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. 2018 Apr 12;13(4):e0195274.
doi: 10.1371/journal.pone.0195274. eCollection 2018.

The Characterization of Surgical Smoke From Various Tissues and Its Implications for Occupational Safety

Free PMC article

The Characterization of Surgical Smoke From Various Tissues and Its Implications for Occupational Safety

Markus Karjalainen et al. PLoS One. .
Free PMC article


Electrosurgery produces surgical smoke. Different tissues produce different quantities and types of smoke, so we studied the particle characteristics of this surgical smoke in order to analyze the implications for the occupational health of the operation room personnel. We estimated the deposition of particulate matter (PM) from surgical smoke on the respiratory tract of operation room personnel using clinically relevant tissues from Finnish landrace porcine tissues including skeletal muscle, liver, subcutaneous fat, renal pelvis, renal cortex, lung, bronchus, cerebral gray and white matter, and skin. In order to standardize the electrosurgical cuts and smoke concentrations, we built a customized computer-controlled platform. The smoke particles were analyzed with an electrical low pressure impactor (ELPI), which measures the concentration and aerodynamic size distribution of particles with a diameter between 7 nm and 10 μm. There were significant differences in the mass concentration and size distribution of the surgical smoke particles depending on the electrocauterized tissue. Of the various tissues tested, liver yielded the highest number of particles. In order to better estimate the health hazard, we propose that the tissues can be divided into three distinct classes according to their surgical smoke production: 1) high-PM tissue for liver; 2) medium-PM tissues for renal cortex, renal pelvis, and skeletal muscle; and 3) low-PM tissues for skin, gray matter, white matter, bronchus, and subcutaneous fat.

Conflict of interest statement

Competing Interests: Authors Markus Karjalainen, Jukka Lekkala, Antti Roine and Niku Oksala are shareholders of Olfactomics Ltd, a company developing applications for eNose technology. This does not alter our adherence to PLOS ONE policies on sharing data and materials.


Fig 1
Fig 1. The measurement system.
Fig 2
Fig 2. Representative image of a pig skeletal muscle sample after being exposed to the ten sample burns.
Fig 3
Fig 3. Median particle number (A) and mass (B) concentrations of different tissue types, produced with the diathermy knife.
The particulate concentrations form three groups: high-PM, medium-PM, and low-PM.
Fig 4
Fig 4. Boxplot presentation of the distributions of the measured total particle number for each tissue.
Medians are presented as dots between the quartile lines.

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Grant support

This study was supported by grants from following foundations: Finnish Foundation for Technology Promotion (TES) to M.K., Tampereen Tuberkuloosisäätiö (Tampere Tuberculosis Foundation), Emil Aaltonen foundation, and Pirkanmaan sairaanhoitopiiri (PSHP) grants 9s045, 151B03, 9T044, 9U042, 150618, and 9V044 to N.O., which were used partially for salaries for authors M.K. and A.K. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. Olfactomics Ltd did not provide any funding for the study and did not play any role in the study design.