Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and its Reduction Strategies: A Systematic Review
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Abstract
Background: Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team.
Methods: A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria.
Results: Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff.
Conclusion: Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.
1. Ragde SF, Jørgensen RB, Føreland S (2016). Characterisation of exposure to ultrafine particles from surgical smoke by use of a fast mobility particle sizer. Ann Occup Hyg, 60:860-74.
2. Hensman C, Baty D, Willis RG, Cuschieri A (1998). Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment. An in vitro study. Surg Endosc, 12(8):1017-9.
3. Fitzgerald JEF, Malik M, Ahmed I (2012). A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc, 26(2):337-42.
4. Hill DS, O'Neill JK, Powell RJ, et al (2012). 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, 65(7):911-6.
5. Oganesyan G, Eimpunth S, Kim SS, et al (2014). Surgical smoke in dermatologic surgery. Dermatol Surg, 40(12):1373-7.
6. Ilce A, Yuzden GE, Yavuz van Giersbergen M (2017). The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions. J Clin Nurs, 26(11-12):1555-1561.
7. Hahn KY, Kang DW, Azman ZAM, et al (2017). Removal of Hazardous Surgical Smoke Using a Built-in-Filter Trocar: A Study in Laparoscopic Rectal Resection. Surg Laparosc Endosc Percutan Tech, 27(5):341-345.
8. OSHA (2007). Laser/Electrosurgery Plume. OSHA.
9. Ha HI, Choi MC, Jung SG, et al (2019). Chemicals in surgical smoke and the efficiency of built-in-filter ports. JSLS, 23(4): e2019.00037.
10. Liu Y, Song Y, Hu X, et al (2019). Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer, 10(12):2788-2799.
11. Ball K (2010). Compliance with surgical smoke evacuation guidelines: implications for practice. AORN J, 92(2):142-9.
12. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
13. Bratu AM, Petrus M, Patachia M, et al (2015). Quantitative analysis of laser surgical smoke: Targeted study on six toxic compounds. Romanian Journal of Physics, 60(1):215-227.
14. Choi DH, Choi SH, Kang DH (2017). Influence of surgical smoke on indoor air quality in hospital operating rooms. Aerosol Air Qual Res, 17:821-830.
15. Choi SH, Choi DH, Kang DH, et al (2018). Activated carbon fiber filters could reduce the risk of surgical smoke exposure during laparoscopic surgery: application of volatile organic compounds. Surg Endosc, 32(10):4290-4298.
16. Chung YJ, Lee SK, Han SH, et al (2010). Harmful gases including carcinogens produced during transurethral resection of the prostate and vaporization. Int J Urol, 17(11):944-9.
17. Dobrogowski M, Wesołowski W, Kucharska M, et al (2015). Health risk to medical personnel of surgical smoke produced during laparoscopic surgery. Int J Occup Med Environ Health, 28(5):831-40.
18. Kocher GJ, Sesia SB, Lopez-Hilfiker F, et al (2019). Surgical smoke: still an underestimated health hazard in the operating theatre (vol 55, pg 626, 2019). Eur J Cardiothorac Surg, 55(4):626-631.
19. Kokosa JM, Eugene J (1989). Chemical Composition of Laser‐Tissue Interaction Smoke Plume. J Laser Appl, 1:59-63.
20. Krones CJ, Conze J, Hoelzl F, et al (2007). Chemical composition of surgical smoke produced by electrocautery, harmonic scalpel and argon beaming - A short study. European Surgery, 39:118-121.
21. Lin Y-W, Fan S-Z, Chang K-H, et al (2010). A Novel Inspection Protocol to Detect Volatile Compounds in Breast Surgery Electrocautery Smoke. J Formos Med Assoc, 109(7):511-6.
22. Oganesyan G, Eimpunth S, Kim SS, et al (2014). Surgical Smoke in Dermatologic Surgery. Dermatol Surg, 40(12):1373-7.
23. Sahaf O, Vega-Carrascal I, Cunningham F, et al (2007). Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci, 176(3):229-32.
