�山����

When considering the risks of surgery, we think of the dangers that the patient faces. However, there are risks to the surgeon as well. And not just the psychological stress of being in control of another human life. There is another lesser known risk about operating: the smoke risk. According to the Center for Disease Control and Prevention, when electrosurgical tools are used, they produce smoke. Commonly termed “surgical smoke”, Tomita et. al. found that “the mutagenic potency observed was comparable to that of cigarette smoke. The amount of these smoke condensates from 1 g of tissue was equivalent to those from 3-6 cigarettes as to total mutagenicity.”
Surgical smoke largely consists of water vapour, but also contains particles that can cause harm to anyone who inhales the smoke. Small particles can deposit themselves in the walls of the nose and trachea. Even smaller particles can deposit themselves in the lungs causing inflammation. Surgical smoke contains dozens of chemical compounds including benzene, toluene, hydrogen cyanide, and methane, and carbon monoxide. These particles can have detrimental effects including binding to hemoglobin, potentially leading to hypoxia, a reduction in the amount of oxygen available to tissues.

Surgical smoke can also contain viable pathogens. It was found that antigens from the Hepatitis B virus were found in smoke when the patient had small amounts of the antigens in their blood. While the infecting potential for the Hepatitis B virus via smoke is unknown, the fact that pathogenic particles can also spread via smoke does not bode well. Human Papillomavirus (HPV) DNA has also been identified in certain types of surgical smoke. Surgi-
cal smoke can also cause fog and block clear vision in the OR.��

To combat this problem, companies such as Medtronic have developed smoke evacuation systems which utilize suction and ventilation to remove surgical smoke. Recent developments have led to quick removal of smoke (under 30 seconds to remove a majority of the smoke), and large volumes of smoke that can be cleared. According to Gioutsos et. al, smoke evacuation systems today are highly efficient, with some reaching up to a 95% clearance rate. Smoke evacuation systems are able to remove a large amount of smoke particles through filtration technologies like HEPA (high efficiency particulate air) and ULPA (ultra-low penetration air) filters. Designs were guided by studies performed by researchers, engineers, and scientists.

One such study is Kumar et. al, which studied the fluid flow of the surgical smoke. They analyzed the Lagrangian Coherent Structures found in surgical smoke patterns, and utilized computational fluid dynamics models to analyze velocity fields, and outlet flow rates. Researchers also found that the finite time Lyapunov exponent (FTLE) fields can also be used to inform efficiency of surgical smoke removal systems.

Unfortunately, according to a survey by AORN, 94% of facilities in Virginia had smoke evacuation technologies, but only 26% of participants reported usage during smoke generating procedures. Despite the reduction in risks when using a smoke evacuation system, only 17 states mandate the use of smoke evacuation systems during surgical procedures. This means that there are surgeons and patients across the United States who may be inhaling toxic smoke every day. The dangers of surgical smoke affect patients and surgeons. Surgical smoke is more than a hassle- it’s a hazard. Although smoke evacuation systems are widespread, their use is limited. To ensure safety, eliminating surgical smoke should be a priority for hospitals, policymakers, and surgeons.