Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

Abstract

Objectives: The aim of this study was to assess the exposure of patients to organic substances produced and identified in surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy. Material and Methods: Identification of these substances in surgical smoke was performed by the use of gas chromatography-mass spectrometry (GC-MS) with selective ion monitoring (SIM). The selected biomarkers of exposure to surgical smoke included benzene, toluene, ethylbenzene and xylene. Their concentrations in the urine samples collected from each patient before and after the surgery were determined by SPME-GC/MS. Results: Qualitative analysis of the smoke produced during laparoscopic procedures revealed the presence of a wide variety of potentially toxic chemicals such as benzene, toluene, xylene, dioxins and other substances. The average concentrations of benzene and toluene in the urine of the patients who underwent laparoscopic cholecystectomy, in contrast to the other determined compounds, were significantly higher after the surgery than before it, which indicates that they were absorbed. Conclusions: The source of the compounds produced in the abdominal cavity during the surgery is tissue pyrolysis in the presence of carbon dioxide atmosphere. All patients undergoing laparoscopic procedures are at risk of absorbing and excreting smoke by-products. Exposure of the patient to emerging chemical compounds is usually a one-time and short-term incident, yet concentrations of benzene and toluene found in the urine were significantly higher after the surgery than before it.

Operation Clean Air: Implementing a Surgical Smoke Evacuation Program

“…During the study, the patients did not smoke cigarettes and were not exposed to cigarette smoke. Significant findings included an increase in concentration of toluene and a threefold increase in concentration of benzene after surgery compared with concentrations before surgery 16 . Toluene and benzene are both common chemicals found in cigarette smoke 17 .…”

“…One approach to minimally invasive surgery is laparoscopy, during which the surgeon places trocars and uses carbon dioxide to inflate the abdomen. When the surgeon uses electrosurgery with laparoscopic techniques, the patient may directly absorb the generated smoke through their peritoneum and into their blood stream and other body fluids 16 . Dobrogowski et al 16 conducted a study analyzing the preoperative and postoperative urine samples of 82 patients undergoing laparoscopic cholecystectomy for the toxic compounds found in surgical smoke (urine directly filters out the toxic components found in blood).…”

“…When the surgeon uses electrosurgery with laparoscopic techniques, the patient may directly absorb the generated smoke through their peritoneum and into their blood stream and other body fluids 16 . Dobrogowski et al 16 conducted a study analyzing the preoperative and postoperative urine samples of 82 patients undergoing laparoscopic cholecystectomy for the toxic compounds found in surgical smoke (urine directly filters out the toxic components found in blood). The researchers collected the urine samples preoperatively during hospital admission and postoperatively as the first urine excreted within 5 to 12 hours after surgery.…”

Can Image Enhancement be Beneficial to Find Smoke Images in Laparoscopic Surgery?

“…Moreover, surgical smoke is composed of chemical, physical or Congcong Wang and Vivek Sharma contributed equally to this work and listed in alphabetical order. biological particles, which may be harmful for surgeons and patients [4][5][6]. Therefore, it is of vital importance to remove the smoke by computer vision algorithms [7] and by smoke evacuation techniques [8,9].…”

Health risk to medical personnel of surgical smoke produced during laparoscopic surgery

“…Some identified substances of surgical smoke include aromatic hydrocarbons, unsaturated hydrocarbons, aldehydes, alcohols and ketones, as well as dioxins. Many of these substances are recognized to be mutagenic, teratogenic and carcinogenic [2,3]. The presence of these substances in the urine of the operated patients proves that they are absorbed by the peritoneum into the organism.…”