24. Neumann K, Cavalar M, Rody A, et al (2018). Is surgical plume developing during routine LEEPs contaminated with high-risk HPV? A pilot series of experiments. Arch Gynecol Obstet, 297(2):421-424.
25. Kwak HD, Kim S-H, Seo YS, et al (2016). Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med, 73(12):857-86.
26. Sarkarizi HK, Salimnejad R, Jafarian AH, et al (2020). Effects of Electrocauterization Smoke on Nasal Mucosa in Rats. Crescent J Medical Biol Sci, 7:34-39.
27. Garden J, O’Banion M, Bakus A, et al (2002). Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol, 138(10):1303-7.
28. Sawchuk WS, Weber PJ, Lowy DR, et al (1989). Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol, 21(1):41-9.
29. Capizzi PJ, Clay RP, Battey MJ (1998). Microbiologic activity in laser resurfacing plume and debris. Lasers Surg Med, 23(3):172-4.
30. NIOSH (2014). Control of Smoke From Laser/Electric Surgical Procedures. CDC,
31. Ball K (2004). Controlling surgical smoke: A team approach. Information Booklet.
32. Ulmer BC (2008). The hazards of surgical smoke. AORN J, 87(4):721-34; quiz 735-8.
33. ERUS (2020). Guidelines during COVID-19 emergency.
34. CDC (2020). Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team. CDC,
35. Edwards BE, Reiman RE (2008). Results of a survey on current surgical smoke control practices. AORN J, 87(4):739-49.
36. NIOSH (2017). Health and Safety Practices Survey of Healthcare Workers. CDC.
37. WHO (2020) Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that causes COVID-19. WHO.
38. Choi SH, Kwon TG, Chung SK, et al (2014). Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery. Surg Endosc, 28(8):2374-80.
39. Sisler JD, Shaffer J, Soo JC, et al (2018). In vitro toxicological evaluation of surgical smoke from human tissue. J Occup Med Toxicol, 13:12.
40. Tseng HS, Liu SP, Uang SN, et al (2014). Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel. World J Surg Oncol, 12: 31.
41. Wenig BL, Stenson KM, Wenig BM, et al (1993). Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system. Lasers Surg Med, 13(2):242-5.
42. Atar Y, Salturk Z, Kumral TL, et al (2017). Effects of Smoke Generated by Electrocautery on the Larynx. J Voice, 31(3):380.e7-380.e9.
43. Baggish MS, Elbakry M (1987). The effects of laser smoke on the lungs of rats. Am J Obstet Gynecol, 156(5):1260-5.
44. Navarro-Meza MC, González-Baltazar R, Aldrete-Rodríguez MG, et al (2013). [Respiratory symptoms caused by the use of electrocautery in physicians being trained in surgery in a Mexican hospital]. Rev Peru Med Exp Salud Publica, 30(1):41-4.
45. McKinley IB, Ludlow MO (1994). Hazards of laser smoke during endodontic therapy. J Endod, 20(11):558-9.
46. Taravella MJ, Weinberg A, May M, et al (1999). Live virus survives excimer laser ablation. Ophthalmology, 106(8):1498-9.
47. Zhou Q, Hu X, Zhou J, et al (2019). Human papillomavirus DNA in surgical smoke during cervical loop electrosurgical excision procedures and its impact on the surgeon. Cancer Manag Res, 11:3643-3654.
48. Fletcher JN, Mew D, Descôteaux JG (1999). Dissemination of melanoma cells within electrocautery plume. Am J Surg, 178(1):57-9.
49. In SM, Park DY, Sohn IK, et al (2015). Experimental study of the potential hazards of surgical smoke from powered instruments. Br J Surg, 102(12):1581-6.
50. Tomita Y, Mihashi S, Nagata K, et al (1981). Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutat Res, 89(2):145-9.
51. Gatti JE, Bryant CJ, Noone RB, et al (1992). The mutagenicity of electrocautery smoke. Plast Reconstr Surg, 89:781-4; discussion 785-6.
