Surgical Smoke Plume Article Library - All

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Title Category Publication Date Description Publication Author


Aerosols and Splatter in Dentistry

Drills, Orthopedic, Reamers, Saws



The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental


The Journal of the American Dental Association, Vol 135, No 4 


Stephen K. Harrel, DDS; John Molinari, PhD  

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Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility 

General, Laparoscopic, OB/GYN 



Discusses the relationship of particle size in plume during laparoscopic procedures. Applies to general surgery as well as gynecologic laparoscopy.

Journal of Endourology, Vol 21, No 3


Kyle J. Weld, MD; Stephen Dryer; Caroline D. Ames; Kuk Cho; Chris Hogan; Myonghwa Lee; Pratim Biswas; Jamie Landman,  

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Biosafety Considerations for Autopsy


Drills, Reamers, Saws




An autopsy may subject prosecutors and others to a wide variety of infectious agents, including blood borne and aerosolized pathogens such as human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Other hazards include toxic chemicals (e.g., formalin, cyanide, and organophosphates) and radiation from radionuclides used for patient therapy and diagnosis. These risks can be substantially mitigated through proper assessment, personal protective equipment, appropriate autopsy procedures, and facility design.


The American Journal of Forensic Medicine and Pathology, Vol 23, No 2


Kurt B. Nolte, MD; David G. Taylor, PhD; Jonathan Y. Richmond, PhD

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Cancer Risk of Incremental Exposure to Polycyclic Aromatic Hydrocarbons in Electrocautery Smoke for Mastectomy Personnel


General, Plastic




The carcinogenic effects of PAHs in ES on the occupational health of surgical staff should not be neglected. The use of an effective ES evacuator or smoke removal apparatus is strongly suggested to diminish the electrosurgical smoke hazards to surgical staff.



Hsin-Shun Tseng, Shi-Ping Liu, Shi-Nian Uang, Li-Ru Yang, Shien-Chih Lee, Yao-Jen Liu and Dar-Ren Chen

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Chemical Composition of Smoke Produced by High-frequency Electrosurgery


Aesthetics, Cardiothoracic, Dermatology, Drills, ENT, General, Laparoscopic, Laser, Orthopedic, Plastic, Plume, Saws, Smoke




This study demonstrated the presence of irritant, carcinogenic and neurotoxic compounds in electrosurgical smoke such as toluene, ethylbenzene and xylene. This may have considerable implications for the health and safety of all involved in surgical practice, as exposure to these compounds pose potential risks to health.


Irish Journal of Medical Science


O.S. Al Sahaf; I.Vega-Carrascal; F.O. Cunningham; J.P. MCGrath; F.J. Bloomfield

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Comparison of Current and Past Surgical Smoke Control Practices


Aesthetics, Cardiothoracic, Dentistry, Dermatology, Drills, ENT, Laparoscopic, Laser, OB/GYN, Orthopedic, Plastic, Plume, Veterinary




This is the result of a survey conducted by the authors regarding various surgical smoke control practices throughout the United States. The results showed a variety of Local Exhaust Ventilation, Suction and respiratory protection measures.


AORN Journal


Ben E. Edwards, MS, CLSO, RRPT, CHP, CMLSO; Robert E. Reiman, MSPH, MD

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Cytotoxicity of Electrosurgical Smoke Produced in An Anoxic Environment


General, Laparoscopic




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.


The American Journal of Surgery


C. Hensman FRACS A; E. L. Newman PhD A; S. M. Shimi FRCS A; A. Cuschieri MD, FRCS A

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Dissemination of Melanoma Cells within Electrocautery Plume


Dermatology, General, Laparoscopic




Results of this study confirm that application of electrocautery to a pellet of melanoma cells releases these cells into the plume. These cells are viable and may be grown in culture. This release of malignant cells may explain the appearance of port metastases at sites that are remote from the surgical dissection or that were never in direct contact with the tumor.


Excerpta Medica, Inc., July 1999, Vol 178


John N. Fletcher, MD; Daphne Mew, PhD, MD, FRCS; Jean-Gaston DesCoˆ teaux, MA, MD, FRCS

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Effects of Plume Produced by the Nd: YAG Laser and Electrocautery on the Respiratory System


Dermatology, ENT, General, Laser




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.


 Wiley-Liss, Inc., Vol 13


Barry L. Wenig, MD; Kerstin M. Stenson, MD; Diane Tracey, BS

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Electrosurgery Revisted


Laser, OB/GYN




This article discusses the hazards of surgical smoke plume, including the presence of HPV, HIV and other viruses as well as DNA. They also discuss the use of smoke evacuators.


