Surgical smoke and the orthopedic surgeon: a non-systematic review of the hazards and strategies for mitigating risk.
Carcinogens
Orthopedics
Smoke inhalation
Surgery
Surgical smoke
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
16
03
2023
accepted:
22
06
2023
medline:
13
11
2023
pubmed:
13
7
2023
entrez:
13
7
2023
Statut:
ppublish
Résumé
Surgical smoke generated through the use of electrical surgical devices poses a risk to the surgeon, medical personnel in the operating room, and the patient by exposing them to environmentally hazardous particulate matter. Previous investigation has shown that surgical smoke leads to an increased risk of pulmonary conditions, circulatory disorders, and irritation of the eyes, nose, and throat. Transmission of infectious disease can occur through inhalation of viral particles, and the presence of carcinogens are also of major concern. The deleterious effects of surgical smoke are well documented in several subspecialties, namely dermatology and general surgery, but there has been little discussion on the topic amongst orthopedic surgeons. A non-systematic review of the literature was completed with the aim of identifying the major categories of adverse health effects associated with surgical smoke inhalation and offering recommendations to reduce these hazards in the orthopedic surgical community. Three primary categories of risk associated with surgical smoke inhalation were identified: inflammation, viral/bacterial transmission, and carcinogenicity. In addition, strategies for mitigating risk and best practice recommendations were explored. Surgical smoke is an under-recognized occupational hazard within the orthopedic surgery literature. There are several strategies which can be employed to reduce risk. Further investigation is needed to understand the long-term impact of these risks, as well as what can be done to improve the practicality and compliance with protective measures.
Identifiants
pubmed: 37439949
doi: 10.1007/s00402-023-04967-y
pii: 10.1007/s00402-023-04967-y
doi:
Substances chimiques
Smoke
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
6975-6981Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Ryu RC, Behrens PH, Malik AT, Lester JD, Ahmad CS. Are we putting ourselves in danger? Occupational hazards and job safety for orthopaedic surgeons. J Orthop. 2021;24:96–101. Published 2021 Feb 20. https://doi.org/10.1016/j.jor.2021.02.023
Kugelman D, Weppler CG, Warren CF, Lajam CM (2022) Occupational hazards of orthopedic surgery exposures: infection, smoke, and noise. J Arthroplasty 37(8):1470–1473. https://doi.org/10.1016/j.arth.2022.03.034
doi: 10.1016/j.arth.2022.03.034
pubmed: 35304300
Patel K, Judd H, Harm RG, Spanyer J (2022) Occupational hazards for the practicing orthopaedic surgeon: a standard review. J Am Acad Orthop Surg 30(7):e607–e616. https://doi.org/10.5435/JAAOS-D-21-00612
doi: 10.5435/JAAOS-D-21-00612
pubmed: 35171850
Vajapey SP, Li M, Glassman AH. Occupational hazards of orthopaedic surgery and adult reconstruction: a cross-sectional study. J Orthop. 2021;25:23–30. Published 2021 Apr 2. doi: https://doi.org/10.1016/j.jor.2021.03.026
Liu Y, Song Y, Hu X et al (2019) Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer 10(12):2788–2799
doi: 10.7150/jca.31464
pubmed: 31258787
pmcid: 6584931
Limchantra IV, Fong Y, Melstrom KA (2019) Surgical smoke exposure in operating room personnel: a review. JAMA Surg 154(10):960–967
doi: 10.1001/jamasurg.2019.2515
pubmed: 31433468
