title: Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery.
abstract: BACKGROUND
  Hepatitis B virus (HBV) transmission is known to occur through direct contact with infected blood. There has been some suspicion that the virus can also be detected in aerosol form. However, this has never been directly shown. The purpose of this study was to sample and analyse surgical smoke from laparoscopic surgeries on patients with hepatitis B to determine whether HBV is present.
  
  
  METHODS
  A total of 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in this study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analysed by using nested PCR.
  
  
  RESULTS
  Robotic or laparoscopic colorectal resections were performed in 5 cases, laparoscopic gastrectomies in 3 cases and laparoscopic hepatic wedge resections in another 3 cases. Preoperatively, all of the patients had positive hepatitis B surface antigen (HBsAg). 2 patients had detectable HBsAb, and 2 were positive for hepatitis B e antigen. 3 patients were taking antihepatitis B viral medications at the time of the study. The viral load measured in the patients' blood was undetectable to 1.7×108IU/mL. HBV was detected in surgical smoke in 10 of the 11 cases.
  
  
  CONCLUSIONS
  HBV is detectable in surgical smoke. This study provides preliminary data in the investigation of airborne HBV infection.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Han Deok
authors.identifier: http://orcid.org/0000-0002-7225-1947
authors.initials: HD
authors.lastname: Kwak
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.
authors.forename: Seon-Hahn
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.affiliation: Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Joon
authors.initials: KJ
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D004784:Environmental Monitoring; D005260:Female; D006511:Hepatitis B Antigens / Q000302:isolation & purification*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D016133:Polymerase Chain Reaction; D056910:Republic of Korea; D012906:Smoke / Q000009:adverse effects / Q000032:analysis*
chemical_list: D006511:Hepatitis B Antigens; D012906:Smoke
keywords: HBV; Hepatitis B virus; Laparoscopic surgery; Surgical smoke; Transmission