Journal of Gynecologic Surgery


Baggish, Michael

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Evaluation of the Risk of Infection Through Exposure to Aerosols and Splatters in Dentistry






Many dental procedures produce extensive aerosols and spatters that are routinely contaminated with microorganisms. This study revealed contamination of both air and surfaces by blood particulate. Furthermore, with the exception of one sample, the sedimenting particulate when analyzed was positive for the presence of Hb (Hemoglobin).


Association for Professionals in Infection Control and Epidemiology


Maria Luisa Cristina, PhD; Anna Maria Spagnolo, BScD; Marina Sartini, PhD; Maurizio Dallera, BScD; Gianluca Ottria, BScD; Roberto Lombardi, PhD; Fernanda Perdelli, PhD

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Harmful Gasses Produced During Transurethral Resection Of The Prostate And Vaporization


Electrosurgery, Urology




A total of 12 smoke samples were collected from a continuous irrigation suction drainage system to a Tenax adsorber at a 0.05L/min flow rate during TURP and vaporization. The gasses were quantitatively and qualitatively analyzed by gas chromatography-mass spectrometry (GC-MS) equipped with a purge and trap sample injector.


The Japanese Urological Association


Chung YJ; Lee SK; Han SH; Zhao C; Kim MK; Park SC; Park JK 

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HPV Positive Tonsillar Cancer in Two Laser Surgeons: Case Reports



Dermatology, Plastic




A 53 year-old male gynecologist presented with human papillomavirus (HPV) 16 positive tonsillar squamous cell carcinoma. He had no identifiable risk factors with the exception of long term occupational exposure to laser plumes, having performed laser ablations and loop electrosurgical excision procedures (LEEP) on greater than 3000 dysplastic cervical and vulvar lesions over 20 years of practice. The second patient is a 62 year old male gynecologist with a 30 year history of laser ablation and LEEP who subsequently developed HPV 16 positive base of tongue cancer. He also had very few other risk factors for oropharyngeal cancer or HPV infection. HPV is a probable causative agent for oropharyngeal squamous cell carcinoma and has been reported as being transmittable through laser plume.


Journal of Otolaryngology, Head and Neck Surgery, 42:54


Margo Rioux, Andrea Garland, Duncan Webster and Edward Reardon

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Human Immunodeficiency Virus-1 (HIV-1) in the Vapors of Surgical Power Instruments






Cool vapors and aerosols produced by several common surgical power instruments and hot smoke plumes generated with electrocautery on known HIV-1 inoculated blood were gently bubbled through sterile viral culture media.


Journal of Medical Virology


Johnson GK; Robinson WS

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Human Papillomavirus DNA in CO2 Laser Generated Plume of Smoke and Its Consequences to the Surgeon







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 (HPV)-containing genital infections was explored using a filter hybridization technique.


Obstetrics and Gynecology, Vol 75, No 1


Alex Ferenczy, MD; Christine Bergeron, MD; Ralph M. Richart, MD

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Infectious Papillomavirus in the Vapor of Warts Treated with Carbon Dioxide Laser or Electrocoagulation: Detection and Protection



Dermatology, Plastic




Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator safety. 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.


Journal of the American Academy of Dermatology, Vol 21, No 1


 William S. Sawchuk, MD; Paul J. Weber, MD; Douglas R. Lowy, MD; Leonard M. Dzubow, MD

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Laryngeal Papillomatosis with Human Papillomavirus DNA Contracted by a Laser Surgeon







A 44-year-old laser surgeon presented with laryngeal papillomatosis. In situ DNA hybridization of tissue from these tumors revealed human papillomavirus DNA types 6 and 11. Past history revealed that the surgeon has given laser therapy to patients with anogenital condylomas, which are known to harbor the same viral types. These findings suggest that the papillomas in our patient may have been caused by inhales virus particles present in the laser plume.


European Archives of Oto-Rhino-Laryngology, Vol 248


P. Hallmo; O.Naess

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Maximizing Surgeon Safety During Excimer Laser Photorefractive Procedures







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. A number of laboratory studies have been designed and executed to test this hypothesis.