Choi SH, Kwon TG, Chung SK et al (2014) Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery. Surg Endosc 28(8):2374–2380
doi: 10.1007/s00464-014-3472-3
pubmed: 24570016
Li CI, Chou YH, Pai JY, Chen CH, Chiang MC. Investigating surgical smoke in otolaryngology operating rooms. Sci Rep. 2022;12(1):1719. Published 2022 Feb 2. https://doi.org/10.1038/s41598-022-05701-1
Swerdlow BN (2020) Surgical smoke and the anesthesia provider. J Anesth 34(4):575–584. https://doi.org/10.1007/s00540-020-02775-x
doi: 10.1007/s00540-020-02775-x
pubmed: 32296937
Kokosa JM, Eugene J (1989) Chemical composition of laser-tissue interaction smoke plume. J Laser Appl 1(3):59–63
doi: 10.2351/1.4745238
Oberdöster G, Oberdöster E, Oberdöster J (2005) Nanotoxicology an emerging discipline evolving from studies of ultrafine particles. Environ Health Perspec 113(7):823–839
doi: 10.1289/ehp.7339
Bruske-Hohlfeld I, Preissler G, Jauch KW et al (2008) Surgical smoke and ultrafine particles. J Occup Med Toxicol 3:31
doi: 10.1186/1745-6673-3-31
pubmed: 19055750
Kunachak S, Sobhon P (1998) The potential alveolar hazard of carbon dioxide laser-induced smoke. J Med Assoc Thai 81(4):278–282
pubmed: 9623022
Yeganeh A, Hajializade M, Sabagh AP, Athari B, Jamshidi M, Moghtadaei M. Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries. World J Orthop. 2020;11(3):177–183. Published 2020 Mar 18. https://doi.org/10.5312/wjo.v11.i3.177
Ulmer BC (2008) The hazards of surgical smoke. AORN J 87(4):721–738
doi: 10.1016/j.aorn.2007.10.012
pubmed: 18461735
Barrett WL, Garber SM: Surgical smoke: a review of the literature. Is this just a lot of hot air? Surg Endosc 2003;17(6):979 –87.
Steege AL, Boiano JM, Sweeny MH (2016) Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke. Am J Ind Med 59(11):1020–1031
doi: 10.1002/ajim.22614
pmcid: 5069165
Canicoba ARB, Poveda VB (2022) Surgical smoke and biological symptoms in healthcare professionals and patients: a systematic review. J Perianesth Nurs 37(1):130–136. https://doi.org/10.1016/j.jopan.2021.06.106
doi: 10.1016/j.jopan.2021.06.106
pubmed: 34802919
Alp E, Bijl D, Bleichrodt RP, Hansson B et al (2006) Surgical smoke and infection control. J Hosp Infect 62(1):1–5
doi: 10.1016/j.jhin.2005.01.014
pubmed: 16002179
Ball K (2010) Compliance with surgical smoke evacuation guidelines: implications for practice. Aorn J 92(2):142–149
doi: 10.1016/j.aorn.2010.06.002
Bernstein JA, Alexis N, Bacchus H, Bernstein IL et al (2008) The health effects of nonindustrial indoor air pollution. J Allergy Clin Immunol 121(3):585–591
doi: 10.1016/j.jaci.2007.10.045
pubmed: 18155285
Okoshi K, Kobayashi K, Kinoshita K, Tomizawa Y et al (2015) Health risks associated with exposure to surgical smoke for surgeons and operating room personnel. Surg Today 45(8):957–965
doi: 10.1007/s00595-014-1085-z
pubmed: 25421864
Baggish MS, Baltoyannis P, Sze E (1988) Protection of the rat lung from the harmful effects of laser smoke. Lasers Surg Med 8(3):248–253
doi: 10.1002/lsm.1900080305
pubmed: 3393053
Baggish MS, Elbakry M (1987) The effects of laser smoke on the lungs of rats. Am J Obstet Gynecol 156(5):1260–1265
doi: 10.1016/0002-9378(87)90158-X
pubmed: 3107392
Capizzi PJ, Clay RP, Battey MJ (1998) Microbiologic activity in laser resurfacing plume and debris. Lasers Surg Med 23(3):172–174
doi: 10.1002/(SICI)1096-9101(1998)23:3<172::AID-LSM7>3.0.CO;2-M
pubmed: 9779652
Butler D: Health Risks of Indoor Exposure to Particulate Matter: Workshop Summary. Washington, DC: National Academies Press (US); 2016 Sept 26.
