Introduction
Surgical smoke, also known as surgical plume, is an unavoidable by-product of many modern surgical procedures. It is generated when tissue is dissected, cauterized, or vaporized by energy-based instruments such as electrosurgical units, lasers, or ultrasonic devices. Although often invisible, surgical smoke poses significant risks to both patients and operating room staff. This article explores the dangers of surgical smoke and reviews effective strategies to reduce exposure, ensuring a safer surgical environment.
What Is Surgical Smoke?
Surgical smoke consists of 95% water vapor and 5% particulate matter, but that small fraction includes toxic chemicals and potentially infectious material. Studies have shown that it contains:
- Chemical toxins: benzene, formaldehyde, hydrogen cyanide.
- Biological content: viable cellular material, blood fragments, and viral DNA.
- Particle size: ultrafine particles (0.07–0.42 μm) capable of penetrating deep into the lungs.
Procedures most associated with surgical smoke include electrocautery, laser surgery, and ultrasonic scalpels, all of which are widely used in operating rooms worldwide.
Why Is Surgical Smoke Dangerous?
Health Risks to Surgical Staff
Continuous exposure to surgical smoke can cause:
Acute symptoms: eye, nose, and throat irritation; headaches; nausea.
Respiratory complications: chronic bronchitis and reduced lung function.
Long-term risks: mutagenic and carcinogenic potential from toxic compounds.
In addition, studies have shown the presence of viral DNA (e.g., human papillomavirus, HIV) in surgical smoke, raising concerns about the possibility of disease transmission.
Impact on the Operating Room Environment
Reduced visibility during surgery, increasing operative difficulty.
Contamination of OR ventilation systems.
Research suggests that daily exposure to surgical smoke is comparable to inhaling the smoke of 20–30 cigarettes.
Effective Solutions to Prevent Surgical Smoke
1. Smoke Evacuation Systems
The most effective method of reducing exposure is the use of dedicated smoke evacuation systems.
Ceiling-mounted or portable units can capture smoke at the source.
Systems should include HEPA or ULPA filters, often combined with activated carbon to remove both particles and odors.
Integrated pendant-based evacuation provides a hands-free solution that improves workflow.
2. Local Exhaust Ventilation (LEV)
Positioning suction nozzles within 2 inches of the surgical site significantly increases effectiveness. Adjustable arms or pendant-mounted LEV devices allow surgeons to operate without obstruction while maintaining safety.
3. Personal Protective Equipment (PPE)
Standard surgical masks do not filter out ultrafine particles. Staff should use:
N95 respirators or laser masks.
Protective eyewear to prevent irritation.
4. Operating Room Ventilation
A well-designed OR ventilation system ensures continuous air exchange and dilution of contaminants. Compliance with ASHRAE and WHO standards is recommended, with adequate air changes per hour to maintain clean airflow.
Guidelines and Standards
Several international organizations have issued recommendations:
NIOSH (National Institute for Occupational Safety and Health): Advocates the use of local exhaust ventilation and smoke evacuation for all procedures producing smoke.
AORN (Association of periOperative Registered Nurses): States that smoke evacuation should be used whenever surgical smoke is generated.
OSHA (Occupational Safety and Health Administration): Recognizes surgical smoke as a workplace hazard and supports engineering controls to protect staff.
WHO (World Health Organization): Encourages hospitals to adopt best practices for occupational health in surgical environments.
Conclusion
Surgical smoke is a hidden but significant occupational hazard in the operating room. Exposure can cause immediate symptoms and long-term health risks for surgical teams. The combination of smoke evacuation systems, local exhaust ventilation, PPE, and proper OR ventilation offers the most effective protection. Hospitals and surgical centers must prioritize staff safety by adopting these measures and following international guidelines.
By investing in modern OR equipment and training, healthcare facilities not only protect their staff but also enhance surgical efficiency and patient outcomes.
References
1. NIOSH. Control of Smoke From Laser/Electric Surgical Procedures. DHHS (NIOSH) Publication No. 96–128.
2. AORN. Guideline for Surgical Smoke Safety. Association of periOperative Registered Nurses, 2022.
3. OSHA. Hazard Information Bulletin: Surgical Smoke. U.S. Department of Labor.
4. Barrett WL, Garber SM. Surgical smoke: a review of the literature. Surgical Endoscopy. 2003;17(6):979–987.
5. World Health Organization. Occupational Health: Workplace Health Promotion. WHO Guidelines, 2021.