American Journal of Ophthalmology, Vol 130, No 6


Jay S. Pepose, MD, PhD

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Mutagenicity of Smoke Condensates Induced by CO2 - Laser Irradiation and Electrocauterization






Smoke condensates generated from mucous membrane of the canine tongue irradiated with a CO2 laser showed mutagenicity on Salmonella typhimurium TA98 under metabolic activation with S9 mix. Strain TA100 was not so sensitive to the condensates with or without S9 mix. The revertant number per mg of the smoke condensates from laser irradiation was one-half that of the smoke condensates from electrocauterization (1623 and 3371) in TA98. The mutagenic potency observed was comparable to that of cigarette smoke. The amount of these smoke condensates from 1g of tissue was equivalent to those from 3-6 cigarettes as to total mutagenicity.


Mutation Research


Toshifumi Tomita; Shigenobu Mihashi; Kazuto Nagata; Setsuo Ueda; Masakazu Fujiki; Minoru Hirano; Tomio Hirohata

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Pilot Study of Directional Airflow and Containment of Airborne Particles in the Size of Mycobacterium Tuberculosis in an Operating Room



Aesthetics, Cardiothoracic, Dentistry, Dermatology, Drills, ENT, General, Laparoscopic, Laser, OB/GYN, Plastic, Plume, Reamers, Saws, Smoke




This pilot study clearly indicates that avoiding the use of freestanding HEPA filters inside an OR during a surgical procedure is prudent and consistent with Centers for Disease Control and Prevention guidelines.


American Journal of Infection Control, Vol 36, No 4


Russell N. Olmsted, MPH, CIC

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Presence of Human Immunodeficiency Virus DNA in Laser Smoke






Laser vaporous by-products (plume) have been shown to contain fine particulate matter which creates anatomically identifiable lesions when chronically inspired…


Lasers in Surgery & Medicine, Vol 11


Michael S. Baggish, MD; Bernard J. Poiesz, MD; Dale Joret, MD; Patrick Williamson, MD; Ashraf Refai, MD

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Surgical Smoke a Health Hazard in the Operating Theatre: A study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units


Aesthetics, Cardiothoracic, Dentistry, Dermatology, Drills, ENT, General, Laparoscopic, Laser, Plastic, Plume, Reamers, Saws, Smoke




This study looked at the contents of surgical plume in the United Kingdom from plastic surgery centers. Their results revealed the equivalent mutagenicity and other hazards as smoking 27-30 cigarettes per day for OR staff. The contents of the plume were very similar to those of tobacco smoke and have the same disease causing capability.




D.S.Hill, J.K. O'Neill, R.J. Powell, D.W. Oliver

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Surgical Smoke and Infection Control


Laparoscopic, Laser




Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as ‘surgical smoke’. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes...


Journal of Hospital Infection


E. Alp, D.Bijl; R.P. Bleichrodt; B. Hansson; A. Voss

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Surgical Smoke and the Dermatologist


Dermatology, Plastic




The use of electrosurgery and lasers by dermatologists and dermatologic surgeons has increased in recent years with the growth of technology and procedures performed. These devices produce surgical smoke that has been demonstrated to harbor live viruses and bacteria in addition to hazardous chemicals.


American Academy of Dermatology, Inc., 2010, doi:10.1016/j.jaad, 11.017


Jesse Lewin, Jeremy Brauer, Ariel Ostad

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Surgical Smoke: A Review of the Literature



General, Laparoscopic




Electrocautery, laser tissue ablation and ultrasonic (harmonic) scalpel tissue dissection all create a gaseous by-product, commonly referred to as ‘smoke’, that can be seen and smelt easily. Concern about this smoke has led to numerous investigations in an effort to determine what, if any, risks this byproduct poses to surgeons, operating room (OR) personnel and/or patients. Some of the findings from these investigations have led to significant concerns regarding the safety of surgical smoke.


Business Briefing: Global Surgery


William L. Barrett, MD; Shawn M. Garber, MD

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Surgical Smoke and Ultrafine Particles



General, Laser




This article takes measures to quantify the amount of particulate that resides within surgical smoke plume during a series of different procedures. As part of their examination, the authors discuss the respiratory hazards associated with the inhalation of particles less than 2.5 microns as these particles are able to reach the deepest regions of the lungs, the alveolar.


Journal of Occupational Medicine and Toxicology


Irene Brüske-Hohlfeld; Gerhard Preissler; Karl-Walter Jauch; Mike Pitz; Dennis Nowak; Annette Peters; H-Erich Wichmann

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Surgical Smoke: Plume What Do We Know


General, Orthopedic, Plastic




This paper provides information of what we know about surgical smoke, the associated health risks and current global recommendations and regulations.




