Knowledge mapping of surgical smoke from 2003 to 2022: a bibliometric analysis.

PURPOSE: The purpose of this study is to identify and characterize the literature on surgical smoke, visualize the data and sketch a certain trending outline. METHODS: In the Web of Science Core Collection (WoSCC), all the data were acquired from January 1st 2003 to December 31st 2022. VOSviewer and CiteSpace were employed to visualize data, based on publications, bibliographic coupling, co-citation, or co-authorship relations. Microsoft Excel 2019 was used to comb and categorize all the statistics. RESULT: A total 363 of journal papers were retrieved. The publication number was in a slow but steady growth between 2003 and 2019, followed by a sharp surge in 2020, and then the publication kept in a productive way. Surgical endoscopy and other interventional techniques was the most active journal on surgical smoke. USA played an important role among all the countries/regions. There were 1847 authors for these 363 papers, among whom 44 authors published more than three articles on surgical smoke. "Surgical smoke", "covid-19" and "surgery" were the top 3 appeared keywords, while the latest hot-spot keywords were "COVID-19", "virus", "transmission", "exposure" and "risk". There were 1105 co-cited references and 3786 links appeared in all 363 articles. Among them, 38 references are cited more than 10 times. The most co-cited article was "Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery." Based on the titles of references and calculated by CiteSpace, the top 3 cluster trend network are "laparoscopic surgery", "COVID-19 pandemic" and "surgical smoke". CONCLUSION: According to bibliometric analysis, the research on surgical smoke has been drawing attention of more scholars in the world. Increasing number of countries or regions added in this field, and among them, USA, Italy, and China has been playing important roles, however, more wide and intense cooperation is still in expectation.

Characterisation and mitigation of gas leaks at laparoscopy: an international prospective, multi-center cohort clinical trial.

INTRODUCTION: Gas leaks polluting the operating room are common in laparoscopy. Studies defining methods for sensitive leak characterisation and mechanical mitigation in real world settings are, however, lacking. METHODS: Mobile optical gas imagers (both a miniaturised Schlieren system and sensitive tripod-mounted near-infrared carbon dioxide camera (GF343, FLIR)) prospectively defined trocar-related gas leaks occurring either spontaneously or with instrumentation during planned laparoscopic surgery at three hospitals. A boutique Matlab-based analyser using sequential frame subtraction categorised leaks (class 0-no observable leak; class 1-marginally detectable leak; class 2-short-lived plume; class 3-energetic, turbulent jet). Concurrently, the usefulness of a novel vacuum-ring device (LeakTrap™, Palliare, Ireland) designed as a universal adjunct for existing standard laparoscopic ports at both abdominal wall and port valve level was determined similarly in a phase I/11 clinical trial along with the device's useability through procedural observation and surgeon questionnaire. RESULTS: With ethical and regulatory approval, 40 typical patients (mean age 58.6 years, 20 males) undergoing planned laparoscopic cholecystectomy (n = 36) and hernia repair (n = 4) were studied comprising both control (n = 20) and intervention (n = 20) cohorts. Dual optical gas imaging was successfully performed across all procedures with minimal impact on procedural flow. In total, 1643 trocar instrumentations were examined, 819 in the control group (mean 41 trocar instrumentations/procedure) and 824 in the intervention group (mean 41.2 trocar instrumentations/procedure). Gas leaks were detected during 948(62.6%) visualised trocar instrumentations (in 129-7.8%-the imaging was obscured). 14.8% (110/742) and 60% (445/742) of leaks in control patients were class 0 and 3, respectively, versus 59.1% (456/770) and 8.7% (67/772) in the interventional group (class 3 v non-class 3, p < 0.0001, χ2). The Leaktrap proved surgically acceptable without significant workflow disruption. CONCLUSION: Laparoscopic gas leaks can be sensitively detected and consistently, effectively mitigated using straightforward available-now technology with most impact on the commonest, highest energy instrument exchange leaks.

Analysis and visualization of the research progress on surgical smoke.

