Electrocautery smoke exposure and efficacy of smoke evacuation systems in minimally invasive and open surgery: a prospective randomized study

Abstract

Worldwide, health care professionals working in operating rooms (ORs) are exposed to electrocautery smoke on a daily basis. Aims of this study were to determine composition and concentrations of electrocautery smoke in the OR using mass spectrometry. Prospective observational study at a tertiary care academic center, involving 122 surgical procedures of which 84 were 1:1 computer randomized to smoke evacuation system (SES) versus no SES use. Irritating, toxic, carcinogenic and mutagenic VOCs were observed in OR air, with some exceeding permissible exposure limits (OSHA/NIOSH). Mean total concentration of harmful compounds was 272.69 ppb (± 189 ppb) with a maximum total concentration of harmful substances of 8991 ppb (at surgeon level, no SES). Maximum total VOC concentrations were 1.6 ± 1.2 ppm (minimally-invasive surgery) and 2.1 ± 1.5 ppm (open surgery), and total maximum VOC concentrations were 1.8 ± 1.3 ppm at the OR table 'at surgeon level' and 1.4 ± 1.0 ppm 'in OR room air' away from the operating table. Neither difference was statistically significant. In open surgery, SES significantly reduced maximum concentrations of specific VOCs at surgeon level, including aromatics and aldehydes. Our data indicate relevant exposure of health care professionals to volatile organic compounds in the OR. Surgical technique and distance to cautery devices did not significantly reduce exposure. SES reduced exposure to specific harmful VOC's during open surgery.Trial Registration Number: NCT03924206 (clinicaltrials.gov).

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1

Flow chart overview of data analysis. *1 breath analysis was excluded for technical reasons. **In total, 17 datasets had to be excluded because of incomplete data (n = 6) or for technical reasons (n = 11).

Figure 2

OR set-up for measurements at surgeon level. The inlet of the mass spectrometer (I) was placed at the level of the surgeon’s (D) mouth/nose, directly above the operative field (C). (Figure created with Adobe Photoshop version 22.4.2; https://www.adobe.com/products/photoshop.html).

Figure 3

Face mask with dedicated connector for the mass spectrometry inlet (red circle) allowed measurement of inhaled and exhaled VOC’s during surgery.

Figure 4

Maximum concentrations of selected VOCs at surgeon level during open procedures and minimally invasive procedures. Each subplot compares operations in which SES was used (red) to operations in which it was not (black). p values are given. The horizontal dash marks are the concentrations measured during individual operations, and the box and whisker plots show the maximum, 75th percentile, average (circle marker), 50th percentile, and 25th percentile for all operations.