Occupational Safety and Health Administration acts on guidelines for electrosurgical smoke

Ulmer, Brenda C.

doi:10.1016/s0001-2092(06)62612-4

Cited by 14 publications

(11 citation statements)

References 1 publication

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“…Even more concerning is the fact that this space is not yet well-understood or -explored, as few studies have been performed to understand this issue at levels sufficient enough to garner strong understanding and scope of the potential problem [11][12][13][14][15][16][17]. However, those few studies have shown that viruses such as Hepatitis B and HPV have been shown to aerosolize in the smoke evacuated during laparoscopic surgery as well as during open surgery [11,[18][19][20][21][22][23][24][25]. The known aerosolization of these other viruses combined with several new articles documenting COVID-19 in the peritoneal fluid have led numerous international surgical societies to encourage exercising caution when performing minimally invasive surgery [2][3][4][5][6][7][8].…”

Section: Aerosolized Viral Particles In Surgerymentioning

confidence: 99%

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Uecker

Fagerberg²,

Ahmad³

et al. 2020

Surg Endosc

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Background Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. Methods A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure. Results For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. Conclusions Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.

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Section: Aerosolized Viral Particles In Surgerymentioning

confidence: 99%

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Uecker

Fagerberg²,

Ahmad³

et al. 2020

Surg Endosc

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“…The most important outcome of the second smoke conference was the development of a guidance document from OSHA that was intended to support evacuation of surgical smoke. The detailed, 20‐page document was sent out to reviewers in 1998 in anticipation of publication and was similar in scope to the 1996 NIOSH alert 8 . By the year 2000, the guidance document still had not been published, and in July 2000, OSHA stated that the delay was caused by a need for more evidence 9…”

Section: Efforts To Raise Awarenessmentioning

confidence: 99%

The Hazards of Surgical Smoke

Ulmer¹

2008

AORN Journal

187

215

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Surgical smoke is a part of the environment during operative and invasive procedures. As lasers and electrosurgery have become commonplace, perioperative practitioners are at increased risk for health concerns associated with exposure to surgical smoke. Since the mid 1970s, the body of evidence documenting the hazardous components of surgical smoke has continued to grow. Despite the evidence and recommendations of a variety of organizations, there are no uniform requirements mandating surgical smoke evacuation. This article reviews current research to identify the potential health hazards as well as the current recommendations related to the filtration and evacuation of surgical smoke.

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“…8-12 Smoke evacuation (SEvac) has been shown to mitigate the risk of SP exposure, and its routine use is recommended. 13,14…”

mentioning

confidence: 99%

Surgical Team Exposure to Cautery Smoke and Its Mitigation during Tonsillectomy

O’Brien

Lee

Soo

et al. 2020

Otolaryngol.--head neck surg.

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Objectives To assess the exposure of surgical personnel to known carcinogens during pediatric tonsillectomy and adenoidectomy (T&A) and compare the efficacy of surgical smoke evacuation systems during T&A. Study Design Prospective, case series. Setting Tertiary children’s hospital. Subjects and Methods The present study assessed operating room workers’ exposure to chemical compounds and aerosolized particulates generated during T&A. We also investigated the effect of 3 different smoke-controlling methods: smoke-evacuator pencil cautery (SE), cautery with suction held by an assistant (SA), and cautery without suction (NS). Results Thirty cases were included: 12 in the SE group, 9 in SA, and 9 in NS. The chemical exposure levels were lower than or similar to baseline background concentrations, with the exception of methylene chloride and acetaldehyde. Within the surgical plume, none of the chemical compounds exceeded the corresponding occupational exposure limit (OEL). The mean particulate number concentration in the breathing zone during tonsillectomy was 508 particles/cm3 for SE compared to 1661 particles/cm3 for SA and 8208 particles/cm3 for NS cases. NS was significantly different compared to the other two methods ( P = .0009). Conclusions Although the exposure levels to chemicals were considerably lower than the OELs, continuous exposures to these chemicals could cause adverse health effects to surgical personnel. These findings suggest that the use of a smoke-evacuator pencil cautery or an attentive assistant with handheld suction would reduce exposure levels to the aerosolized particles during routine T&A, compared to the use of cautery without suction.

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Occupational Safety and Health Administration acts on guidelines for electrosurgical smoke

Cited by 14 publications

References 1 publication

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

The Hazards of Surgical Smoke

Surgical Team Exposure to Cautery Smoke and Its Mitigation during Tonsillectomy

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