Laser Plume Articles

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.
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.
Lasers have assumed an increasingly important role in otolaryngology-head and neck surgery in the past 10 years, with numerous studies in the literature supporting the use of this modality of treatment for various head and neck diseases. Relatively little data, however, exist regarding the effects of the smoke or plume byproducts resulting from this surgery.
A novel model system was used to investigate the spread of infectious particles and live cells through the application of lasers commonly used in clinical medicine. Supernatants from a cell line producing recombinant retroviruses carrying a marker gene were exposed to ER:YAG laser bearms.
Carbon dioxide laser energy is absorbed by intracellular water but not by proteins or nucleic acids. The possibility of dispersing viral DNA during laser therapy of human papillomavirus containing genital infections was explored using a filter hybridization technique. Samples were taken using dacron swabs from 110 patients in nine separate treatment sessions as wll as from five pre-filter canisters.
The potential hazards of aerosols produced by surgical devices interacting with human tissue and fluids are a source of concern to surgical staff and patients. Typical devices and procedures that can generate airborne debris are bone saws, surgical drills, electrocautery procedures, and laser surgery.
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.
The possibility that laser surgeons might inhale virus particles from laser vapor during the removal of certain lesions has been pointed out by several authors. The risk, however, is regarded as being low, provided adequate precautions are taken. Safety procedures related to eye protection, smoke evacuator systems, etc. have been established.
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.
This year, it has been estimated that more than 1 million excimer laser procedures will be performed in the United States alone. A number of viral pathogens have been identified in tears and the ocular surface. This raises the possibility that viral particles or subcomponents may become part of the airborne contaminants of the laser that are ejected into the air at supersonic speed during excimer laser ablation.
With the performance of CO2 laser resurfacing in venues such as television studios, concerns have arisen in the plastic surgical community about appropriate safety precautions being taken. The literature supports the presence of viable tumor cells and intact viral DNA and proviral human immunodeficiency virus (HIV)-DNA within the laser plume during laser ablation procedures utilizing continuous-wave lasers. Furthermore, inspired laser vapor by-products have been demonstrated to cause anatomically identifiable lesions in animals.
OSHA prepares guidelines to deal with laser surgery, which may be mroe dangerous to the surgeon than previously thought. Gerald L. Tennant, MD, began performing photorefactive keratectomy with an excimer laser in October 1990. Five years later, the surgeon was forced to retire due to health problems he believes may have been caused by airborne corneal particles or viruses contained in the plume generated from the laser.
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.
Laser vaporous by-products (plume) have been shown to contain fine particulate matter which creates anatomically identifiable lesions when chronically inspired. The particulates are commonly minuscule with mean aerodynamic diameters of 0.1 – 0.3 micron. Careful and continuous evacuation of the smoke with high flow rate evacuation systems equipped with sophisticated filtration systems have been shown to protect animal models breathing filtered plume.
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.
Excimer laser surgery for the correction of refractive errors is becoming one of the most widely performed ocular procedures. The surgery involves ablation of the corneal stroma and, in some cases, the corneal epithelium. Concern has increased about the potential health risks faced by excimer laser surgeons while performing photorefractive keratectomy and laser in-situ keratomileusis.
The most common questions that I am asked aboute CO2 laser skin resurfacing pertain to preoperative and postoperative care. This topic seems to be a leading source of contention among plastic surgeons. Actually, most of the care relies on common sense, and, once principles are understood, the plastic surgeon can add to or subtract from the basic formula.
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.
Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a surgical smoke containing ultrafine and accumulation mode particles. Epidemiological and toxicological studies have shown that exposure to particulate air pollution is associated with adverse cardiovascular and respiratory health effects.
Dermabrasion and carbon dioxide laser surgery aerosolize patient blood and tissue particles. The operating physician and assistants may therefore have intimate inhalational and mucous membrane contact with patients’ body fluids. Herein is described the use of an isolated ventilation system to protect physicians and assistants from blood and tissue products aerosolized during the course of dermabrasion and carbon dioxide laser surgery.
There has been an increasing awareness of the potential health risk of laser generated plume. Many laser systems, on impact with targeted tissue, produce a plume of smoke containing debris and vapor, which is released into the surrounding area. Concerns involving aerosolized carbonized material, viable tumor cell dispersion, and infection transmission have been evaluated.