title: Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery.
abstract: BACKGROUND
  Surgical smoke production is inevitable during surgical procedures. Although many workplaces have adopted smoke-free environments, healthcare workers, especially surgeons, continue to be exposed to surgical smoke.
  
  
  METHODS
  From February 2013 to March 2013, a total of 20 patients underwent transperitoneal laparoscopic nephrectomy for renal cell carcinoma. A 5-L gas sample was collected 30 min after the electrocautery device was first used and was analyzed by gas chromatography and mass spectrometry. Cancer risk was calculated for carcinogenic compounds and hazard quotient was calculated for noncarcinogenic compounds using US Environmental Protection Agency guidelines.
  
  
  RESULTS
  Twenty patients with a median age of 57.5 years were enrolled in the study. Eighteen volatile organic compounds were detected by Japanese indoor air standards mix analysis. The cancer risks were ethanol, 5.10 × 10(-5) ± 6.35 × 10(-5); 1,2-dichloroethane, 4.75 × 10(-3) ± 7.42 × 10(-4); benzene, 1.09 × 10(-3) ± 4.33 × 10(-4); ethylbenzene, 2.87 × 10(-5) ± 1.32 × 10(-5); and styrene, 2.94 × 10(-6) ± 1.16 × 10(-6). The hazard quotients were acetone, 1.88 × 10(-2) ± 7.63 × 10(-3); hexane, 1.48 × 10(-1) ± 8.70 × 10(-2); benzene, 4.66 ± 1.85; toluene, 2.61 × 10(-2) ± 7.23 × 10(-3); p-xylene, 1.81 × 10(-1) ± 6.45 × 10(-2); o-xylene, 2.40 × 10(-2) ± 3.33 × 10(-2); and styrene, 5.15 × 10(-3) ± 2.03 × 10(-3).
  
  
  CONCLUSIONS
  For five carcinogenic compounds detected, the cancer risk was greater than negligible. For 1,2-dichloroethane and benzene, the risk was classified as unacceptable. Analysis of noncarcinogenic compounds showed that risk reduction measures are needed for benzene. Even though surgical smoke is not an immediate health hazard, operating room personnel should be aware of the potential long-term health risks associated with exposure.
authors.affiliation: Department of Urology, School of Medicine, Kyungpook National University Medical Center, Hakjeong-dong, Buk-gu, Daegu, 702-210, Korea, skhwan@gmail.com.
authors.forename: Seock Hwan
authors.initials: SH
authors.lastname: Choi
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Sung Kwang
authors.initials: SK
authors.lastname: Chung
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000096:Acetone / Q000032:analysis; D000368:Aged; D000395:Air Pollutants, Occupational / Q000737:chemistry; D001554:Benzene / Q000032:analysis; D001555:Benzene Derivatives / Q000032:analysis; D002273:Carcinogens / Q000032:analysis; D000431:Ethanol / Q000032:analysis; D005025:Ethylene Dichlorides / Q000032:analysis; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D015386:Hazardous Substances / Q000032:analysis; D006586:Hexanes / Q000032:analysis; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D009873:Operating Rooms; D012906:Smoke / Q000009:adverse effects*; D020058:Styrene / Q000032:analysis; D066231:Surgeons; D014050:Toluene / Q000032:analysis; D014992:Xylenes / Q000032:analysis
chemical_list: D000395:Air Pollutants, Occupational; D001555:Benzene Derivatives; D002273:Carcinogens; D005025:Ethylene Dichlorides; D015386:Hazardous Substances; D006586:Hexanes; D012906:Smoke; D014992:Xylenes; D000096:Acetone; D014050:Toluene; D000431:Ethanol; D020058:Styrene; C031286:4-xylene; D001554:Benzene; C004912:ethylbenzene; C026114:2-xylene