Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment. An in vitro study.
BACKGROUND
High-frequency (HF) electrocoagulation and cutting procedures produce smoke by high-temperature pyrolysis of tissues. As distinct from the experience of conventional surgery, electrosurgical smoke is produced in a closed gaseous environment during laparoscopic operations. As a result, toxic chemicals may be absorbed into the circulation. The effects of this absorption are not known. Furthermore, the chemical composition of electrosurgical smoke produced in an anoxic environment may be different from that produced in air.


METHODS
Smoke was produced in vitro by HF electrocutting of fresh porcine liver in helium, CO2, and air-saturated closed environments. Smoke samples were collected and analyzed by gas chromatography-mass spectrometry (GC-MS).


RESULTS
The chemical constituents of electrosurgical smoke produced in air, CO2, and helium were similar. To date, 21 chemicals, some highly toxic, have been identified in the electrosurgical smoke produced in a closed environment. These consist of hydrocarbons, nitriles, fatty acids, and phenols.


CONCLUSIONS
Electrosurgical smoke produced in a closed environment contains several toxic chemicals. The effects of these on cell viability, macrophage, and endothelial cell activation are not known but are being investigated. Meantime, measures to reduce smoke and evacuate it during endoscopic surgery are advisable.
Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
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Hensman
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Baty
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Willis
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Cuschieri
D000393:Air Pollutants / Q000737:chemistry*; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis*; D000818:Animals; D046508:Culture Techniques; D004598:Electrosurgery / Q000009:adverse effects / Q000379:methods; D004784:Environmental Monitoring / Q000379:methods*; D008401:Gas Chromatography-Mass Spectrometry; D008099:Liver / Q000601:surgery*; D016273:Occupational Exposure / Q000032:analysis*; D011846:Radio Waves / Q000009:adverse effects; D000078702:Radiofrequency Therapy; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012906:Smoke / Q000009:adverse effects / Q000032:analysis*; D013552:Swine
D000393:Air Pollutants; D012906:Smoke