Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

JSLS. Oct-Dec 2019;23(4):e2019.00037. doi: 10.4293/JSLS.2019.00037.

Abstract

Background and objectives: Surgical smoke contains various malodorous and hazardous combustion byproducts. We aimed to analyze hydrocarbons accumulated in the abdominal cavity during laparoscopic gynecologic surgery and determine the efficiency of a built-in-filter port.

Methods: We prospectively followed seven patients with benign uterine pathology. Surgical smoke was generated using laparoscopic or robotic electrocautery. The smoke was collected twice for each patient using a built-in-filter port and a conventional port. The concentrations of volatile organic compounds and aldehydes were determined using gas chromatography with mass spectrometry and high-performance liquid chromatography with ultraviolet visible light detection and compared using the paired-sample Wilcoxon signed-rank test.

Results: Five volatile organic compounds and five aldehydes had toxic effects or unpleasant odors. The median concentration of formaldehyde before filtration (0.870 ppm) exceeded the time-weighted average concentration (0.75 ppm) of the Occupational Safety and Health Administration. Built-in-filter ports significantly reduced the concentration of five volatile organic compounds and two aldehydes but not that of formaldehyde, acetaldehyde, and propionaldehyde. Formaldehyde concentration decreased by 50% after filtration but remained above the recommended exposure limit (0.016 ppm) of the National Institute of Occupational Safety and Health.

Conclusions: Surgical smoke in minimally invasive gynecologic procedures contains several hazardous hydrocarbons including formaldehyde. Built-in-filter ports have the potential to reduce the exposure of surgical smoke to surgeons and operating room personnel; nevertheless, development of built-in-filter ports is necessary to improve the filtering efficiency for highly concentrated formaldehydes.

Keywords: Aldehydes; Laparoscopy; Volatile organic compounds.

MeSH terms

  • Adult
  • Aldehydes / analysis*
  • Electrocoagulation*
  • Female
  • Filtration / instrumentation*
  • Gas Chromatography-Mass Spectrometry
  • Gynecologic Surgical Procedures
  • Humans
  • Laparoscopy
  • Middle Aged
  • Operating Rooms
  • Prospective Studies
  • Smoke / analysis*
  • Smoke / prevention & control
  • Volatile Organic Compounds / analysis*

Substances

  • Aldehydes
  • Smoke
  • Volatile Organic Compounds