Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation
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Although its theoretical usefulness has been reported, the true value of automatic smoke evacuation system in laparoscopic surgery remains unknown. This is mainly due to the lack of objective evaluation. The purpose of this study was to determine the efficacy of the automatic smoke evacuator in laparoscopic surgery, by real-time objective evaluation system using an industrial smoke-detection device.
Six pigs were used in this study. Three surgical ports were placed and electrosurgical smoke was generated in a standard fashion, using either a high-frequency electrosurgical unit (HF-ESU) or laparosonic coagulating shears (LCS). The smoke was evacuated immediately in the evacuation group but not in the control nonevacuation group. The laparoscopic field-of-view was subjectively evaluated by ten independent surgeons. The composition of the surgical smoke was analyzed by mass spectrometry. The residual smoke in the abdominal cavity was aspirated manually into a smoke tester, and stains on a filter paper were image captured, digitized, and semiquantified.
Subjective evaluation indicated superior field-of-view in the evacuation group, compared with the control, at 15 s after activation of the HF-ESU (P < 0.05). The smoke comprised various chemical compounds, including known carcinogens. The estimated volume of intra-abdominal residual smoke after activation of HF-ESU was significantly lower in the evacuation group (47.4 ± 16.6) than the control (76.7 ± 2.4, P = 0.0018). Only marginal amount of surgical smoke was detected in both groups after LCS when the tissue pad was free from burnt tissue deposits. However, the amount was significantly lower in the evacuation group (21.3 ± 10.7) than the control (75 ± 39.9, P = 0.044) when the tissue pad contained tissue sludge.
Automatic smoke evacuation provides better field-of-view and reduces the risk of exposure to harmful compounds.
KeywordsAutomatic smoke evacuator Laparoscopic surgery High-frequency electrosurgical unit Laparosonic coagulating shears Smoke tester
The authors acknowledge AMCO Incorporated, Tokyo, Japan and Simadzu Incorporated, Kyoto, Japan for their technical supports.
Drs. Takahashi, Yamasaki, Hirota, Miyazaki, Moon, Souma, Mori, Doki, and Nakajima report no conflict of interest or financial ties with any of the firms mentioned in this report.
Movie 1 Representative laparoscopic field of view in the two groups (left: group E; evacuator group, right: group N; control group). (MPG 3592 kb)
Movie 2 The industrial use smoke tester equipped with filter paper was connected to the working port. The residual surgical smoke stained the filter paper after ten pulls of the cylinder. (MPG 4490 kb)