Minimizing operating room personnel exposure to surgical smoke with an easy and costless method

Abstract

Diathermies are commonly used in surgery for precise dissection, hemostasis and tissue mobilization, being sometimes preferable over scalpels because of their ability in reducing operating time, blood loss, and increasing visibility. Because their utilization is always associated with the production of a variable amount of surgical smoke, plastic surgeons and operating room personnel are routinely exposed to it during eighter aesthetic and reconstructive procedures. It is reported that the smoke produced by these devices contains particulate matter, the smallest particles of which can be absorbed into the bloodstream if inhaled and potentially cause adverse consequences to the respiratory, circulatory, and nervous systems. Studies have shown that 1 g of tissue may produce smoke plumes equivalent to six unfiltered cigarettes and that the average amount of surgical smoke produced daily may have the mutagenic equivalent of about 27 to 30 cigarettes [1]. There have been numerous studies on the chemical composition of surgical smoke, but quality and quantity of the particulate matter seems to depend on the different instrument used and the structure of the tissue that was treated [2]. Despite Personal Protective Equipment (PPE) such as standard surgical masks and N95 masks are designed to filter respectively particles over 5 lm and 0.3 lm, the size of the particles produced by the electrocautery is reported to measure between 0.07 and 0.42 lm [3], making these medical devices not totally protective. Health organizations created guidelines regarding exposure to surgical smoke, but it is still not delineated a mandatory conduct to adopt in order to reduce such occupational hazard [3, 4]. Most surgeons use dispersion as the only method of smoke clearance, which mainly depends on a suction device held close to the generated smoke. To be effective, it is recommended that the aspirator is kept within 5 cm from the source of combustion and have an aspiration velocity of 31–46 m per minute [5]. For this reason, many medical manufacturers are now producing electrocauteries with incorporated smoke suction systems, obviating issues relative to common suction apparatuses but at the same time elevating costs attributable to this technology. Here we describe a method for self-producing such devices in a completely sterile environment (Figs. 1 and 2). The distal end of a n 16 Jaques/Nelaton catheter, commonly available in most operating theatres, is cut by scissors and the drilled part removed. Two semi-circular incisions are then performed in the remaining end of the catheter, creating a tunnel in which the diathermy blade is introduced in a proximal to distal direction. The blade is then assembled to the handpiece and secured with the aid of steri-strips, both in the distal and in the proximal part. & Luca Patanè [email protected]