2. Hensman C, Baty D, Willis RG, Cuschieri A (1998). Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment. An in vitro study. Surg Endosc, 12(8):1017-9.
3. Fitzgerald JEF, Malik M, Ahmed I (2012). A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc, 26(2):337-42.
4. Hill DS, O'Neill JK, Powell RJ, et al (2012). 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, 65(7):911-6.
5. Oganesyan G, Eimpunth S, Kim SS, et al (2014). Surgical smoke in dermatologic surgery. Dermatol Surg, 40(12):1373-7.
6. Ilce A, Yuzden GE, Yavuz van Giersbergen M (2017). The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions. J Clin Nurs, 26(11-12):1555-1561.
7. Hahn KY, Kang DW, Azman ZAM, et al (2017). Removal of Hazardous Surgical Smoke Using a Built-in-Filter Trocar: A Study in Laparoscopic Rectal Resection. Surg Laparosc Endosc Percutan Tech, 27(5):341-345.
8. OSHA (2007). Laser/Electrosurgery Plume. OSHA.
9. Ha HI, Choi MC, Jung SG, et al (2019). Chemicals in surgical smoke and the efficiency of built-in-filter ports. JSLS, 23(4): e2019.00037.
10. Liu Y, Song Y, Hu X, et al (2019). Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer, 10(12):2788-2799.
11. Ball K (2010). Compliance with surgical smoke evacuation guidelines: implications for practice. AORN J, 92(2):142-9.
12. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
13. Bratu AM, Petrus M, Patachia M, et al (2015). Quantitative analysis of laser surgical smoke: Targeted study on six toxic compounds. Romanian Journal of Physics, 60(1):215-227.
14. Choi DH, Choi SH, Kang DH (2017). Influence of surgical smoke on indoor air quality in hospital operating rooms. Aerosol Air Qual Res, 17:821-830.
15. Choi SH, Choi DH, Kang DH, et al (2018). Activated carbon fiber filters could reduce the risk of surgical smoke exposure during laparoscopic surgery: application of volatile organic compounds. Surg Endosc, 32(10):4290-4298.
16. Chung YJ, Lee SK, Han SH, et al (2010). Harmful gases including carcinogens produced during transurethral resection of the prostate and vaporization. Int J Urol, 17(11):944-9.
17. Dobrogowski M, Wesołowski W, Kucharska M, et al (2015). Health risk to medical personnel of surgical smoke produced during laparoscopic surgery. Int J Occup Med Environ Health, 28(5):831-40.
18. Kocher GJ, Sesia SB, Lopez-Hilfiker F, et al (2019). Surgical smoke: still an underestimated health hazard in the operating theatre (vol 55, pg 626, 2019). Eur J Cardiothorac Surg, 55(4):626-631.
19. Kokosa JM, Eugene J (1989). Chemical Composition of Laser‐Tissue Interaction Smoke Plume. J Laser Appl, 1:59-63.
20. Krones CJ, Conze J, Hoelzl F, et al (2007). Chemical composition of surgical smoke produced by electrocautery, harmonic scalpel and argon beaming - A short study. European Surgery, 39:118-121.
21. Lin Y-W, Fan S-Z, Chang K-H, et al (2010). A Novel Inspection Protocol to Detect Volatile Compounds in Breast Surgery Electrocautery Smoke. J Formos Med Assoc, 109(7):511-6.
22. Oganesyan G, Eimpunth S, Kim SS, et al (2014). Surgical Smoke in Dermatologic Surgery. Dermatol Surg, 40(12):1373-7.
23. Sahaf O, Vega-Carrascal I, Cunningham F, et al (2007). Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci, 176(3):229-32.
24. Neumann K, Cavalar M, Rody A, et al (2018). Is surgical plume developing during routine LEEPs contaminated with high-risk HPV? A pilot series of experiments. Arch Gynecol Obstet, 297(2):421-424.
