In electro-surgery, surgical smoke was hazard to surgeons and patient in theatre. In order to institute effective countermeasures, quantifying of the effect of tip temperature of electro-surgical unit to surgical smoke distribution in theatre was studied. The relation of tip temperature to power of electro-surgical unit through in vitro cutting experiment. Based on experiment data, the mathematical model was established to simulate the electro-surgery in laminar operation room. As the power of electro-surgical knife increased, the knife tip temperature increased. Total content of (CO, CO2, CH4, NH3) in waste gas and net flow rate of waste gas at outlet increased with the rising temperature of knife tip and formation rate of condensed tar droplets and non-viable particles also increased. Based on simulation, it was found that The maximum height of surgical smoke rising right above the incision of electro-surgical unit was increased with rising temperature of electro-surgical knife tip. There was a spread route of dispersed surgical smoke near the walls of theatre through natural convection. The polynomial fitting relationship was derived. As the tip temperature of knife increased from 200 to 500°C, maximum ascending height of surgical smoke right above the incision position of electro-surgical unit increased from 1.1 m to 1.45 m. When the tip temperature of electro-knife was more 400°C, the CO content in the surgeon's operating zone was more than 200 ppm, which would cause the surgeon's HbCO level increased. As the patient's tissue in the wound during operation was open, when the electro-knife of more than 400°C, the content of condensed tar droplets and in-viable particle was higher than 20 g/m3 and 12 g/m3 in the zone around patient's wound of open tissue, which should be hazard to health of patient.

Surgical smoke generated through the use of electrical surgical devices poses a risk to the surgeon, medical personnel in the operating room, and the patient by exposing them to environmentally hazardous particulate matter. Previous investigation has shown that surgical smoke leads to an increased risk of pulmonary conditions, circulatory disorders, and irritation of the eyes, nose, and throat. Transmission of infectious disease can occur through inhalation of viral particles, and the presence of carcinogens are also of major concern. The deleterious effects of surgical smoke are well documented in several subspecialties, namely dermatology and general surgery, but there has been little discussion on the topic amongst orthopedic surgeons.

A non-systematic review of the literature was completed with the aim of identifying the major categories of adverse health effects associated with surgical smoke inhalation and offering recommendations to reduce these hazards in the orthopedic surgical community.

Three primary categories of risk associated with surgical smoke inhalation were identified: inflammation, viral/bacterial transmission, and carcinogenicity. In addition, strategies for mitigating risk and best practice recommendations were explored.

Surgical smoke is an under-recognized occupational hazard within the orthopedic surgery literature. There are several strategies which can be employed to reduce risk. Further investigation is needed to understand the long-term impact of these risks, as well as what can be done to improve the practicality and compliance with protective measures.

Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery (MIS). Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and mortality. MIS has become the first-line surgical intervention for some types of gastrointestinal surgery, such as laparoscopic cholecystectomy and appendicectomy. Carbon dioxide (CO2) is the main gas used for insufflation in MIS. CO2 contributes 9%-26% of the greenhouse effect, resulting in global warming. The rise in global CO2 concentration since 2000 is about 20 ppm per decade, up to 10 times faster than any sustained rise in CO2 during the past 800000 years. Since 1970, there has been a steady yet worrying increase in average global temperature by 1.7 °C per century. A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO2 emission per surgery, with higher CO2 emission following robotic compared to laparoscopic surgery. However, with superior benefits of MIS over open surgery, this poses an ethical dilemma to surgeons. A recent survey in the United Kingdom of 130 surgeons showed that the majority (94%) were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental sustainability. Given the deleterious environmental effects of MIS, this study aims to summarize the trends of MIS and its carbon footprint, awareness and attitudes towards this issue, and efforts and challenges to ensuring environmental sustainability.

This study aimed to identify the evidence in the scientific literature between exposure to surgical smoke and biological symptoms in healthcare professionals and patients.

A systematic review.

Electronic databases were searched, including vivo observational and experimental studies published until August 2020 in Portuguese, English, Spanish and French.

We identified 13 studies, with a predominance of cross-sectional (6; 46.15%), experimental laboratory (4; 30.76%) and cohort (3; 23.07%) studies. The main manifestations identified were related to respiratory tract and headache. There was identification of histopathological changes in the nasal mucosa of healthcare professionals and the presence of toxic substances from smoke identified in the urine of patients and healthcare professionals.

The scientific literature on the biological symptoms of surgical smoke is mainly composed of observational studies with a reduced sample size, thus constituting aspects which limit a broader and long-term understanding of the biological effects of surgical smoke exposure in healthcare professionals and patients.

Surgical smoke produced by electrosurgery contains various chemical substances such as volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). The aim of this study is to investigate airborne concentrations of VOCs and PAHs during electrosurgery in an operating room, in relation to metabolites in urine in order to assess the absorbed dose. A 5-day exposure study was set up in a general surgery operation room including surgeons, scrub assistants and circulation nurses (n = 15). Stationary and personal air sampling for VOCs and PAHs were carried out. Pre-, mid- and end-shift analysis of urinary S-phenylmercapturic acid (SPMA), o-cresol, mandelic acid and 1-hydroxypyrene was performed to assess the internal exposure to respectively benzene, toluene, styrene and PAHs. Several VOCs (styrene, ethyl benzene, benzene and toluene), ranging from 0.7 to 3.27 μg/m³ were detected in the air samples, along with one PAH (naphthalene, ranging from 0.012 to 0.39 μg/m³). There was no significant correlation between air monitoring and urinary biomonitoring. O-cresol levels were increased, especially among assistants and nurses at mid- and end-shift, exceeding current biological exposure indices several times. External and internal exposure for assistants and nurses was substantially more, compared to surgeons. This study confirms the presence of VOCs and PAHs in surgical smoke and shows the presence of their metabolites in urine, but the association is unclear. Urinary biomonitoring shows especially high concentrations of o-cresol.