Plume risk in videolaparoscopy and in endoscopic surgery

Approximately 90% of endoscopic and open surgical procedures generate some level of surgical smoke. (Ulmer B, 1998). Lasers and electrosurgery devices commonly used to cut, coagulate, vaporize, and ablate tissue are the “hot” tools that cause targeted cells to heat to the point of rupturing the cellular membrane and spewing cellular contents into the air as surgical smoke. Through continuous exposure, the inhalation of surgical smoke can become harmful to the surgical team members. Plume can also be hazardous to patients during laparoscopy or other endoscopy procedures when the contaminants of surgical smoke are absorbed into the patient’s vascular system. Research studies have repeatedly highlighted the hazards of surgical smoke during laser use so smoke evacuation has been accepted as a common practice. Unfortunately evacuation of smoke generated during electrosurgery has not been as widely accepted even though research has been definitive in proving inhalation hazards. One of the most interesting paper, by Tomita, demonstrated that using an electrosurgery device on one gram of tissue, inhaling the plume was equivalent to smoking 6 unfiltered cigarettes. This study demonstrated that plume generated during electrosurgical procedures has the potential to be twice as harmful as the smoke produced during laser surgeries. (Tomita et al., 1989) The bottom line is that all surgical smoke should be considered as harmful if not evacuated appropriately. Unfortunately many healthcare professionals are indifferent and do not feel the need to evacuate plume since they have been breathing it for years. The following toxic chemical byproducts have been identified in surgical smoke resulting from tissue pyrolysis: (Hoglan, 1995 and Ott, 1993) acrolein, acetonitrile acrylonitrile, methane phenol polycyclic aromatic hydrocarbons propene propylene pyridene pyrrole styrene toluene xylene, acetylene alkyl benzenes, benzene, butadiene, butane, carbon monoxide creosols, ethane, ethylene, formaldehyde, free radicals hydrogen, cyanide isobutene. Complete evacuation of surgical smoke is necessary because of these unwanted hazards and potential complications. Research has conclusively shown that surgical smoke is hazardous to the surgical team members who are exposed to it on a continual basis and hazardous to endoscopic patients when the plume is not evacuated. Also during endoscopic procedures the usage of electric tools to cut and coagulate is frequent, and this could represent a real problems for operators may be more than for the patients. At the present time it is not possible to find in literature papers about hazards of surgical smoke during endoscopic procedures even if they have to be considered definitely as surgical procedures. This implies the necessity of a deeper consciousness to the smokes risk and consequently a more care in operators and patients protection.