BACKGROUND: With the advancement of medical technology, tools such as electrosurgical equipment, laser knives, and ultrasonic scalpels have made modern medical procedures more convenient and effective. However, the generation of surgical smoke during these procedures poses significant health risks to medical personnel. Despite this, only a few studies have examined the literature systematically in this area. By analyzing bibliometric data on surgical smoke, we can gain insights into current research hotspots and forecast future trends. METHODS: This study included literature related to surgical smoke from the Web of Science and China National Knowledge Infrastructure (CNKI) databases, covering the period from 2000 to 2024. We used VOSviewer, CiteSpace, and BioBERT to visualize research trends and hotspots. RESULTS: In the early stages of research, the focus was mainly on the composition, generation mechanisms, and susceptible populations related to surgical smoke. In recent years, with the development of laparoscopic surgery and the global COVID-19 pandemic, research interests have shifted towards occupational protection of healthcare workers and public health. Currently, the research in this field primarily explores the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as occupational protection and health education for healthcare workers. Disease research focuses heavily on Smoke Inhalation Injury, Infections, Neoplasms, Postoperative Complications, and Inflammation. CONCLUSION: We explored future research directions in the field of surgical smoke using VOSviewer, CiteSpace, and BioBERT. Our findings indicate that current research focuses on investigating the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as on occupational protection and health education for healthcare workers. We summarized existing preventive measures, aiming to facilitate further research advancements and the translation of research outcomes into clinical results. These efforts provide new insights for advancing research in occupational protection of healthcare workers.

Virus and viral components transmitted through surgical smoke; a silent danger in operating room: a systematic review.

BACKGROUND: During surgical procedures, heat-generating devices are widely used producing surgical smoke (SS). Since the SS can transmit infectious viruses, this systematic review was designed to investigate the potential viruses transmitted through SS. METHODS: PubMed, Scopus, Web of Science, ProQuest, and Embase databases, along with Cochran Library, and Google Scholar search engine were searched systematically (by April 21, 2024). No language, place, and time restrictions were considered. All studies evaluating the SS and virus transmission, and whole investigations regarding the viral infections transmitted through SS were totally considered inclusion criteria. Besides, non-original, qualitative, case reports, case series, letters to the editor, editorial, and review studies were excluded from the analysis. This study was conducted in accordance with the PRISMA 2020 statement. RESULTS: Twenty-six eligible studies were selected and reviewed for data extraction. The results showed that the SS contains virus and associated components. Six types of viruses or viral components were identified in SS including papillomavirus (HPV, BPV), Human Immunodeficiency Virus (HIV), varicella zoster, Hepatitis B (HBV), SARS-CoV-2, and Oral poliovirus (OPV), which are spread to surgical team through smoke-producing devices. CONCLUSIONS: Since the studies confirm the presence of viruses, and viral components in SS, the potential risk to the healthcare workers, especially in operating room (OR), seems possible. Thus, the adoption of protective strategies against SS is critical. Despite the use of personal protective equipment (PPE), these viruses could affect OR personnel in surgical procedures.

Escape of surgical smoke particles, comparing conventional and valveless trocar systems.

BACKGROUND: During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. MATERIALS AND METHODS: Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. RESULTS: The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. CONCLUSIONS: This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.

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.

BACKGROUND: Surgical 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. METHODS: In 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. RESULTS: We 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. CONCLUSION: We 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.

The Feasibility and Efficacy of a Novel Nano Filter in Reducing the Hazards of Surgical Smoke Exposure During Gynecological Laparoscopic Surgery.

NEED: This study developed a nano-filter to reduce the concentration of hazardous substances in surgical smoke. METHODOLOGY AND DEVICE DESCRIPTION: The nano-filter consists of nanomaterials and hydrophilic materials. Smoke was collected before and after using the new nano-filter during the surgery. PRELIMINARY RESULTS: The concentration of PM2.5 and PAHs produced by the monopolar device was the highest (P < .05). The concentration of PM2.5 and PAHs after using a nano-filter was less than the non-filter group (P < .05). CURRENT STATUS: Surgical smoke generated by monopolar and bipolar devices pose a potential cancer risk to health staff in the operational room. The concentration of PM and PAHs were reduced and the cancer risk was not obvious by using the nano-filter.

