Surgical Smoke

No evidence exists as to whether occupational HPV vaccination would provide protection for OR personnel who participate in surgical smoke–generating procedures involving tissue containing oncogenic HPV types (eg, HPV 16, HPV 18). The Centers for Disease Control and Prevention currently does not provide HPV vaccination recommendations for health care workers, although clinical trials are underway.

Resource:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated: October 7, 2021

No, surgical smoke and cigarette smoke do not contain the same chemicals. However, both types of smoke are considered hazardous. The contents of surgical smoke have been widely studied, including estimated equivalent mutagenicity to cigarette smoke. Surgical smoke not only contains harmful chemicals and lung-damaging particulate matter, but it may also contain biohazardous materials such as viruses, bacteria, blood, and potentially viable cancer cells.

Resources:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
• Hill DS, O'Neill JK, Powell RJ, Oliver DW. Surgical smoke—a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. J Plast Reconstr Aesthet Surg. 2012;65(7):911-916.
• Stewart CL, Raoof M, Lingeman R, et al. A quantitative analysis of surgical smoke exposure as an occupational hazard. Ann Surg. 2021;274(2):306-311.
• Tomita Y, Mihashi S, Nagata K, et al. Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutat Res. 1981;89(2):145-149.

Updated: October 7, 2021

No, a surgical smoke precipitator is not considered a surgical smoke evacuation device. The surgical smoke precipitator uses electrostatic precipitation (ESP) technology to clear the visual field by negatively charging suspended smoke particles during laparoscopic surgery. The device precipitates the charged particles from surgical smoke onto the inner surface of the patient’s peritoneum. This device is categorized by the US Food and Drug Administration as a surgical smoke precipitator.

Resource:

• Guideline for Surgical Smoke Safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated: October 7, 2021

Yes, respiratory protection (eg, a surgical N95 filtering facepiece respirator) should be worn in conjunction with the use of smoke evacuation and filtration devices during procedures that generate surgical smoke on tissue containing HPV.

Resources:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
• Jones E. Clinical issues-November 2021. AORN J. 2021;114(5). In press.

Updated: October 7, 2021

If the surgical smoke evacuation system is ineffective, the team should evaluate the system to verify that smoke is being captured at the site where it is being generated, that there is efficient air movement through the device, and that the filters are present and within their useful life. Possible adjustments to the smoke evacuation and filtration equipment may include

• repositioning the smoke evacuation accessory,
• changing the type of smoke evacuation accessory,
• switching from wall-suction with an in-line ULPA filter to a smoke evacuator device,
• adding an activated carbon filter,
• replacing the filter, or
• adding a smoke evacuator device.

Resource:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated: October 7, 2021

An ultra-low particulate air (ULPA) filter demonstrates an efficiency of no less than 99.999% at a most penetrating particle size (MPPS) (eg, 0.12 μm). The MPPS is the particle size that most easily passes through the filter media. Filter efficiencies are tested and validated by the manufacturer. Capture efficiency (%) and MPPS diameter (μm) of a filter are functions of straining, diffusion, inertial impaction, and interception, which are mechanisms that allow greater filter efficiencies for particles larger and smaller than the MPPS.

Surgical energy devices applied to tissue produce by-products of toxic gaseous chemicals and vapors. An activated carbon filter acts to adsorb odors and gases (eg, volatile organic compounds) in surgical smoke.

Resources:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
• Jones E. Clinical issues-November 2021. AORN J. 2021;114(5). In press.

Updated: October 7, 2021

Yes. There are many options for surgical smoke evacuation and filtration during minimally invasive procedures. The updated AORN guideline discusses options studied in the literature such as trocars, tubing, or accessories with ULPA and activated carbon filtration. Unfiltered surgical smoke should not be released into the OR during minimally invasive surgical procedures.

Resource

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated: October 7, 2021

Yes, when a small amount of surgical smoke is anticipated, a medical-surgical vacuum with an in-line surgical smoke filter (ie, ULPA and activated carbon filter) may be used. The surgical smoke in-line filter should be placed between the wall outlet and the suction cannister.

Change the in-line surgical smoke filter according to manufacturer’s instructions for use. Always handle used smoke evacuation supplies using standard precautions.

Resource:

• Guideline for surgical smoke safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated: October 7, 2021