title: Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility.
abstract: OBJECTIVE
  We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility.
  
  
  METHODS
  The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles >500 nm and <500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.
  
  
  RESULTS
  The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components. The aerosol produced by the Bipolar Macroforceps obscured visibility the least (relative visibility 0.887) among the instruments tested. Particles from the Harmonic Scalpel resulted in a relative visibility of 0.801. Monopolar-based instruments produced plumes responsible for the poorest relative visibility (Floating Ball 0.252; Monopolar Shears 0.026).
  
  
  CONCLUSIONS
  Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.
authors: Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: Kyle J
authors: KJ
authors: Weld
authors: Stephen
authors: S
authors: Dryer
authors: Caroline D
authors: CD
authors: Ames
authors: Kuk
authors: K
authors: Cho
authors: Chris
authors: C
authors: Hogan
authors: Myonghwa
authors: M
authors: Lee
authors: Pratim
authors: P
authors: Biswas
authors: Jaime
authors: J
authors: Landman
mesh_terms: D000336:Aerosols; D000395:Air Pollutants, Occupational / Q000032:analysis; D000818:Animals; D066298:In Vitro Techniques; D010535:Laparoscopy; D008854:Microscopy, Electron; D023421:Models, Animal; D016658:Psoas Muscles / Q000601:surgery; D012906:Smoke / Q000032:analysis*; D013525:Surgical Instruments; D013552:Swine; D014785:Vision, Ocular
chemical_list: D000336:Aerosols; D000395:Air Pollutants, Occupational; D012906:Smoke