Hi-tech Surgery Creates Toxic Particles

Hi-tech Surgery Creates Toxic Particles

By Susan English

Marlborough, MA–A recent seminar on “Safety & Infection Control in the OR” at the Third Annual Northeast Infection Control Conference & Products Exhibition addressed the recently documented effects of electrosurgery unit (ESU) smoke and “laser smoke plume” on surgical personnel and their patients in the operating room. Smoke ingested from ESUs has been found to be very similar to cigarette smoke in lethal capacity. (ESUs are used for many of the same surgical applications as lasers, including excision of malignant tumors.) Both kinds of smoke are generated as a result of tissue combustion, cell destruction caused by the heating and ultimate vaporization of water in the dermal cells.

According to one expert, putting a nonsmoker in a normal laser or cautery laparoscopic procedure is “equivalent to [the patient] smoking 60 cigarettes.” In addition, laproscopic smoke (smoke ingested in the belly of the patient during surgery) creates certain gases in the blood, causing a very significant difference in recovery rates of patients. It is also linked to the creation of adhesions in the abdomen, which can cause the organs to stick together, resulting in scarring and other post-operative difficulties.

But there is another problem brought out at the seminar: viral infection. A leading researcher, Dr. Douglas E. Ott says: “Smoke produced from tissue combustion creates a toxic bioaerosol.” Evidence indicates that ESU smoke has a significantly higher amount of viable viral content than laser smoke. In a session on “Prevention and Control of Surgical Smoke,” Kay Ball, RN, MSA, CNOR, director of education at the United Medical Network (Lewis Center, OH), and a leading expert in the field of laser surgery technology, cited recent studies showing that viable HIV DNA and HPV DNA has been found in both elecrocautery and laser plume.

Smoke or plume that occurs at the point of incision is usually evacuated by in-line suction and, optimally, a centralized air evacuation system or by portable smoke evacuation units. Unfortunately, such “centralized” systems are rare and costly and many surgeons object to the noise of the portable units as well as the floor space they use. It seems that some doctors have yet to recognize the significant danger to which not only they but their assistants and patients are exposed during smoke-generating surgery. The general consensus at the sessions was that if there were such portable smoke evacuators sitting in the OR, they somehow “never get turned on.”

In her book Lasers: The Perioperative Challenge, (Second Edition, Mosby-Year Book, Inc., St. Louis, 1995) Kay Ball points out that laser plume consists of “particles, toxins, and steam.” Particles include carbonized tissue, blood, and potential virus and bacteria. Toxins consist of polycyclic aromatic hydrocarbons, benzene, toluene, formaldehyde, and acrolein, as well as other mutagens and carcinogens, which produce the offensive odor within the smoke. Studies have shown that 77 percent of the particulate matter in the plume is smaller than 1.1 &#181m, which makes it easily deposited in the alveoli of the lungs if inhaled, causing chronic irritation that can lead to bronchitis or emphysema-like conditions.

While bacteria only colonize on air particles that are 5 &#181m or larger, viral organisms are smaller than 0.1 &#181m and usually attach themselves to larger cells. This makes them easy to evacuate, and a typical filter can evacuate plume particulate matter down to 0.1 or 0.3 &#181m. Filtering usually involves a three-step process: a pre-filter to capture large particles and fluid; an ULPA filter for small particles; and a charcoal filter to adsorb toxic, odorous gases. n


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