Health Sciences Review (Mar 2023)
A systematic review of the harmful effects of surgical smoke inhalation on operating room personnel
Abstract
Background: Surgical smoke refers to the plume produced by usage of energy-generating surgical equipment on tissues. This review aimed to assess the potential of this smoke to be a serious occupational hazard to theatre staff due to its composition, particularly during the COVID-19 pandemic. Method: A search of Ovid MEDLINE, EMBASE, and PubMed databases was undertaken for publications reporting plume composition, presence of infectious material, carcinogenic potential and comparisons between production in laparoscopic versus open surgery. All human in-vivo and ex-vivo primary studies were included, provided English language translation was available. A narrative synthesis was conducted due to the methodologic heterogeneity of the studies. Results: 25 studies resulted from the primary search, and an additional 3 from cross-referencing, leading to 28 included studies. Studies addressing particle size found that smoke particles were respirable in size. Viral DNA was present in 3 studies, while 2 studies demonstrated the ability for surgical smoke to produce infection of nasal epithelial cells. Chemical composition was explored in 8 studies, revealing the presence of carcinogenic compounds in concentrations above occupational safety limits. These chemicals are recognised as carcinogenic to humans by the International Agency for Research on Cancer criteria. Open surgery was found to generally produce less smoke than laparoscopic, however, both surgical methods resulted in particulate counts higher than Air Quality Index standards. Conclusion: Surgical smoke contains a myriad of hazardous constituents, such as carcinogenic compounds and infectious materials, however, more research surrounding the implications of inhalation of surgical smoke is required to grasp the true extent to which these plumes may be harmful. Safety measures such as extraction of plumes using local exhaust ventilation, and usage of protective equipment such as N95 masks, should be instilled due to the components of this plume.