The Problem with 'Suction Only' Methods to Reduce Surgical Smoke Exposure.

Surgical staff and patients are frequently exposed to surgical smoke and there is mounting evidence that this may be harmful. Borsetti et al. have devised a novel approach to minimising intraoperative exposure to surgical smoke. Here, I briefly outline my concerns with the 'suction only' approach to addressing this problem. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical smoke and the orthopedic surgeon: a non-systematic review of the hazards and strategies for mitigating risk.

INTRODUCTION: Surgical smoke generated through the use of electrical surgical devices poses a risk to the surgeon, medical personnel in the operating room, and the patient by exposing them to environmentally hazardous particulate matter. Previous investigation has shown that surgical smoke leads to an increased risk of pulmonary conditions, circulatory disorders, and irritation of the eyes, nose, and throat. Transmission of infectious disease can occur through inhalation of viral particles, and the presence of carcinogens are also of major concern. The deleterious effects of surgical smoke are well documented in several subspecialties, namely dermatology and general surgery, but there has been little discussion on the topic amongst orthopedic surgeons. METHODS: A non-systematic review of the literature was completed with the aim of identifying the major categories of adverse health effects associated with surgical smoke inhalation and offering recommendations to reduce these hazards in the orthopedic surgical community. RESULTS: Three primary categories of risk associated with surgical smoke inhalation were identified: inflammation, viral/bacterial transmission, and carcinogenicity. In addition, strategies for mitigating risk and best practice recommendations were explored. CONCLUSION: Surgical smoke is an under-recognized occupational hazard within the orthopedic surgery literature. There are several strategies which can be employed to reduce risk. Further investigation is needed to understand the long-term impact of these risks, as well as what can be done to improve the practicality and compliance with protective measures.

Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study.

Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.

In vivo and in vitro study of the potential hazards of surgical smoke during cervical cancer treatment with an ultrasonic scalpel.

OBJECTIVE: To explore the composition and potential hazards of cervical cancer surgical smoke generated by ultrasonic scalpels. METHODS: Surgical smoke was collected during the cutting and coagulation of cervical cancer xenograft tumors using an ultrasonic scalpel. Surgical smoke-filtered cells were cultured and subcutaneously injected into nude mice. Cell morphology and viability were assessed by HE, Pap and trypan blue staining. HPV DNA in surgical smoke samples was identified by PCR. HPV transmission was determined by culturing HPV-negative C33A cells in HPV-positive surgical smoke-filtered medium. The cytotoxicity of surgical smoke to small airway epithelial cells (SAECs) and THP-1 cells was determined by CCK-8, MTS and LDH release assays. Volatile organic compounds (VOCs), which are present in cervical cancer surgical smoke samples obtained by laparoscopic hysterectomy, were analyzed by gas chromatography-mass spectrometry (GC-MS). RESULTS: Cellular debris and epithelioid cells were found in surgical smoke, but no malignant cells were observed. HPV DNA was identified in all smoke samples, and HPV genotypes were matched to those in cervical cancer cells. Coculture with HPV-positive surgical smoke-filtered medium induced an 83% (15 of 18) HPV positivity rate in C33A cells. Subculture in normal medium decreased this rate to 50% (9 of 18). The proliferation of SAECs and THP-1 cells was inhibited by smoke-filtered medium in a time-dependent manner. The concentration of total VOCs, especially benzene, toluene and xylene, in surgical smoke exceeded the standard for good indoor air quality. CONCLUSION: Cervical cancer surgical smoke contains HPV and VOCs and exhibits cytotoxicity and infectivity in vitro. Surgical smoke is an occupational hazard to health care workers.

Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era.