25. Kwak HD, Kim S-H, Seo YS, et al (2016). Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med, 73(12):857-86.
26. Sarkarizi HK, Salimnejad R, Jafarian AH, et al (2020). Effects of Electrocauterization Smoke on Nasal Mucosa in Rats. Crescent J Medical Biol Sci, 7:34-39.
27. Garden J, O’Banion M, Bakus A, et al (2002). Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol, 138(10):1303-7.
28. Sawchuk WS, Weber PJ, Lowy DR, et al (1989). Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol, 21(1):41-9.
29. Capizzi PJ, Clay RP, Battey MJ (1998). Microbiologic activity in laser resurfacing plume and debris. Lasers Surg Med, 23(3):172-4.
30. NIOSH (2014). Control of Smoke From Laser/Electric Surgical Procedures. CDC,
31. Ball K (2004). Controlling surgical smoke: A team approach. Information Booklet.
32. Ulmer BC (2008). The hazards of surgical smoke. AORN J, 87(4):721-34; quiz 735-8.
33. ERUS (2020). Guidelines during COVID-19 emergency.
34. CDC (2020). Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team. CDC,
35. Edwards BE, Reiman RE (2008). Results of a survey on current surgical smoke control practices. AORN J, 87(4):739-49.
36. NIOSH (2017). Health and Safety Practices Survey of Healthcare Workers. CDC.
37. WHO (2020) Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that causes COVID-19. WHO.
38. Choi SH, Kwon TG, Chung SK, et al (2014). Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery. Surg Endosc, 28(8):2374-80.
39. Sisler JD, Shaffer J, Soo JC, et al (2018). In vitro toxicological evaluation of surgical smoke from human tissue. J Occup Med Toxicol, 13:12.
40. Tseng HS, Liu SP, Uang SN, et al (2014). Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel. World J Surg Oncol, 12: 31.
41. Wenig BL, Stenson KM, Wenig BM, et al (1993). Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system. Lasers Surg Med, 13(2):242-5.
42. Atar Y, Salturk Z, Kumral TL, et al (2017). Effects of Smoke Generated by Electrocautery on the Larynx. J Voice, 31(3):380.e7-380.e9.
43. Baggish MS, Elbakry M (1987). The effects of laser smoke on the lungs of rats. Am J Obstet Gynecol, 156(5):1260-5.
44. Navarro-Meza MC, González-Baltazar R, Aldrete-Rodríguez MG, et al (2013). [Respiratory symptoms caused by the use of electrocautery in physicians being trained in surgery in a Mexican hospital]. Rev Peru Med Exp Salud Publica, 30(1):41-4.
45. McKinley IB, Ludlow MO (1994). Hazards of laser smoke during endodontic therapy. J Endod, 20(11):558-9.
46. Taravella MJ, Weinberg A, May M, et al (1999). Live virus survives excimer laser ablation. Ophthalmology, 106(8):1498-9.
47. Zhou Q, Hu X, Zhou J, et al (2019). Human papillomavirus DNA in surgical smoke during cervical loop electrosurgical excision procedures and its impact on the surgeon. Cancer Manag Res, 11:3643-3654.
48. Fletcher JN, Mew D, Descôteaux JG (1999). Dissemination of melanoma cells within electrocautery plume. Am J Surg, 178(1):57-9.
49. In SM, Park DY, Sohn IK, et al (2015). Experimental study of the potential hazards of surgical smoke from powered instruments. Br J Surg, 102(12):1581-6.
50. Tomita Y, Mihashi S, Nagata K, et al (1981). Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutat Res, 89(2):145-9.
51. Gatti JE, Bryant CJ, Noone RB, et al (1992). The mutagenicity of electrocautery smoke. Plast Reconstr Surg, 89:781-4; discussion 785-6.
| Files | ||
| Issue | Vol 51 No 1 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i1.8289 | |
| Keywords | ||
| Surgical smoke Electrosurgery Electrocautery Ultrasonic scalpel | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Merajikhah A, Imani B, Khazaei S, Bouraghi H. Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and its Reduction Strategies: A Systematic Review. Iran J Public Health. 2022;51(1):27-36.