Hedley AK: Surgical Smoke Almost Killed Me. Outpatient Surgery Magazine. 2018;32–39.
Taravella MJ, Weinberg A, May M et al (1999) Live virus survives excimer laser ablation. Ophthalmology 106(8):1498–1499
doi: 10.1016/S0161-6420(99)90442-6
pubmed: 10442893
K HD, Kim SH, Seo YS, et al: Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Ocup Environ Med 2016;73(12):857–863.
Zhou Q, Hu X, Zhou J et al (2019) Human papillomavirus DNA in surgical smoke during cervical loop electrosurgical excision procedures and its impact on the surgeon. Cancer Manag Res 11:3643–3654
doi: 10.2147/CMAR.S201975
pubmed: 31118787
pmcid: 6499148
Garden GM, O’Banion K, Bakus AD et al (2002) Viral disease transmitted by laser-generated plume (aerosol). Arch Dermat 138(10):1303–1307
doi: 10.1001/archderm.138.10.1303
Tomita Y, Mihashi S, Nagata K et al (1981) Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutat Res 89(2):145–149
doi: 10.1016/0165-1218(81)90120-8
pubmed: 7027028
Hill DS, O’Neill JK, Powell RJ, Oliver DW. 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. J Plast Reconstr Aesthet Surg. 2012;65(7):911–916.
Al Sahaf OS, Vega-Carrascal I, Cunningham FO et al (2007) Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci 176(3):229–232
doi: 10.1007/s11845-007-0068-0
pubmed: 17653513
Hui Y, Yan J (2018) Effect of electrosurgery in the operating room on surgeons’ blood indices: a simulation model and experiment on rabbits. J Int Med Res 46(12):5245–5256
doi: 10.1177/0300060518804376
pubmed: 30343611
pmcid: 6300964
Douglas JDM, McLean N, Horsley C et al (2020) COVID-19: smoke testing of surgical mask and respirators. Occup Med 70(8):556–563
doi: 10.1093/occmed/kqaa167
Zakka K, Erridge S, Chidambaram S et al (2020) Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic? Ann Surg 272(3):e257–e262. https://doi.org/10.1097/SLA.0000000000004112
doi: 10.1097/SLA.0000000000004112
pubmed: 32541232
Matta I, Laganà AS, Ghabi E et al (2022) COVID-19 transmission in surgical smoke during laparoscopy and open surgery: a systematic review. Minim Invasive Ther Allied Technol 31(5):690–697. https://doi.org/10.1080/13645706.2021.1982728
doi: 10.1080/13645706.2021.1982728
pubmed: 34612141
Chapman LW, Korta DZ, Lee PK et al (2017) Awareness of surgical smoke risks and assessment of safety practices during electrosurgery among US dermatology residents. JAMA Dermatol 153(5):467–468
doi: 10.1001/jamadermatol.2016.5899
pubmed: 28249072
pmcid: 5817491
Edwards BE, Rieman RE (2012) Comparison of current and past surgical smoke control practices. AORN J 95(3):337–350
doi: 10.1016/j.aorn.2011.07.019
pubmed: 22381553
Oberg T, Brosseau LM (2008) Surgical mask filter and fit performance. Am J Infect Control 36(4):276–282
doi: 10.1016/j.ajic.2007.07.008
pubmed: 18455048
pmcid: 7115281
Makison Booth C, Clayton M, Crook B et al (2013) Effectiveness of surgical masks against influenza bioaerosols. J Hosp Infect 84(1):22–26
doi: 10.1016/j.jhin.2013.02.007
pubmed: 23498357
Benson SM, Novak DA, Ogg MJ (2013) Proper use of surgical n95 respirators and surgical masks in the OR. Aorn j 97(4):457–467
doi: 10.1016/j.aorn.2013.01.015
pubmed: 23531312
pmcid: 7105909
Doyle C: Surgical Smoke: A Potential Risk Too Real to Ignore Any Longer. General Surgery News. Sept 22, 2020