title: Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation.
abstract: BACKGROUND
  Although its theoretical usefulness has been reported, the true value of automatic smoke evacuation system in laparoscopic surgery remains unknown. This is mainly due to the lack of objective evaluation. The purpose of this study was to determine the efficacy of the automatic smoke evacuator in laparoscopic surgery, by real-time objective evaluation system using an industrial smoke-detection device.
  
  
  METHODS
  Six pigs were used in this study. Three surgical ports were placed and electrosurgical smoke was generated in a standard fashion, using either a high-frequency electrosurgical unit (HF-ESU) or laparosonic coagulating shears (LCS). The smoke was evacuated immediately in the evacuation group but not in the control nonevacuation group. The laparoscopic field-of-view was subjectively evaluated by ten independent surgeons. The composition of the surgical smoke was analyzed by mass spectrometry. The residual smoke in the abdominal cavity was aspirated manually into a smoke tester, and stains on a filter paper were image captured, digitized, and semiquantified.
  
  
  RESULTS
  Subjective evaluation indicated superior field-of-view in the evacuation group, compared with the control, at 15 s after activation of the HF-ESU (P < 0.05). The smoke comprised various chemical compounds, including known carcinogens. The estimated volume of intra-abdominal residual smoke after activation of HF-ESU was significantly lower in the evacuation group (47.4 ± 16.6) than the control (76.7 ± 2.4, P = 0.0018). Only marginal amount of surgical smoke was detected in both groups after LCS when the tissue pad was free from burnt tissue deposits. However, the amount was significantly lower in the evacuation group (21.3 ± 10.7) than the control (75 ± 39.9, P = 0.044) when the tissue pad contained tissue sludge.
  
  
  CONCLUSIONS
  Automatic smoke evacuation provides better field-of-view and reduces the risk of exposure to harmful compounds.
authors: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2-E2, Suita, Osaka 565-0871, Japan. htakahashi@gesurg.med.osaka-u.ac.jp
authors: Hidekazu
authors: H
authors: Takahashi
authors: Makoto
authors: M
authors: Yamasaki
authors: Masashi
authors: M
authors: Hirota
authors: Yasuaki
authors: Y
authors: Miyazaki
authors: Jeong Ho
authors: JH
authors: Moon
authors: Yoshihito
authors: Y
authors: Souma
authors: Masaki
authors: M
authors: Mori
authors: Yuichiro
authors: Y
authors: Doki
authors: Kiyokazu
authors: K
authors: Nakajima
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004564:Electrocoagulation; D004867:Equipment Design; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D012906:Smoke / Q000517:prevention & control*; D014691:Ventilation / Q000295:instrumentation*
chemical_list: D012906:Smoke