Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries

doi:10.5312/wjo.v11.i3.177

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World Journal of Orthopedics

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World J Orthop. Mar 18, 2020; 11(3): 177-183
Published online Mar 18, 2020. doi: 10.5312/wjo.v11.i3.177

Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries

Ali Yeganeh, Mikaiel Hajializade, Alireza Pahlevan Sabagh, Babak Athari, Mahbobeh Jamshidi, Mehdi ‎Moghtadaei

Ali Yeganeh, Mikaiel Hajializade, Alireza Pahlevan Sabagh, ‎Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical ‎Sciences, Tehran 1445613131, Iran

Babak Athari, Department of Orthopaedics Surgery, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Hormozgan, Bandarabbas 1445613131, Iran

Mahbobeh Jamshidi, Department of Chemistry, Payam-e-Nour University, Ghazvin 1445613131, Iran

Mehdi ‎Moghtadaei, Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Tehran âProvince, Tehran, Satarkhan 1445613131, Iran

Author contributions: Yeganeh A ‎designed research; Moghtadaei M and Pahlevan sabagh‎ A performed research; Athari‎ B contributed new reagents ‎or analytic tools; Jamshidi M analyzed data; Hajializade‎ M wrote the paper.

Institutional review board statement: ‎This study was reviewed and approved by the Ethics Committee of Iran University of Medical Sciences.

Informed consent statement: ‎ The patients provided written consent before participation in the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: ‎All data requests should be submitted to the corresponding author for consideration. Access to anonymized data may be granted following review.

STROBE statement: ‎ The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared according to the STROBE Statement-checklist of items.

Corresponding author: Mehdi Moghtadaei, MD, Associate Professor, Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical ‎Tehran Province, Tehran, Satarkhan St. 1445613131, Iran. medicine.ortho@yahoo.com

Received: September 19, 2019
Peer-review started: September 19, 2019
First decision: October 13, 2019
Revised: November 13, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: March 18, 2020
Processing time: 179 Days and 9.7 Hours

Abstract

BACKGROUND

Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut.

AIM

To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries.

METHODS

The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min.

RESULTS

None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable ‎in electrocautery smoke collected from the surgical cutting of the different tissues.‎ The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). ‏‎The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (‎Toluene, Ethylbenzene, and Styrene). No ‎ toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue.

CONCLUSION

Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.

Keywords: Electrocautery smoke; Volatile organic compounds; Polycyclic aromatic hydrocarbons; Surgeon caution

Core tip: No toxic and carcinogenic volatile organic compounds was detected in electrocautery smoke released from ‎ligament and adipose tissue, while‎ electrocautery smoke released from meniscus and muscle tissue contains ‎significant toxicity and carcinogenicity.‎‏ ‏Therefore‏,‏‎ we recommend that surgeons to use other ‎electrosurgical techniques for cutting these tissues.‎