Hazards of surgical smoke in the Operating rooms

Although in most cases surgical smoke is not an immediate threat to the patient, surgeon, and OR personnel, it cannot be ignored. Surgeons and OR personnel should be aware of the potential risks that surgical smoke poses and utilize reasonable measures to minimize exposure and prevent adverse effects.The following established and theoretical concerns regarding surgically generated smoke are supported by scientific data:1. Human-to-human viral transmission can occur via laser smoke when the tissue being ablated contains a high concentration of virus, such as in cases of papilloma ablation. One case of viral transmission has essentially been proven, and a number of others have been suggested. Smoke evacuators and high-efficiency filtration masks/respirators can help prevent viral transmission.2. Electrocautery generates CO in the peritoneal cavity that exceeds recommended ambient exposure levels and can lead to methemoglobinemia that will not be indicated by pulse oximetry. This may be significant for patients with coronary artery disease and may be a contributing factor in the development of postoperative nausea and headache after laparoscopic surgery. Ventilation with high concentrations of oxygen and continuous ventilation of the pneumoperitoneum during and after electrocautery use can attenuate the increase in CO.3. Viable cells can be present in the electrocautery plume and may lead to port-site metastases through a method known as the chimney effect. Avoidance of port-site gas leakage, minimal tumor handling to prevent exfoliation and aerosolization of cell, and ventilation of the pneumoperitoneum through cannulas either continuously or intermittently may help to prevent port-site metastases.4. Surgical smoke and aerosols are irritating to the lungs and have approximately the mutagenicity of cigarette smoke. Risks from exposure are cumulative, and are greater for those closer to the point of smoke production. OR personnel should decide which, if any, methods they want to utilize to minimize their exposure.5. The risks posed by the aerosol generated from the ultrasonic (harmonic) scalpel compared to that of laser and electrocautery is not known, and may be greater due to the larger size of particles generated and because it is a cooler aerosol and therefore may contain more biologically viable particles.6. The toxic effects of aerosols on the intraabdominal cellular immune system are not known, and may decrease this system’s ability to fight intraabdominal infection and cancer.