Release of hazardous volatile organic compounds from endoscopic submucosal dissection.
Endoscopic submucosal dissection
Gas chromatography
Stomach cancer
Volatile organic compounds
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
14
02
2020
accepted:
27
08
2020
pubmed:
24
9
2020
medline:
21
10
2021
entrez:
23
9
2020
Statut:
ppublish
Résumé
Although it has been proven that various volatile organic compounds (VOCs) are produced during surgery, there have been no studies focusing specifically on endoscopy. Therefore, we aimed to investigate VOCs produced during endoscopic submucosal dissection (ESD). Thirty-one patients scheduled for ESD were enrolled in this study. Sorbent tubes were installed to collect gas at two sites: one in a suction bottle and the other at the level of the endoscopists' upper chest. Gas collections were performed for up to 30 min during submucosal dissection. Quantitative analysis of the VOCs in gas samples was performed using gas chromatography and mass spectrometry. Concentrations of fifteen VOCs were measured. The total concentration of volatile organic compounds (TVOC) was also calculated. Among the five carcinogens-benzene, ethylbenzene, formaldehyde, tetrachloroethylene, and trichloroethylene (TCE)-measured, excess life-time risks of cancer for benzene and TCE were interpreted as unacceptable based on the New Jersey Department of Environmental Protection Division of Air Quality and the Environmental Protection Agency guidelines (5 × 10 Various carcinogenic and non-carcinogenic VOCs were detected at levels higher than the reference "safe" values during the submucosal dissection step of ESD. Implementation of counter measures is essential to protect medical personnel who are involved in ESD surgeries.
Sections du résumé
BACKGROUND
Although it has been proven that various volatile organic compounds (VOCs) are produced during surgery, there have been no studies focusing specifically on endoscopy. Therefore, we aimed to investigate VOCs produced during endoscopic submucosal dissection (ESD).
METHODS
Thirty-one patients scheduled for ESD were enrolled in this study. Sorbent tubes were installed to collect gas at two sites: one in a suction bottle and the other at the level of the endoscopists' upper chest. Gas collections were performed for up to 30 min during submucosal dissection. Quantitative analysis of the VOCs in gas samples was performed using gas chromatography and mass spectrometry. Concentrations of fifteen VOCs were measured. The total concentration of volatile organic compounds (TVOC) was also calculated.
RESULTS
Among the five carcinogens-benzene, ethylbenzene, formaldehyde, tetrachloroethylene, and trichloroethylene (TCE)-measured, excess life-time risks of cancer for benzene and TCE were interpreted as unacceptable based on the New Jersey Department of Environmental Protection Division of Air Quality and the Environmental Protection Agency guidelines (5 × 10
CONCLUSIONS
Various carcinogenic and non-carcinogenic VOCs were detected at levels higher than the reference "safe" values during the submucosal dissection step of ESD. Implementation of counter measures is essential to protect medical personnel who are involved in ESD surgeries.
Identifiants
pubmed: 32964306
doi: 10.1007/s00464-020-07966-x
pii: 10.1007/s00464-020-07966-x
doi:
Substances chimiques
Air Pollutants
0
Volatile Organic Compounds
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4520-4527Références
Moot AR, Ledingham KM, Wilson PF, Senthilmohan ST, Lewis DR, Roake J, Allardyce R (2007) Composition of volatile organic compounds in diathermy plume as detected by selected ion flow tube mass spectrometry. ANZ J Surg 77:20–23
doi: 10.1111/j.1445-2197.2006.03827.x
Des Couteaux JG, Picard P, Poulin C, Baril M (1996) Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc 19:152–158
doi: 10.1007/BF00188362
Wenig BL, Stenson KM, Wenig BM, Tracey D (1993) Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system. Lasers Surg Med 13:242–245
doi: 10.1002/lsm.1900130213
Fitzgerald JE, Malik M, Ahmed I (2012) A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc 26(2):337–342
doi: 10.1007/s00464-011-1872-1
Weston R, Stephenson RN, Kutarski PW, Parr NJ (2009) Chemical composition of gases surgeons are exposed to during endoscopic urological resections. Urology 74:1152–1154
doi: 10.1016/j.urology.2009.04.100
Sagar PM, Meagher A, Sobczak S (1996) Chemical composition and potential hazards of electrocautery smoke. Br J Surg 83:1792
doi: 10.1002/bjs.1800831241
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225
doi: 10.1007/PL00011720
Kume K (2014) Endoscopic therapy for early gastric cancer: standard techniques and recent advances in ESD. World J Gastroenterol 20:6425–6432
doi: 10.3748/wjg.v20.i21.6425
World Health Organization (2010) WHO guidelines for indoor air quality: selected pollutants. WHO Regional Office for Europe, Copenhagen
Azuma K, Uchiyama I, Ikeda K (2008) The regulations for indoor air pollution in Japan: a public health perspective. J Risk Res 11:301–314
doi: 10.1080/13669870801967119
Technical Manual 1003: guidance on preparing a risk assessment protocol for air contaminant emissions. https://www.nj.gov//dep/aqpp/risk.html
Baan R, Grosse Y, Straif K, Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Freeman C, Galichet L, Cogliano V (2009) A review of human carcinogens—Part F: chemical agents and related occupations. Lancet Oncol 10:1143–1144
doi: 10.1016/S1470-2045(09)70358-4
Commonwealth of Australia and States and Territories of Australia (2008) Indoor air quality handbook. Australian Building Codes Board, Canvera
Järnström H, Saarela K, Kalliokoski P, Pasanen AL (2008) Comparison of VOC and ammonia emissions from individual PVC materials, adhesives and from complete structures. Environ Int 34:420–427
doi: 10.1016/j.envint.2007.09.011
Hong Kong Environmental Protection Department (2003) Guidance notes for the management of indoor air quality in offices and public places. Indoor Air Quality Management Group, The Hong Kong Government of Special Administrative Region, Hong Kong
Department for Environment, Food and Rural Affairs (2011) Air quality strategy for England, Scotland, Wales and Northern Ireland. The Stationery Office, London
Choi SH, Kwon TG, Chung SK, Kim TH (2014) Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery. Surg Endosc 28:2374–2380
doi: 10.1007/s00464-014-3472-3
Ulmer BC (2008) The hazards of surgical smoke. AORN J 87:721–734
doi: 10.1016/j.aorn.2007.10.012
Ott DE, Moss E, Martinez K (1998) Aerosol exposure from an ultrasonically activated (Harmonic) device. J Am Assoc Gynecol Laparosc 5:29–32
doi: 10.1016/S1074-3804(98)80007-8
Okoshi K, Kobayashi K, Kinoshita K, Tomizawa Y, Hasegawa S, Sakai Y (2015) Health risks associated with exposure to surgical smoke for surgeons and operation room personnel. Surg Today 45:957–965
doi: 10.1007/s00595-014-1085-z