Locate answers to frequently asked questions on surgical smoke plume, smoke evacuation guidelines, and the use of a surgical smoke evacuator. It is intended as an easy way to become familiar with the definitions and issues relevant to the generation, hazards and evacuation of surgical smoke.
Surgical smoke is the term used to describe any gaseous byproduct containing bio-aerosols, including viable and non-viable cellular material, resulting from laser tissue ablation and electrocautery. Other terms used to describe this byproduct are plume, aerosol and vapor. It should be noted that manufacturers of ultrasonic scalpels typically use the word vapor. And although most of the research done to date has been on what are called “hot tools” (laser and electrosurgical), the aerosols generated by an ultrasonic device should not be ignored as a potential health hazard. In fact, the risk posed by these devices may even be greater since the lower temperature vapor has a higher chance of containing more infectious and live materials. The volume of surgical smoke created during laser surgery or electrosurgery depends on the type of procedure, the surgeon’s technique, the type of tissue, the power levels used and duration, and the amount of tissue ablated or lased. Surgical smoke has been demonstrated to be cytotoxic, genotoxic and mutagenic.
All surgical smoke should be considered harmful if not evacuated appropriately. The gases produced during laser surgery or electrosurgery consist of carbon monoxide (CO2), hydrogen cyanide, toluene, benzene, formaldehyde, tetrachloroethylene and benz(a)pyrene, to name a few. At a minimum, over forty chemicals have been identified within laser plume and surgical smoke. Many of these chemical toxins have already been identified as known carcinogens. The potential risks to health care professionals from inhalation of these chemical by-products include pulmonary irritation and inflammation, transmission of infection and genotoxicity. There is also a potential risk to patients when the contaminants of surgical smoke are absorbed into a patient’s vascular system, primarily during laparoscopic procedures when surgical smoke is concentrated in the peritoneal cavity. Research studies have conclusively shown that surgical smoke is hazardous. Health care professionals need to be aware of the potential health risks associated with surgical smoke and use reasonable measures to minimize exposure and prevent harmful effects.
The best protection for health care professionals against the health hazards of surgical smoke is a freestanding smoke evacuator with a hose that evacuates the surgical smoke directly at the procedure site. While smoke evacuation systems are still considered by some to be noisy, expensive, annoying and cumbersome, most smoke evacuation systems today are affordable, smaller, quieter and easier to use, especially the smoke evacuation systems offered by Surgimedics. The key components to an efficient smoke evacuation system are: a capture device that does not interfere with the surgeon’s activities; a vacuum source with strong enough suction to evacuate the smoke properly; and a filtration system that is efficient down to 0.1 micron particles at 99.9995% as well as being capable of removing other viral products or harmful by-products. When use of a freestanding smoke evacuator is not available, both the common surgical mask and in-line filters for wall suction systems provide some protection from surgical smoke. Neither of these methods should be viewed as providing absolute protection. There are limitations in both the size of particle a surgical mask is able to trap and the amount of smoke an in-line filter is able to remove.