The whole story surrounding surgical plume is a little up in the air, only, in this case, there’s a pretty solid way to suck up all the fragments.
Experts are starting to talk about it more – including
the International Council on Surgical Plume (ISCP),
suppliers and surgical team members.
Some people agree with the issue presented, and
some say it’s all smoke and mirrors set up by the
industry to get facilities to spend money on new
equipment. Instead of arguing which side is right,
let’s just take a moment and talk about the solutions
so, if a facility sees surgical plume as a problem,
options are identified.
Smoke capture and evacuation suppliers Buffalo
Filter, Cooper-Surgical, I.C. Medical, Megadyne,
Nascent Surgical and Stryker offered their input
on the issue. Since there haven’t been independent
associations or organizations to champion the cause, with the
exception of the ICSP, which was formed in April, suppliers
have tried to educate the industry about the issue they’ve seen
for the last couple of decades. In recent years, a handful of
professional organizations have created policies on how surgical smoke should be approached, including the Association of
periOperative Registered Nurses (AORN).
Defining the Problem
To better understand the solutions, surgical smoke, also
known as surgical plume, has to be defined. According to
AORN, surgical smoke is created during electrosurgical and
laser surgery procedures when a patient’s tissue is cauterized
with devices that transfer heat to the surgical site. The plume
that is released contains about 150 different identified chemicals, such as acrolein, benzene, carbon monoxide, formaldehyde, hydrogen cyanide, methane, toluene and polycyclic aromatic hydrocarbons. Many of these are found in cigarettes, so
the common argument from capture and evacuation advocates
is: facilities wouldn’t allow smoking in the facility, so why
would they allow plume to float around the operating room?
In addition to these chemicals, viruses, bacteria, carbon-
ized tissue and more are released from the patient and carried
around by the plume. Combined, AORN reports these ele-
ments make up about 5 percent of the smoke created during
surgery. The other 95 percent of the plume is water, which
acts as the carrier.
AORN reports chronic inhalation affects healthcare work-
ers in a variety of ways, including: eye, nose and throat irrita-
tion; headaches; nausea and dizziness; runny nose; coughing;
respiratory irritants; fatigue; skin irritation and allergies.
While the electrosurgical smoke and its impacts are reportedly similar to those of laser surgery, regulations don’t surround electrosurgery procedures like they do laser surgery
Some facilities and staff take precautions against electrosurgical plume by wearing surgical masks and respirators.
Normally, surgical masks only filter out particles that are
five microns in size and larger. The particles in electrosurgical smoke come in two relative sizes – large and small, the
Journal of Endourology reported. The larger particles are
bigger than 500 nanometers and the smaller ones are smaller
than 500 nanometers. Just for some perspective, 1,000 nanometers is the size of one micron.
So, while these masks do offer some protection, surgical
smoke capture and evacuation suppliers argue it isn’t enough.
They also agree any exposure to it for any length of time isn’t
healthy for anyone, including patients. Factors like genetics,
pre-existing illnesses and exposure levels can result in greater
impacts on some patients than others.
Solutions for Surgical Plume
Here, a filter is being used during a laparoscopic procure. (Courtesy of
While not everyone agrees it’s an issue, suppliers shared options for facilities that
want more information.
by Rebecca Rudolph, editor