Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries

Abstract

Background: Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut.

Aim: To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries.

Methods: The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min.

Results: None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). ‏The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (Toluene, Ethylbenzene, and Styrene). No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue.

Conclusion: Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.

Keywords: Electrocautery smoke; Polycyclic aromatic hydrocarbons; Surgeon caution; Volatile organic compounds.