Cytotoxicity of Electro-Surgical Smoke Produced in an Anoxic Environment

doi:10.1016/S0002-9610(97)00291-2

The American Journal of Surgery

Volume 175, Issue 3, March 1998, Pages 240-241

https://doi.org/10.1016/S0002-9610(97)00291-2 Get rights and content

Abstract

Background: The effect on cell viability of smoke produced during high-frequency electro-surgery has not been previously reported. The aim of this study was to produce smoke in vitro, in a closed environment similar to that encountered in minimal access surgery, and to test its cytotoxic effects on cultured cells.

Methods: Pig liver was cut repeatedly with an electro-surgical hook knife, and the smoke generated was collected and equilibrated with cell culture medium. MCF-7 human breast carcinoma cells were exposed briefly to various dilutions of this medium and tested for clonogenicity.

Results: Electro-surgical smoke produced in a helium environment reduced the clonogenicity of the MCF-7 human breast carcinoma cells in a dose-dependent manner, falling to 30% when the cells were exposed to undiluted medium for 15 minutes.

Conclusions: We conclude that electro-surgical smoke is cytotoxic. The sublethal effects at lower dilutions are currently being investigated.

References (7)

JE Gatti et al.
The mutagenicity of electrocautery smoke
Plastic Reconstruct Surg
(1992)
PM Sagar et al.
Chemical composition and potential hazards of electrocautery smoke
Br J Surg
(1996)
JG Des Côteaux et al.
Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures
Surg Endosc
(1996)

There are more references available in the full text version of this article.

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Once ablated, the tissue 1 g may have a mutagenic effect whose intensity is equivalent to that of 3-6 cigarettes during laser-assisted and electrocautery, respectively.13 It has been earlier demonstrated that electrosurgical smoke produces a helium environment that reduces the clonogenicity of MCF-7 human breast carcinoma cells in a dose-dependent manner.14 Another study showed that Salmonella TA98 strain undergoes alterations in histidine metabolism once it is exposed to smoke extract from human tissue ablation.15
To analyze the gas generated from the transurethral resection of the prostate (TURP) and transurethral resection of bladder (TURB) tumor.
Thirty-six smoke samples were collected from a continuous irrigation suction system during the TURP and the TURB. Then, they were subdivided into 2 groups: the group I (n = 18; gases generated from the TURP) and the group II (n = 18; gases generated from the TURB). We performed qualitative and quantitative analysis of the samples on gas chromatography/mass spectrometry.
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Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.
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Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as ‘surgical smoke’. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes. Furthermore, cytotoxic, genotoxic and mutagenic effects have been demonstrated. The American Occupational Safety and Health Administration have estimated that 500 000 workers are exposed to laser and electrosurgical smoke each year. The use of standard surgical masks alone does not provide adequate protection from surgical smoke. While higher quality filter masks and/or double masking may increase the filtration capability, a smoke evacuation device or filter placed near (2–5 cm) the electrocautery blade or on endoscope valves offers additional (and necessary) safety for operating personnel and patients.
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Dégagées par les appareils de coagulation ou de résection, ces émanations contiennent des particules, des substances chimiques et/ou des éléments biologiques, qui peuvent se révéler nocives pour les membres de l’équipe chirurgicale.
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Brief ReportsCytotoxicity of Electro-Surgical Smoke Produced in an Anoxic Environment

Abstract

The mutagenicity of electrocautery smoke

Plastic Reconstruct Surg

Chemical composition and potential hazards of electrocautery smoke

Br J Surg

Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures

Surg Endosc

Brief Reports
Cytotoxicity of Electro-Surgical Smoke Produced in an Anoxic Environment