Experimental study of the potential hazards of surgical smoke from powered instruments.
BACKGROUND
Many surgical instruments have been replaced with powered devices in open gastrointestinal and laparoscopic surgery. The production of smoke as a result of vaporization of surgical tissue is inevitable, and exposure to surgical smoke is a long-standing concern. These vapours are potentially hazardous to patients and surgical teams. The present research was designed to compare various surgical devices to determine whether viable cells exist in their surgical smoke.


METHODS
The search for viable cells in surgical smoke was conducted using both in vitro and in vivo experiments. Various cancers were cauterized with electrocautery, radiofrequency ablation and ultrasonic scalpels, and the resulting surgical smoke was aspirated with Transwell(®) membrane; viable cells were sought in the surgical smoke. In an in vivo experiment, samples of SCC7 were cauterized with an ultrasonic scalpel and the sediment from the rinsed Transwell(®) membrane liquid after centrifugation was injected subcutaneously into the lower back of mice.


RESULTS
Viable cells were found only in the smoke from ultrasonic scalpels (in all 25 samples taken 5 cm from the cautery; 2 of 25 samples at 10 cm). Viable cells in the surgical smoke from ultrasonic scalpels implanted in mice grew in 16 of 40 injection sites. Histological and biochemical analyses revealed that these cancer cells were identical to the cancer cells cauterized by the ultrasonic scalpel.


CONCLUSIONS
Viable tumour cells are produced in the surgical smoke from tumour dissection by ultrasonic scalpel. Surgical relevance Surgical smoke is a byproduct of dissection using a number of powered devices. Hazards to operating room personnel and patients are unclear. This study has shown that use of an ultrasonic dissection device can produce smoke that contains viable tumour cells. Although the model is somewhat artificial, a theoretical risk exists, and measures to evacuate surgical smoke efficiently are important.
Department of Otolaryngology, School of Medicine, Konyang University, Daejeon, Korea.
S M
SM
In
Department of Otolaryngology - Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
D-Y
DY
Park
Departments of Otolaryngology, Ajou University, Suwon, Korea.
I K
IK
Sohn
Departments of Otolaryngology, Ajou University, Suwon, Korea.
C-H
CH
Kim
Departments of Otolaryngology, Ajou University, Suwon, Korea.
H L
HL
Lim
Departments of Otolaryngology, Ajou University, Suwon, Korea.
S-A
SA
Hong
Department of Otolaryngology, School of Medicine, Konyang University, Daejeon, Korea.
D Y
DY
Jung
Departments of Medical Genetics, Ajou University, Suwon, Korea.
S-Y
SY
Jeong
Departments of Pathology, School of Medicine, Ajou University, Suwon, Korea.
J H
JH
Han
Departments of Otolaryngology, Ajou University, Suwon, Korea.
H J
HJ
Kim
D000818:Animals; D017115:Catheter Ablation / Q000295:instrumentation*; D004564:Electrocoagulation / Q000295:instrumentation*; D051379:Mice; D009374:Neoplasms, Experimental / Q000473:pathology / Q000601:surgery*; D016273:Occupational Exposure / Q000009:adverse effects*; D009873:Operating Rooms; D012906:Smoke / Q000009:adverse effects*; D013525:Surgical Instruments / Q000009:adverse effects*; D014407:Tumor Cells, Cultured
D012906:Smoke