Donna S. Watson, RN, MSN, CNOR, ARNP-BC

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The Mutagenicity of Electrocautery Smoke






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 determine the potential mutagenicity of the smoke produced by the electrocautery knife during reduction mammoplasty procedures...


Plastic & Reconstructive Surgery, Vol 89, No 5


John E. Gatti, MD; Charles J. Bryant, CIH; R. Barrett No one, MD; J. Brien Murphy, MD

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The Use of Contained Breathing Apparatus to Isolate the Operator and Assist for Aerosolizing Procedures Including Dermabrasion and Laser Surgery


Dermatology, Plastic




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.


Annals of Plastic Surgery, Vol 29, No 2


Paul J. Weber, MD; Allen, E. Wulc, MD

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The Visualisation of Surgical Smoke Produced by Energy Delivery Devices: Significance and Effectiveness of Evacuation Systems






Devices delivering energy to biological tissues (eg lasers, RF and ultrasound) can induce surgical smoke consisting of particles, vapor, gasses and aerosols. Besides interfering 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. However, the impact on health of the users and patients is widely debated. The use of smoke evacuation systems in the OR is usually governed by economical reason instead of safety issues. A special image enhancement technique is used to study the behavior of smoke and aerosols and the effectiveness of smoke evacuation systems. A back scatter illumination.


Proc. of SPIE, Vol. 6440, 64400R


Tjeerd de Boorder, Rudolf Verdaasdonk, John Klaessens

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Don't Be a Victim of Surgical Smoke


General, Laparoscopic




If you saw a low-lying cloud that was labeled clearly with its contents, and the label contained the words benzene, carbon monoxide, formaldehyde, hydrogen cyanide, methane, phenol, styrene, and toluene, would you go out of your way to walk through that cloud and inhale those toxic chemicals? Of course not. But you expose yourself to these same toxic chemicals each time you participate in a surgical procedure in which smoke from tissue . . .


AORN Journal, Vol. 63, No. 3


Beverly P. Giordano, RN, MS

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Viral Disease Transmitted by Laser-Generated Plume (Aerosol)


Dermatology, Plastic, Veterinary




Laser plume has been shown, for the first time to our knowledge, to actually transmit disease. Strict cars must be maintained by the laser practitioner to minimize potential health risks, especially when treating viral-induced lesions or patients with viral disease.


Archives of Dermatology, Vol 138


Jerome M. Garden, MD; M.Kerry O'Banion, MD; PhD, Abnoeal D. Bakus, PhD; Carl Olson, DVM, PhD

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Chemical Composition of Surgical Smoke Formed in the Abdominal Cavity During Laparoscopic Cholecystectomy- Assessment of the Risk to the Patient


General, Laparoscopic




This article discusses the finding of various xenobiotics in patient urine following laparoscopic cholecystectomy. These chemicals, including benzene, xylene and toluene, were absorbed by the patient from surgical smoke in their abdomen during laparoscopy and found by urinalysis post operatively. They also discuss various risk factors to the patient from the absorption of these chemicals, including the possibility of fetal harm.


International Journal of Occupational Medicine and Environmental Health, 27(2):314 – 325


Dobrogowski, Wesolowski, Kucharske et al

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No Smoking Allowed: Addressing the Dangers of ESU/Laser Plume and Surgical Fires in the OR






Surgical smoke and laser plume are byproducts that are created when tissue and cells are vaporized during electrosurgical and laser procedures. While these methods provide immeasurable benefit for the patients they treat, they and the healthcare workers (HCWs) who perform and facilitate the ...


Infection Control Today, Vol 8, No 10


Kris Ellis

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Surgical Smoke Without Fire: The Risks to the Plastic Surgeon






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...


Journal of the American Society of Plastic Surgeons Plastic & Reconstructive Surgery, Vol 114


R.O.S. Karoo, M.B., M.R.C.S.; I. S. Whitaker, M.A.; Cantab., M.B. B. Chir. G. Offer, M.B. B.Chir., F.R.C.S.; 

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Where There's Smoke...There's Progress


General, Laparoscopic, Orthopedic, Plastic




There was nothing magic about the way we began to clear the air in our ORs. Yes, there was smoke, and yes, there were mirrors — to get started, we took a good long look at ourselves and our knowledge base — but ultimately, it was education and information, not sleight of hand, that began to make the difference. Our initiative is ongoing, but we've made some significant progress in protecting the health of our OR teams and patients. Here's how.