BACKGROUND: Surgical smoke during operation is a well-known health hazard for medical staff. This study aimed to investigate the dynamics of surgical smoke during open surgery or laparoscopic surgery for colorectal disease. METHODS: This study quantitated particulate matter (PM) counts as part of surgical smoke in 31 consecutive patients who underwent colectomy at the Niigata City General Hospital using a laser particle counter. Particles were graded by size as ≤ 2.5 µm PM (PM2.5) or > 2.5 µm PM (large PM). Operative procedures were categorized as either open surgery (n = 14) or laparoscopic surgery (n = 17). RESULTS: The median patient age was 72 (range 41-89) years and 58.1% were male. The total PM2.5, PM2.5 per hour, and maximum PM2.5 per minute counts during operation were significantly higher in open surgery than in laparoscopic surgery (P = 0.001, P < 0.001, and P = 0.029, respectively). Large PM counts (total, per hour, and maximum per minute) were also higher in the open surgery group than in the laparoscopic surgery group. The maximum PM2.5 concentration recorded was 38.6 µm/m3, which is considered "unhealthy for sensitive groups" according to the U.S. Environment Protection Agency air quality index standards, if it was a 24-h period mean value. CONCLUSION: Exposure to surgical smoke is lower during laparoscopic surgery than during open surgery for colorectal diseases.

The introduction of wide-angle 270° laparoscopy through a novel laparoscopic camera system.

BACKGROUND: Laparoscopy has enjoyed improvements over the last three decades primarily in achieving high definition, but the 70° field of view (FOV) remains unchanged. Complications related to events that take place out of the FOV continue to be reported. Additional problems leading to poor visualization are fogging and smoke accumulation. A novel laparoscopic system (SurroundScope, 270Surgical) was developed and dramatically expands the FOV from the 70° to 270° by adding side cameras at the distal tip of the laparoscope, while LED illumination eliminates fogging and improves smoke effects. This study describes the initial clinical experience with SurroundScope and its potential advantages over traditional laparoscopy. METHODS: SurroundScope was studied at Bnai Zion Medical Center in Israel and the Minnesota Institute for Minimally Invasive Surgery in America. 27 laparoscopic surgeries were performed, and at the end of each procedure, evaluations were completed by all surgeons and camera holders. RESULTS: All 27 cases were completed successfully without adverse events. No injuries occurred as a result of surgical tool manipulation outside of the central frame while 133 potentially adverse events were identified on side frames. There was no fogging across the 27 cases. The impact of smoke was negligible in all cases, as laparoscope removal or venting was never necessary. Surgeon respondents indicated that tools could be followed from the port to the site of surgery without camera manipulation. Most surgeons strongly agreed that the potential to identify bleeding was improved. Camera holders strongly agreed that the ergonomics were improved and that they moved the camera less than with a standard laparoscope. CONCLUSIONS: Initial results demonstrate numerous advantages for SurroundScope as compared to traditional laparoscopy. The important benefits of expanded FOV, complete lack of fogging, and negligible smoke may improve patient safety, reduce adverse events and the duration of surgery. Further investigation to quantify these benefits is recommended.

Characterisation of trocar associated gas leaks during laparoscopic surgery.

BACKGROUND: During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. METHODS: A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. RESULTS: Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. CONCLUSIONS: We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.

Exposure of operating room surgical staff to surgical smoke under different ventilation schemes.

In operating rooms (ORs), surgical smoke is released during electro and laser surgery as well as in ultrasound applications, which poses a health risk to the surgical personnel. In this experimental study, a surgical smoke substitute was developed. The particle concentration near the facial region of different OR staff members and the extract concentration were measured while varying the airflow (unidirectional air flow (UDAF), turbulent mixing ventilation (TMV), and displacement ventilation (DV)) as well as the OR light configuration (lamp positions and shapes). The lowest exposure was observed with DV due to the upward flow motion of contaminants toward the extract openings in the ceiling. UDAF was the only airflow scheme in which the presence of surgical lights affected personnel exposure to surgical smoke; where the presence of OR lights greatly increased surgical smoke exposure due to the wake below the lights. In summary, it was found that the highest exposure to surgical smoke occurred in UDAF and the surgeons were exposed to a significantly higher concentration of surgical smoke than the assistant and anesthesiologist.

Ultrafine particle concentrations during laser hair removal: Effectiveness of smoke evacuators.

