Lin YW (2011) Chemical production in electrocautery smoke by a novel predictive model. Eur Surg Res 46:102–107PubMedCrossRef
24.
Abramson AL, Dilorenzo TP, Steinberg BM (1990) Is papillomavirus detectable in the plume of laser-treated laryngeal papilloma? Arch Otolaryngol Head Neck Surg 116:604–607PubMedCrossRef
25.
Capizzi PJ, Clay RP, Battey MJ (1998) Microbiologic activity in laser resurfacing plume debris. Lasers Surg Med 23:172–174PubMedCrossRef
26.
Hughes PSH, Hughes AP (1998) Absence of human papillomavirus DNA in the plume of erbium: YAG laser-treated warts. J Am Acad Dermatol 38:426–428PubMedCrossRef
27.
Kunachak S, Sithisarn P, Kulapaditharom (1996) Are laryngeal papillomavirus-infected cells viable in the plume derived from a continuous mode carbon dioxide laser, and are they infectious? a preliminary report on one laser mode. J Laryngol Otol 110:1031–1033PubMedCrossRef
28.
Sawchuk WS, Weber PJ, Lowy DR, Dzubow LM (1989) Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol 21:41–49PubMedCrossRef
29.
Wisniewski PM, Warhol MJ, Rando RF, Sedlacek TV, Kemp JE, Fisher JC (1990) Studies on transmission of viral disease via the CO2 laser plume and ejecta. J Reprod Med 35:1117–1123PubMed
30.
Gatti JE, Bryant CJ, Noone RB, Murphy JB (1992) The mutagenicity of electrocautery smoke. Reconstr Surg 89:781–784CrossRef
31.
Ikramuddin S, Lucas J, Ellison EC, Schirmer WJ, Melvin WS (1998) Detection of aerosolised cells during carbon dioxide laparoscopy. J Gastro Surg 2:580–583CrossRef
32.
33.
34.
Lewin JM, Brauer JA, Ostad A (2011) Surgical smoke and the dermatologist. J Am Acad Dermatol 65:636–641PubMedCrossRef
35.
Donaldson K, Brown D, Clouter A, Duffin R, Macnee W, Renwick L, Tran L, Stone V (2002) The pulmonary toxicology of ultrafine particles. J Aerosol Med 15:213–220PubMedCrossRef
36.
Gates MA, Feskanich D, Speizer FE, Hankinson SE (2007) Operating room nursing and lung cancer risk in a cohort of female registered nurses. Scand J Work Environ Health 33:140–147PubMedCrossRef
37.
38.
Metadata
Title
Is surgical smoke harmful to theater staff? a systematic review
Authors
Nicholas Mowbray
James Ansell
Neil Warren
Pete Wall
Jared Torkington
Publication date
01-09-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-2940-5

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