Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery

Abstract

Background

Surgical smoke production is inevitable during surgical procedures. Although many workplaces have adopted smoke-free environments, healthcare workers, especially surgeons, continue to be exposed to surgical smoke.

Methods

From February 2013 to March 2013, a total of 20 patients underwent transperitoneal laparoscopic nephrectomy for renal cell carcinoma. A 5-L gas sample was collected 30 min after the electrocautery device was first used and was analyzed by gas chromatography and mass spectrometry. Cancer risk was calculated for carcinogenic compounds and hazard quotient was calculated for noncarcinogenic compounds using US Environmental Protection Agency guidelines.

Results

Twenty patients with a median age of 57.5 years were enrolled in the study. Eighteen volatile organic compounds were detected by Japanese indoor air standards mix analysis. The cancer risks were ethanol, 5.10 × 10⁻⁵ ± 6.35 × 10⁻⁵; 1,2-dichloroethane, 4.75 × 10⁻³ ± 7.42 × 10⁻⁴; benzene, 1.09 × 10⁻³ ± 4.33 × 10⁻⁴; ethylbenzene, 2.87 × 10⁻⁵ ± 1.32 × 10⁻⁵; and styrene, 2.94 × 10⁻⁶ ± 1.16 × 10⁻⁶. The hazard quotients were acetone, 1.88 × 10⁻² ± 7.63 × 10⁻³; hexane, 1.48 × 10⁻¹ ± 8.70 × 10⁻²; benzene, 4.66 ± 1.85; toluene, 2.61 × 10⁻² ± 7.23 × 10⁻³; p-xylene, 1.81 × 10⁻¹ ± 6.45 × 10⁻²; o-xylene, 2.40 × 10⁻² ± 3.33 × 10⁻²; and styrene, 5.15 × 10⁻³ ± 2.03 × 10⁻³.

Conclusions

For five carcinogenic compounds detected, the cancer risk was greater than negligible. For 1,2-dichloroethane and benzene, the risk was classified as unacceptable. Analysis of noncarcinogenic compounds showed that risk reduction measures are needed for benzene. Even though surgical smoke is not an immediate health hazard, operating room personnel should be aware of the potential long-term health risks associated with exposure.