Laparoscopic Smoke Filtration

The Harmful Impact of Surgical Smoke

Surgical smoke is not only a nuisance because of the vision obstruction to surgeons and its noxious odor, it also puts the entire surgical staff’s health at risk. Surgical smoke is a mix of water vapor, volatile gaseous compounds, and particles derived from the degradation of tissue during laser and electrocautery surgeries. Among the substances found in surgical smoke are toxic, teratogenic, and carcinogenic chemicals. It may also contain viable viruses and cellular material. Chronic exposure to surgical smoke is a concern for healthcare professionals working in a confined space of the Operating Room (OR) where the constituents of the smoke can be inhaled and absorbed through the lungs.¹ Surgical smoke is also harmful to the patient, as it can be absorbed via the peritoneum and cause nausea or a longer recovery time.

Every year over one and a half million healthcare workers including surgeons, nurses, surgical technicians, and others are exposed to surgical smoke. Transmission of human papillomavirus (HPV) through surgical smoke from lasers has been documented. This raises concerns about possible infections from desufflation gases. To avoid the risk of smoke inhalation and potential SARS-CoV-2 transmission, several national and international societies recommend surgical smoke filtration in response to the COIVD-19 crisis.

An Easy to Use Passive Surgical Smoke Evacuation System

The Pall LaparoShield® Laparoscopic Smoke Filtration System is an easy to use passive smoke evacuation system which removes particles, bacteria, viruses and odor causing noxious chemicals from surgical smoke generated in laparoscopic procedures while maintaining a clear field of vision. The universal luer connector meets ISO standards for leak free connection to the trocar. The LaparoShield is indicated for use during any minimally invasive surgery involving insufflation, electrocautery, laser, or ultrasonic scalpel use. The lightweight, low profile construction makes efficient use of materials providing a non-obtrusive, cost-effective solution to laparoscopic smoke removal. It is also packaged in a sterile double peel-pouch allowing easy presentation into the sterile field.

Features and Benefits of Our LaparoShield Laparoscopic Smoke Filtration System

Remove Particles: Surgical smoke from both lasers and electrocautery contains large quantities of particles ranging in size from 10 nm to 1 µm,² a size classified as “lung damaging dust”. Studies show both laser and electrocautery plume produce pathologic changes in the lungs of rats and are too small to be filtered by surgical masks.^3-4 The LaparoShield Filtration System has be shown to remove more than 99.999% of aerosolized monodispersed 0.02 µm MS-2 bacteriophage. The Pall LaparoShield is also classified as a Ultra Low Penetration Air (ULPA) Filter.

Protect Patients: Surgical smoke has shown to be cytotoxic.⁵ It can be absorbed into the patient's blood, causing elevated methemoglobin and carboxyhemoglobin levels.^2,14 This can contribute to headaches, double vision, muscle weakness, nausea and vomiting in patients recovering from laparoscopic procedures.⁶ The LaparoShield Filtration System allows for an efficient and continuous evacuation of smoke throughout the surgical procedure, minimizing the patient's exposure time to potentially harmful surgical smoke.

Maintain Continuity of Surgical Procedures: During tissue ablation, smoke accumulates in the peritoneal cavity obscuring the surgeon's vision.⁷ Interruption of surgical procedures to clear the field of vision can cause delays to re-acquire the pneumoperitoneum and reposition instruments.

Remove Bacteria and Viruses: Viable cells and viruses can exist in electrocautery and laser smoke.^8-10 The LaparoShield Filtration System will remove more than 99.999% of cells and viruses from surgical smoke.

Surgical Smoke Evacuation Legislation Advances Across the Country

While there are so many reasons that you should choose to go smoke free, like protecting your patients and staff from noxious chemicals, it might be mandatory soon. In 2020, surgical smoke evacuation legislation was introduced in: Connecticut, Georgia, Kentucky, Illinois, Iowa, New Jersey, Oregon, Tennessee, and Utah. As of June 2021, Oregon became the fourth state to go surgical smoke free, following Kentucky, Colorado, and Rhode Island. Jennifer Pennock, the senior manager of AORN Government Affairs stated, “Our work for similar legislation will continue across the U.S. until smoke in the operating room is as unacceptable as cigarette smoke on airplanes.” ¹¹

LaparoShield View Product

References

¹ (2016). Pall Laparoshield® Laparoscopic Smoke Filters, Pall Technical Report # 160329.4AGL

² BrÜske-Hohlfeld et al. Surgical smoke and ultrafine particles. J. Occupational Medicine and Toxicology 2008; 3:31.

³ Baggish and Elbakry. The effects of laser smoke on the lungs of rats. Am J Obstet Gynecol.1987; 156(5):1260-5.

⁴ Wenig et al. Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system. Lasers Surg Med. 1993; 13(2):242-5.

⁵ Hensman C. Cytotoxicity of electro-surgical smoke produced in an anoxic environment. Am J Surg. 1998; 175(3):240-1.

⁶ Ott DB. Laparoscopic surgical smoke absorbed into bloodstream. O R Manager 1994; 10:19.

⁷ Nezhat et al. Smoke from laser surgery: Is there a health hazard? Surg Med.1987; 7:376-82.

⁸ Fletcher et al. Dissemination of melanoma cells within electrocautery plume. Am J Surg.1999; 178(1):57-9.

⁹ Baggish et al. Presence of human immunodeficiency virus DNA in laser smoke. Lasers Surg Med. 1991; 11(3):197-203.

¹⁰ Hallmo and Naese. Laryneal papiliomatosis with human papillomovirus DNA contracted by a laser surgeon. Eur Arch Otohinolaryngol.1991; 248:425-

¹¹ AORN (2021Kentucky Secures Third Place in States’ Race to Go Smoke Free [Online]. Available at: https://www.aorn.org/About-AORN/AORN-Newsroom/Health-Policy-News/2021-Health-Policy-News/Kentucky-Passes-Smoke-Bill (Accessed: 16 April 2021)