The effect of a smoke‐evacuation unit on ultrafine particle concentrations in the operating room during approach to the proximal tibia for tibial plateau‐leveling osteotomy surgery in dogs

Abstract

To evaluate the effectiveness of a smoke-evacuation unit on reducing ultrafine particle concentration in the operating room (OR) during the approach to the proximal tibia for tibial plateau-leveling osteotomy (TPLO).Study design: Prospective, randomized, controlled clinical trial. Sample population: Twenty-nine client-owned dogs undergoing unilateral TPLO at a single institution were assigned to either smoke-evacuator groups (SE; n = 15) or non-smoke-evacuator groups (NSE; n = 14). Methods: Dogs were randomly assigned to the SE group or the NSE group.An airborne particle measuring device measured and recorded baseline and intraoperative particles per cm 3 (ppc) during the approach to the proximal tibia during which electrosurgery was used to provide hemostasis, dissect subcutis, transect and elevate fascia. The mean ppc, maximum ppc, and baseline ppc were compared between groups. Mean ppc was also compared to the baseline ppc within each group. Results: During surgery, mean ppc (1352) and maximum ppc (62 450) for the NSE group were higher in than mean ppc (763) and maximum ppc (10 100) for the SE group (P < .0001, P < .0001, respectively). Mean ppc was higher in both SE (mean ppc = 763; P < .0001) and NSE (mean ppc = 1352; P = .0001) than their respective baseline ppc (213 and 240). Conclusion:The use of a smoke evacuator decreased particle concentrations 56.4% during the approach to the proximal tibia. Performing the approach to the proximal tibia resulted in higher particle concentrations than the baseline, regardless of smoke-evacuator use.Clinical significance: Surgeons should be aware of smoke produced by electrosurgery, potential health consequences, and methods of smoke mitigation (smoke evacuation).

Determination of Smoke Particulates and Formaldehyde Removal from the Surgical Site by a Smoke Evacuator

“…[25] Use of a smoke evacuation pencil (Buffalo Filter SnapEvac, Conmed) during canine orthopedic surgery decreased particle concentrations by 56.4%. [26] In open cholecystectomy, a smoke evacuation pencil (Valleylab, Medtronic) reduced particulates by 58%. [27] During spinal surgery, a smoke evacuation pencil (Neptune E-SEP, Stryker Surgical Technologies) decreased PM 2.5 peak levels in the room by approximately 82%.…”

Formaldehyde Reduction in an Operating Room Setting: Comparison of a Catalytic Surgical Vacuum Device With a Traditional Smoke Evacuator

“…In order to reduce exposure to surgical smoke, smoke-evacuating technologies have been developed [2,11]. Handpiece evacuators (HE) contain suction tubing attached to an electrosurgical stylus, which allows some of the smoke generated during electrosurgery to be re-directed to an ultra-low particulate air (ULPA) filter and activated carbon cartridge.…”

Catalytic Surgical Smoke Filtration Unit Reduces Formaldehyde Levels in a Simulated Operating Room Environment

“…Given the potential health consequences of formaldehyde inhalation, various approaches to reduce exposure have been developed. Smoke evacuators are often used to improve occupational safety during electrosurgery. , While these tools remove portions of the surgical plume, some practitioners resist their adoption due to shortcomings that include compromised ergonomics, distraction, and noise . Commercial smoke evacuation systems aim to reduce the concentration of airborne contaminants to as low as possible.…”