The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study

Abstract

BACKGROUND CONTEXT: Exposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries. OBJECTIVE: To examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery. STUDY DESIGN: A prospective self-controlled study. PATIENT SAMPLE: After the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019. OUTCOME MEASURES: Two outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm 3 , ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded. METHODS: Consecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a "para incisional evacuator," which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a "surgical smoke evacuation pencil" which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides. RESULTS: The para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% (287 [interquartile range {IQR}: 126, 526] vs. 1,177 [IQR: 395, 2,702], p<.001). The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% (917 [IQR: 448, 1936] vs. 1,605 [IQR: 775, 4,280], p<.001). Both evacuators significantly reduced peak smoke levels as well. FDA device/drug status: Approved (miniSQUAIR,

State of the Science: A Concept Analysis of Surgical Smoke

“…When analyzing surgical smoke from a linguistic perspective, we noted that the literature frequently included a discussion of its chemical components [21][22][23][31][32][33]40 that expanded into a discussion of the symptoms and illnesses associated with surgical smoke exposure [31][32][33] and concluded with the devices used to protect the health of the perioperative team and patients. 22,33,38,40,45,49 Several studies mentioned the particulate matter found in surgical smoke during specific surgical procedures, such as liver procedures, 44 transurethral resection of the prostate, 21 robotic and laparoscopic colon resections, 27 and breast reduction procedures. 31 Particulate matter reached unhealthy levels for OR staff members when heat-generating instruments produced surgical smoke.…”

“…23,53 Personnel can mitigate some of these effects by employing surgical smoke evacuation devices and practices. 32,38,39,46,49,50 Defining Characteristics…”

Protecting perioperative personnel and patients from surgical smoke

“…One study compared two common smoke evacuators in 51 open spinal surgeries: a para incisional evacuator (25 patients) and a surgical smoke evacuation pencil (26 patients) 1 . When exposing the spine on two sides, the amount of smoke exposure was measured on one side with the smoke evacuator off and one side with the smoke evacuator on 1 .…”

“…When exposing the spine on two sides, the amount of smoke exposure was measured on one side with the smoke evacuator off and one side with the smoke evacuator on 1 . The para incisional evacuator and surgical smoke evacuation pencil significantly reduced the average smoke level (i.e., mean of all measurements) by 59.7 percent and 44.1 percent, respectively, and peak smoke levels (i.e., highest measurements) by 95.9 percent and 75.3 percent, respectively 1 . Two other experimental studies showed that although surgical smoke evacuation systems can reduce particulates and volatile organic compounds, they cannot entirely eliminate them 9,10 …”

Surgical Smoke and Airborne Microbial Contamination in Operating Theatres: Influence of Ventilation and Surgical Phases

“…Occupational Safety and Health Administration (OSHA) [42] states that nearly 500,000 healthcare workers are exposed to laser and electrosurgical smoke in OTs. OSHA and the National Institute for Occupational Safety and Health (NIOSH) [43] recommend the use of preventive measures and personal protective equipment (PPE) against surgical smoke, and the Association of periOperative Registered Nurses (AORN) [44], Association of Surgical Technologists (AST) [45], American National Standards Institute (ANSI) [46] and Liu [47] also suggest the use of local exhaust ventilation (LEV) system to protect workers from surgical smoke hazard. In addition, operating room team members are concerned about surgical smoke safety [48].…”