Outpatient Surgery Magazine


S.L. Chavis RN

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Study of Health Care Workers Shows Prevalence of Surgical Smoke Exposure


General, Orthopedic, Plastic




Surgical smoke is a serious and preventable hazard that affects thousands of health care workers every year, according to a NIOSH study presented Nov. 3 at the American Public Health Association’s annual meeting.


Safety and Health Magazine


Andrea Steege

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Call to Tackle Toxic Surgery Smoke Risk for Doctors, Nurses, Patients


Aesthetics, Cardiothoracic, Dentistry, Dermatology, Drills, ENT, General, Laparoscopic, Laser, OB/GYN, Orthopedic, Plastic, Plume, Reamers, Saws, Veterinary




Surgeons, nurses and patients are being exposed to toxic surgical smoke from burnt body parts, and health staff want new safety measures to combat the risks in New Zealand hospitals.


John Weekes

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The Examination of Problems Experienced by Nurses and Doctors Associated with Exposure to Surgical Smoke and the Necessary Precautions


Aesthetics, Cardiothoracic, Dermatology, ENT, General, OB/GYN, Orthopedic, Plastic, Veterinary




This article researches the problems experienced by the nurses and doctors as a result of exposure to surgical smoke included: headache, watering of the eyes, cough, sore throat, bad odors absorbed in the hair, and nausea; then drowsiness, dizziness, sneezing and rhinitis.


Journal of Clinical Nursing

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Health Risk Assessment of VOCs from Surgical Smoke


Aesthetics, Cardiothoracic, Dermatology, Drills, Electrosurgery, ENT, General, Laparoscopic, Laser, Orthopedic, Plastic, Plume, Reamers, Saws, Smoke, Urology, Veterinary




The authors conduct a health risk analysis based on exposure to surgical smoke and length of exposure. They found an increased risk of cancer based on the quantity of benzene and formaldehyde found in surgical smoke. They recommend the use of a high flow vacuum device to remove surgical smoke at the source as a means of protection.


Creative Commons CC


Shaohua She, Gang Lu, Wah Yang, Mianwei Hong, and Lingfei Zhu

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Health Risk Assessment of VOCs from Surgical Smoke



a, Aesthetics, Cardiothoracic, Dermatology, General, Laparoscopic, Laser, Plastic, Reamers, Saws, Veterinary




The authors conduct a health risk analysis based on exposure to surgical smoke and length of exposure. They found an increased risk of cancer based on the quantity of benzene and formaldehyde found in surgical smoke. They recommend the use of a high flow vacuum device to remove surgical smoke at the source as a means of protection.


Creative Commons CC


Shaohua She, Gang Lu, Wah Yang, Mianwei Hong, and Lingfei Zhu

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Surgical Smoke Nearly Killed Me


Electrosurgery, Orthopedic




The personal story of Dr. Anthony Headley of the Headley Orthopaedic Institute in Phoenix AZ. 
Dr. Headley developed idiopathic pulmonary fibrosis and had a double lung transplant. He states that the cause was exposure to surgical smoke.


Outpatient Surgery Magazine February 2018 XIX, No. 2


Anthony Hedley, MD, FACS

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The Examination of Problems Experienced by Nurses and Doctors Associated with Exposure to Surgical Smoke and the Necessary Precautions



Aesthetics, Cardiothoracic, Dermatology, ENT, General, Laser, OB/GYN, Orthopedic, Veterinary




This article researches the problems experienced by the nurses and doctors as a result of exposure to surgical smoke included: headache, watering of the eyes, cough, sore throat, bad odors absorbed in the hair, and nausea; then drowsiness, dizziness, sneezing and rhinitis.


Journal of Clinical Nursing


Arzu Ilce, Ganime Esra, Yuzden, Meryem Yavuz van Giersbergen

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Call to tackle toxic surgery smoke risk for doctors, nurses, patients



Aesthetics, Cardiothoracic, Dentistry, Dermatology, Drills, Electrosurgery, ENT, General, Laparoscopic, OB/GYN, Orthopedic, Smoke, Urology, Veterinary




Article discusses a surgeons concerns regarding exposure to surgical smoke in New Zealand Hospitals


John Weekes

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Canadian Study Finds Dozens of Deaths from 'Minimally Invasive' Laparoscopic Surgeries






This article discusses the complications related to minimally invasive, laparoscopic surgery


National Post (Canada)


Sharon Kirkey

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