Electrocautery smoke exposure and smoke evacuation in thoracic surgery: A prospective randomized study

Abstract Objective Worldwide, health care professionals working in operating rooms (ORs) are exposed to electrocautery smoke on a daily basis. Aims of this study were to determine the composition and concentrations of electrocautery smoke in the OR using mass spectrometry and investigate whether smoke evacuation systems, operative technique and distance to the cautery source are effective in reducing exposure. Methods Single-center study at our thoracic surgical unit including 122 surgical procedures. Besides room air measurements away from the operating table (n=35) and direct breath analysis (n=3), 84 minimally invasive and open procedures were in each group 1:1 computer randomized to smoke evacuation system (SES) versus no SES use and hazardous compounds were measured at the height of the operating surgeons respiratory tract. Results Irritating, toxic, carcinogenic and mutagenic volaticle organic compounds (VOCs) were observed in OR air, with some exceeding permissible exposure limits (OSHA/NIOSH). Mean total concentration of harmful compounds at surgeon height without SES was 273ppb (±189ppb) with a maximum total concentration of harmful substances of 8991ppb . Maximum total VOC concentrations were 1.6±1.2 ppm (minimally-invasive surgery) and 2.1±1.5 ppm (open surgery), and total maximum VOC concentrations were 1.8±1.3 ppm at the OR table and 1.4±1.0 ppm in OR air in general. Neither difference was statistically significant. In open surgery, SES significantly reduced maximum concentrations of specific VOCs at surgeon height, including aromatics and aldehydes. Conclusion Our data indicate relevant exposure of health care professionals to volatile organic compounds in the OR. Surgical technique and distance to cautery devices did not significantly reduce exposure. SES reduced exposure to specific harmful VOC's during open surgery.