Evaluation of fine particles in surgical smoke from an urologist's operating room by time and by distance.
BACKGROUND
Electrocautery, harmonic scalpel tissue dissection and other surgical techniques can generate surgical smoke with high proportion of 'fine particles' (PM(2.5)) <2.5 μm, which is known to have adverse effects on human health. The high-risk zone for PM(2.5) during surgeries by time and by distance has not been well evaluated.


METHODS
The study included open superficial, open abdominal, open pelvic, laparoscopic and transurethral urology surgeries, five of each. A particle counter was placed at three different distances from the incision site, and the real-time PM(2.5) concentration was displayed after each cut. Air Quality Index (AQI) revised by the US Environmental Protection Agency and the calculated inhalation dose were used to evaluate the severity of PM(2.5).


RESULTS
In superficial, abdominal and pelvic surgeries, the peak PM(2.5) concentration may reach 245.7, 149.4 and 165.1 μg/m(3) 3-6 s after a single cut 40 cm from the incision site. By the time, AQI usually turns to 'unhealthy' or 'very unhealthy.' In laparoscopic surgeries, 40 cm from the trocar, the air quality reached 'hazardous' in 3 s after opening of the trocar valve with a peak concentration of 517.5 μg/m(3). In transurethral surgeries, the AQI 40 cm away from the resectoscope is generally at moderate level. In each surgery, the chief surgeon may inhale most of the PM(2.5), while the assistant will inhale less than half the dose, and the scrub nurse may inhale nearly none. The use of wall suction may induce a 48-65 % decrease in fine particle inhalation.


CONCLUSIONS
During surgeries, the concentration of PM(2.5) could reach a very unhealthy status, especially for the chief surgeon who is the nearest to the incision site. Surgical smoke evacuation in the first few seconds of a cut is essential; however, using smoke evacuators such as a wall suction alone may not be enough.
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Hong-Kai
HK
Wang
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Fei
F
Mo
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Chun-Guang
CG
Ma
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Bo
B
Dai
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Guo-Hai
GH
Shi
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
Yao
Y
Zhu
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China. zhanghl918@163.com.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. zhanghl918@163.com.
Hai-Liang
HL
Zhang
Department of Urology, Shanghai Cancer Center, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China. dwyeli@163.com.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. dwyeli@163.com.
Ding-Wei
DW
Ye
D000328:Adult; D000368:Aged; D000395:Air Pollutants, Occupational; D016902:Air Pollution, Indoor / Q000032:analysis*; D004564:Electrocoagulation; D005260:Female; D006282:Health Personnel; D006801:Humans; D007264:Inguinal Canal; D019570:Inhalation Exposure / Q000032:analysis*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016273:Occupational Exposure / Q000032:analysis*; D009873:Operating Rooms; D052638:Particulate Matter / Q000032:analysis; D011446:Prospective Studies; D011468:Prostatectomy; D012906:Smoke / Q000032:analysis*; D013997:Time Factors
D000395:Air Pollutants, Occupational; D052638:Particulate Matter; D012906:Smoke
Air quality; Fine particle; PM2.5; Surgical smoke