Electrosurgical Plume Articles

During the Surgical Application of energybased technologies, there is a well-recognized production of “smoke” that can impede surgical progress. The confined spaces associated with laparoscopic procedures have made smoke production a more significant problem. The aerosolized particles can impair visibility by settling on the lens of the laparoscope or by remaining in suspension between the laparoscopic and the surgical objective.
Electrosurgery is an established and well-accepted medical technique. The term includes electrodessication, electrocoagulation, electrodissection, electrocautery, and electrolysis. Many important developments followed teh first crude experiments in 1875 in which the effects of electricty upon living tissue were evaluated.
When analyzed, smoke from electrosurgical units, commonly known as Bovie smoke, is shown to be quite similar to that of other potentially pathogenic smoke, behaving as a carcinogen, a mutagen and an infectious vector. In addition, particulate matter in smoke is known to have health risks related to inducing inflammatory and allergic responses in susceptible people.
Laparoscopic procedures using laser for tissue combustion processes generate smoke. This biphasic aerosol is confined to the abdominal cavity. Respiratory absoption of carbon monoxide causes changes in carboxyhemoglobin levels. Absorption of smoke components throught the peritoneum has not been evaluated.
Electrosurgical smoke has been recognized as a definite nuisance in the OR for at least a decade and serveral studies imply that viable human bloodborne pathogens can be transferred via smoke plume particulate. These particulates include not only HIV and human papilloma virus, but the probably more pervasive hepatitis and increasingly antibiotic-resistant tuberculosis.
The effect on cell viability of smoke produced during high – frequency electro – surgery has not been previously reported. The aim of this study was to produce smoke in vitro , in a closed environment similar to that encountered in minimal access surgery , and to test its cytotoxic effects on cultured cells.
While the word has been out for many years about the dangers of laser plme, there’s a new alarm being sounded about the plume generated by electrocautery and other thermal cutting methods: That plume may be equally hazardous — or mor so, researchers warn. The problem with smoke from laser and electrical surgical procedures is so serious that NIOSH sent out a Hazard Controls notice.
The observed occurrence of port site recurrence in laparoscopic surgery for malignant disease has stimulated interest in the dissemination of tumor cells during surgery. Study of electrocautery smoke has revealed the presence of large particles and viable viruses. The purpose of this study was to determine if viable malignant cells are present in suspension within the electrocautery plume.
The effect on cell viability of smoke produced during high – frequency electro – surgery has not been previously reported. The aim of this study was to produce smoke in vitro , in a closed environment similar to that encountered in minimal access surgery , and to test its cytotoxic effects on cultured cells.
In a previous issue of this journal (Volume 5, Number 4), I wrote an editorial about the need to approach the resurgence of electrical surgery with caution so as not to repeat the history of past mistakes. I now take the opportunity to expand this admonition and also to eat some of my own words.
Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator saftey. We therefore have studied a group of human and bovine warts to define further the potential risk of wart therapy and to test whether a surgical mask could reduce exposure.
Surgical smoke from laparoscopic surgery has harmful byproducts that are absorbed into the patient’s bloodstream, reaching toxic levels, new research shows. Patients treated by laser or electrosurgery through a scope had acutely highter levels of methemoglobin and carboxyhemoglobin in their blood than control patients who had surgery using nonthermal methods.
These data demonstrate the elevation in blood methemoglodin level occurs acutely due to a smoke component of tissue combustion produced by laser use during laparoscopic procedures. The effect of this prolongs intra-abdominal smoke exposure is seen in some patients as post operative nausea, dizziness and visual disturbances. Increased levels of methemoglobin reduce oxygen carrying capacity to tissues, locally and at distant sites.
Laproscopic procedures which generate smoke confine this toxic material to the intra-abdominal cavity. Absorption of portions of this material may occur via the peritoneal absorption. To evaluate whether smoke generated by by this process is absorbed, a study of changes in blood concentration of methemoglobin was designed.
Containment of airborne microorganisims to prevent transmission in a positively pressured operating room is challenging. Occupational transmission of Mycobacterium tuberculosis to perioperative personnel has occurred, but protection of the surgical site is of equal importance. HEPA filters can mitigate occupational exposure and improve air quality.
Although more and more states are adopting smoking restrictions in workplaces, restaurants, and bars to protect people from the dangers of second-hand cigarette smoke, health care workers continue to be exposed to similar dangers every day in the form of surgical smoke. During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. According to the NIOSH research studies have confirmed that this smoke plume can contain toxic gases and vapors such as benzene, hydrogen cyanide, and formaldehyde; bioaerosols; dead and live cellular material (including blood fragments); and viruses.
This paper deals with the hazzard of smoke production to patients undergoing endoscopic surgery. A study investigating methaemoglobin levels in patient group operated on using smoke generating devices as compared to a control group yielded a significantly positive correlation between smoke production and methaemoglobin concentration.
Surgical masks have been in widespread use since the early 1900s to help prevent infection of surgical wounds from staff-generated nasal and oral bacteria. Today, surgical masks vary widely in style and intended application and can be found in a broad range of hospital and health care settings.
Plastic surgeons encounter surgical smoke routinely as a by-product either of electrocautery, laser ablation, or ultrasonic (harmonic) scalpel tissue dissection. Strictly speaking, “smoke” is composed of the products of combustion, while “plume” is a mix of combusted and noncombusted particles, the mix and size of which can vary with the device used. The hazards of smoke plume inhalation are real, proven both scientifically and clinically.
Careful analysis of electrocautery smoke produced during breast surgery has found organic compounds that are unidentifiable with current analytical techniques. The purpose of this study was to determin the potential mutagenicity of the smoke produced by the electocautery knife during reduction mammaplasty.
Devices delivering energy to biological tissues can induce surgical smoke consisting of particles, vapor, gasses and aerosols. Besides interfeering with the view of the surgeon, the smoke is a risk for the health of both the users and patients. In literature, it has been shown that surgical smoke can contain carcinogenic and harmful biological agents.