A knowledge gap unmasked: viral transmission in surgical smoke: a systematic review

Abstract

Background Concerns regarding the aerosolized transmission of SARS-CoV-2 via SS have caused significant apprehension among surgeons related to the use of minimally invasive surgery (MIS) during the COVID19 pandemic. While a limited number of studies have previously demonstrated the presence of viral material in SS, no comprehensive systematic review exists on the subject of viral transmission in SS. Methods A systematic review of the literature was conducted as per PRISMA guidelines. MEDLINE, EMBASE, and CENTRAL databases were searched for publications reporting the primary outcome of the presence of viral particles in SS and secondary outcomes of indices suggesting transmission of viable virus particles in SS producing clinically important infection. All human, animal, and in vitro studies which used accepted analytic techniques for viral detection were included. A metaanalysis was not complete due to methodologic heterogeneity and inconsistent reporting of outcomes of interest. Results 23 publications addressed the presence of viral components in SS, and 19 (83%) found the presence of viral particles in SS. 21 publications additionally studied the ability of SS to induce clinically relevant infection in host cells, with 9 (43%) demonstrating potential for viral transmission. Conclusion Evidence exists for viral transmission via SS. However, HPV remains the only virus with documented transmission to humans via SS. While meaningful translation into practical guidelines during the COVID pandemic remains challenging, no evidence exists to suggest increased risk in MIS.

In vivo and in vitro study of the potential hazards of surgical smoke during cervical cancer treatment with an ultrasonic scalpel

“…A recent meta-analysis showed that operating room personnel who participated in ablation procedures, such as laser irradiation, LEEP and cryosurgery, were at risk for HPV transmission [24]. Furthermore, a systematic review conducted by Connal et al [25] identified the risk of viral transmission in surgical smoke, and HPV was the only virus that demonstrated clinical infection in humans exposed to surgical smoke, while human immunodeficiency virus, hepatitis B virus and varicella zoster virus tended not to be transmissible. In the present study, we discovered the presence of HPV DNA in surgical smoke and matched HPV genotypes to the corresponding cervical cancer mouse xenograft models.…”

Comparison of Surgical Smoke between Two Approaches for Endoscopic Thyroidectomy and Open Thyroidectomy

“…Usually, smaller PM can travel longer distances and trigger more chemical effects related to surgical smoke, while larger PM may have a higher infection risk. Interestingly, although the size of PM generated by electrosurgical knives is smaller than that generated by ultrasonic devices, the latter devices produce more PM than the former ones [27]. Hence, given the complex in uences of energy-generating devices on surgical smoke, more indepth investigation is necessary.…”

The effect of Covid-19 phobia on work stress and psychological resilience of nurses exposed to surgical smoke in the operating room

“…Despite the precautions taken in operating rooms [5], which naturally contain many stress factors, problems related to surgical smoke and detection of viruses in surgical smoke [9,[12][13][14] can be an additional source of stress for the healthcare personnel working in these units; moreover, it raises the concern that the SARS-CoV-2 virus may be transmitted through surgical smoke [9,28].…”