BACKGROUND AND OBJECTIVES: Laser smoke is a biohazard that contains potentially dangerous toxic and biological components. In laser hair removal (LHR), practitioners undergo prolonged exposure as this procedure is widely used without protective measures. Little is known about the effect of smoke evacuators on ultrafine particle concentrations during LHR. This study aims to assess the effect of different laser devices and different smoke evacuators on the ultrafine particle concentrations in the room during LHR. STUDY DESIGN/MATERIALS AND METHODS: In a prospective observational study, we included patients with skin phototypes 2-4 for 755 nm Alexandrite LHR at two study sites, receiving treatment in axillae and pubic areas. Ultrafine particle concentrations were measured during LHR for two different alexandrite lasers, with and without an external smoke evacuator. Moreover, we assessed a device for LHR with a smoke evacuator integrated into the handpiece. Primary outcomes were the concentration of ultrafine particles (0.2-0.3 µm) per m3 at 1 min after initiation of treatment and maximum concentrations. RESULTS: A total of 15 patients were recruited for routine LHR. Without a smoke evacuator, already at 1 minute after treatment onset, ultrafine particle concentrations rapidly increased. Both external and integrated smoke evacuators were highly effective with a 3.7-7-fold decrease in maximal particle count. Similarly, maximal particle concentrations remained low with both smoke evacuators. At both study sites, particle concentrations decreased slowly (8 min for 50% reduction) when treatment stopped. CONCLUSION: LHR procedures generated an increase of ultrafine particles. Both the external and integrated smoke evacuators are highly effective in controlling ultrafine particle concentrations during LHR. Once particle concentrations are elevated and the process had been completed, clearance of ultrafine particles is rather slow.

Measurement and Control of Surgical Smoke to Enhance Surgical Team Safety.

Amid the coronavirus disease 2019 era, concern about the safety of surgical teams related to surgical smoke (SS) is rising. As simple ventilation improvement methods (SVIMs), we replaced 4 of the 8 supply diffusers with a direction-adjustable louver-type, closed 2 of the 4 exhaust grills, and strengthened the sealing of the doorway. Dynamic changes in the concentration of particulate matter (PM) with sizes of < 1.0 µm (PM1.0) were measured using low-cost PM meters (LCPMs) at eight locations in the operating room (OR). SS concentration up to 4 minutes at the location of the surgeon, first assistant, and scrub nurse before and after SVIMs application decreased from 65.4, 38.2, 35.7 µg/m3 to 9.5, 0.1 and 0.7 µg/m3 respectively. A similar decrease was observed in the other 5 locations. SVIMs could effectively control SS and the LCPM was also effective in measuring SS in the OR or other spaces of the hospital.

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

PURPOSE: Surgical 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. METHODS: We 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. RESULTS: Concentrations 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. CONCLUSION: Surgical 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.

Comparison of surgical smoke between two approaches for endoscopic thyroidectomy and open thyroidectomy.

BACKGROUND: Surgical smoke has been recognized as a potential health risk by an increasing number of researchers. Moreover, the counts of surgical smoke produced during different surgical approaches are different. This study aimed to measure and compare the particulate matter (PM) of surgical smoke generated during open thyroidectomy and two endoscopic approaches for thyroidectomy to provide guidance for safe clinical practices. METHODS: Forty-eight patients with thyroid cancer admitted to our hospital from June 2020 to December 2021 and treated with different surgical approaches were enrolled in this study. The total and peak counts of PM, dynamic changes, and other characteristics of surgical smoke produced during surgery were recorded. PM was classified as PM2.5 (size ≤ 2.5 µm) and PM10 (size ≤ 10 µm). RESULTS: In a single cut, both the peak and total counts of PM2.5 and PM10 of surgical smoke in the open thyroidectomy group (n = 15) were significantly higher than those in the breast approach endoscopic thyroidectomy with CO2 insufflation group (n = 15) and the gasless transaxillary endoscopic thyroidectomy group (n = 18) (p < 0.001). Moreover, the latter two groups showed no significant differences in the peak and total counts of PM2.5 and PM10 (p > 0.05). CONCLUSION: In thyroid surgery, more surgical smoke is produced during open thyroidectomy than during endoscopic thyroidectomy, while different endoscopic approaches showed no significant difference in surgical smoke production. Thus, endoscopic approaches outperform the open thyroidectomy approach with regard to surgical smoke production.

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.