Generation of smoke is inevitable during surgical procedures. Some volatile organic compounds (VOCs) in surgical smoke are known to be strong carcinogens. We used a prototype of a multi-layered complex filter in an attempt to eliminate VOCs.
From June 2015 to July 2015, 20 patients underwent transperitoneal laparoscopic nephrectomy for renal cell carcinoma. Smoke (pre-filter) was collected 20 min after the electrocautery device was first used during the surgery, by the direct collection method, with a 5-L Tedlar® gas-sampling bag. Twenty and 120 min after the filter was applied, smoke (post-filter) was again collected using the same method. The sample was analyzed by gas chromatography and mass spectrography. The cancer risk and hazard quotient were analyzed based on US Environmental Protection Agency guidelines.
Twenty patients with a median age of 54.5 (30–80) years were enrolled in the study. Eighteen VOCs were detected using the Japanese indoor air standards mix analysis. The total elimination rate of the VOCs was 86.49 ± 2.83%. The post-filter (120 min) cancer risk (mean ± standard deviation) reduced to a negligible level for benzene, ethylbenzene, and styrene except 1,2-dichloroethane. The post-filter (120 min) hazard quotient for each compound decreased to levels posing a negligible risk for acetone, hexane, benzene, toluene, p-xylene, o-xylene, and styrene.
Strong carcinogens, such as 1,2-dichloroethane, benzene, and ethylbenzene, were eliminated by more than 85% by using this activated carbon fiber filter and the risks from these compounds decreased to an almost negligible level. We suggest using every measure, including these filters, to protect the health of operating room personnel.
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This research was financially supported by the “Advanced medical new material(fiber) development program” through the Ministry of Trade, Industry & Energy (MOTIE) and Korea Institute for Advancement of Technology (KIAT). Grant number: R0001411.
Dr. Tae-Hwan Kim reports grants from Ministry of Trade, Industry & Energy (MOTIE) and Korea Institute for Advancement of Technology (KIAT), during the conduct of the study. Seock Hwan Choi, Dong Hee Choi, Dong Hwa Kang, Yun-Sok Ha, Jun Nyung Lee, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Tae-Gyun Kwon, and Sung Kwang Chung have no conflicts of interest or financial ties to disclose.
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Choi, S.H., Choi, D.H., Kang, D.H. et al. Activated carbon fiber filters could reduce the risk of surgical smoke exposure during laparoscopic surgery: application of volatile organic compounds. Surg Endosc 32, 4290–4298 (2018). https://doi.org/10.1007/s00464-018-6222-0
- Surgical smoke
- Cancer risk