Surgical Smoke Evacuation

Learn about the dangers of surgical smoke and effective solutions

The use of lasers or electrosurgical devices during surgical procedures can generate surgical smoke from thermal destruction of tissue. The quantity and quality of smoke generated depends on several factors including type of surgical procedure.

One gram of ESU ablated tissue is equivalent to smoking 6 cigarettes. On average, daily smoke produced in an OR is equivalent to 27-30 cigarettes.1 Surgical smoke contains 17X the amount of butadiene and 10X the amount of benzene than secondhand smoke.2 Also, surgical smoke particles can move at a rate of 40mph and be evenly distributed through the OR.3

Surgical smoke has been shown to cause eye irritation.4 Per AANS, Bovie smoke behaves as a carcinogen. The possibility of disease transmission through surgical smoke exists, actual documented cases of pathogen transmission are rare.

It is estimated that 90% of all endoscopic and surgical procedures produce plume, and approximately a half-million health care workers are exposed to laser or electrosurgical smoke each year.5

73.2% of OR nurses report at least one symptom related to exposure to surgical smoke exposure, including inflammatory respiratory changes, headache, nausea/vomiting, or hypoxia/dizziness.6 OR nurses report 2X the incident of respiratory illness than the general population.7

Surgical masks have not been shown to provide adequate protection from surgical smoke because 70% of surgical smoke particles are smaller than 0.3 microns.8 One study determines that 77% of surgical smoke particles are not filtered out by standard surgical masks.9

Healthcare exposure to formaldehyde, acetaldehyde, and the amount of volatile organic compounds was significantly reduced with the use of smoke evacuator.10 ULPA filtration in CONMED smoke evacuation units filter particles 0.1 microns in size and above, whereas N95 masks filter down to only ~0.5 microns in size.11

In addition, proper surgical smoke evacuation provides peace of mind in a healthcare facility. In a recent study, 90% of OR nurses reported being worried about the exposure of surgical smoke plume at work.12

1 1 Hill, D.S. et. Al., Surgical Smoke- A health hazard in the operating theatre. A study to quantify exposure and a survey of smoke extractor systems in UK plastic surgery units. Journal of Plastic, Reconstructive, and Aesthetic Surgery 2012. doi:10.1016/j.bjps.2012.02.012
2 Oganesyan, G., Eimpunth, S. Kim, S., Jiang, S. (2014) Surgical Smoke in Dermatologic Surgery. Dermatol Surgery, 40:1373–1377. DOI: 10.1097/DSS.0000000000000221
3 Nicola JH, Nicola EM, Vieira R, Braile DM, Tanabe MM, Baldin DH. Speed of particles ejected from animal skin by CO2 laser pulses, measured by laser Doppler velocimetry. Phys Med Biol. 2002;47(5):847-856
4 Steege AL, Boiano JM, Sweeney MH. Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke. Am J Ind Med. 2016;59(11):1020-103
5 https://www.ormanagement.net/Clinical-News/Article/09-20/Surgical-Smoke-A-Risk-Too-Real-to-Ignore/59416
6 Giersbergen MYV, Alcan AO, Kaymakci S et. al. Investigation of surgical smoke symptoms and preventive measures in Turkish operating rooms. Int J Health Sci Res. 2019; 9(1):138-144
7 Ball, K., (2010). Compliance With Surgical Smoke Evacuation Guidelines: Implications for Practice. AORN Journal. doi: 10.1016/j.aorn.2010.06.002
8 Tseng, HS., Liu, SP., Uang, SN. et al. Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel. World J Surg Onc 12, 31 (2014). https://doi.org/10.1186/1477-7819-12-31
9 Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecolgists. J Center 2019; 10(12):2788-2799
10 Tokuda, Y., Okamura, T., Maruta, M. et al. Prospective randomized study evaluating the usefulness of a surgical smoke evacuation system in operating rooms for breast surgery. J Occup Med Toxicol 15, 13 (2020). https://doi.org/10.1186/s12995-020-00259-y
11 Katoch, S., & Mysore, V. (2019). Surgical Smoke in Dermatology: Its Hazards and Management. Journal of cutaneous and aesthetic surgery, 12(1), 1–7. https://doi.org/10.4103/JCAS.JCAS_177_18
12 https://www.nursingtimes.net/hospital-nursing/nurses-concerned-about-surgical-smoke-plume-health-risks-30-06-2022/