Summary
Surgeons and operating theatre personnel are routinely exposed to the surgical smoke
plume generated through thermal tissue destruction. This represents a significant
chemical and biological hazard and has been shown to be as mutagenic as cigarette
smoke. It has previously been reported that ablation of 1 g of tissue produces a smoke
plume with an equivalent mutagenicity to six unfiltered cigarettes. We studied six
human and 78 porcine tissue samples to find the mass of tissue ablated during 5 min
of monopolar diathermy. The total daily duration of diathermy use in a plastic surgery
theatre was electronically recorded over a two-month period. On average the smoke
produced daily was equivalent to 27–30 cigarettes. Our survey of smoke extractor use
in UK plastic surgery units revealed that only 66% of units had these devices available.
The Health and Safety Executive recommend specialist smoke extractor use, however
they are not universally utilised. Surgical smoke inhalation is an occupational hazard
in the operating department. Our study provides data to quantify this exposure. We
hope this evidence can be used together with current legislation to make the use of
surgical smoke extractors mandatory to protect all personnel in the operating theatre.
Keywords
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References
- Infectious papillomavirus in the vapour of warts treated with carbon dioxide laser or electrocoagulation: detection and protection.J Am Acad Dermatol. 1989; 21: 41-49
- Studies on the transmission of viral disease via the CO2 laser plume and ejecta.J Reprod Med. 1990; 35: 1117-1123
- Surgical smoke: a review of the literature.Surg Endosc. 2003; 17: 979-987
- Chemical composition of smoke produced by high frequency electrosurgery in a closed gaseous environment.Surg Endosc. 1998; 12: 1017-1019
- The mutagenicity of electrocautery smoke.Plast Reconstr Surg. 1992; 89: 781
- Current attitudes and practices towards diathermy smoke.Ann R Coll Surg Engl. 2007; 89: 162-165
- Mutigenicity of smoke condensates induced by CO2-laser irradiation and electocauterisation.Mutat Res. 1981; 89: 145
- Dissemination of melanoma cells within electrocautery plume.Am J Surg. 1999; 178: 57-59
- Generation of infectious retrovirus aerosol through medical irradiation.Laser Surg Med. 1998; 22: 37-41
- Laryngeal papillomatosis with papilloma virus DNA contracted by a laser surgeon.Eur Arch Otorhinolaryngol. 1991; 248: 425-427
ValleyLab force FX electrosurgical generator. http://www.valleylab.com/product/es/generators/fx-over.html [accessed July 2011].
- Cross-species comparison of gene expression between human and porcine tissue, using single microarray platform–preliminary results.Clin Transplant. 2004; 18: 76-80
British Association of Plastic Reconstructive and Aesthetic Surgeons. http://www.bapras.org.uk [accessed July 2011].
- IARC monographs on the evaluation of carcinogenic risks to humans.Tobacco smoke and involuntary smoking. vol. 83. International Agency For Research on Cancer. World Health Organization, 2002
- Protection of the rat lung from the harmful effects of laser smoke.Laser Surg Med. 1988; 8: 248-253
- The effects of laser smoke on the lungs of rats.Am J Obset Gynecol. 1987; 156: 1260-1265
- Laser smoke effect on the bronchial system.Laser Surg Med. 1989; 7: 283-288
- The hazards of diathermy plume. Part 1 – the literature review.Br J Perioperat Nurs. 2004 Sep; 14: 409-414
- Aerosol penetration and leakage characteristics of masks used in the health care industry.Am J Infect Contr. 1993; 21: 167-173
- Randomized clinical trial of suction versus standard clearance of the diathermy plume.Br J Surg. 2003; 90: 1068-1071
- Surgical smoke without fire: the risks to the plastic surgeon.Plast Reconstr Surg. 2004; 114: 1658-1660
Health Act 2006 (chapter 28). Department of Health. Part 1 – Smoking. London: Stationary Office. http://www.legislation.gov.uk/uksi/2006/3368/contents/made; 2006 [accessed July 2011].
- (Control of Substances Hazardous to Health Regulations (COSHH))Health and safety executive.2002 ([accessed July 2011])
Diathermy emissions. Health Services. Health and Safety Executive. http://www.hse.gov.uk/healthservices/diathermy-emissions.htm [accessed July 2011].
- Surgical Smoke and infection control.J Hosp Infect. 2006; 62: 1-5
Article info
Publication history
Published online: March 26, 2012
Accepted:
February 4,
2012
Received:
October 6,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
