During the Surgical Application of energybased technologies, there is a well-recognized production of “smoke” that can impede surgical progress. The confined spaces associated with laparoscopic procedures have made smoke production a more significant problem. The aerosolized particles can impair visibility by settling on the lens of the laparoscope or by remaining in suspension between the laparoscopic and the surgical objective.

Electrosurgery is an established and well-accepted medical technique. The term includes electrodessication, electrocoagulation, electrodissection, electrocautery, and electrolysis. Many important developments followed teh first crude experiments in 1875 in which the effects of electricty upon living tissue were evaluated.

When analyzed, smoke from electrosurgical units, commonly known as Bovie smoke, is shown to be quite similar to that of other potentially pathogenic smoke, behaving as a carcinogen, a mutagen and an infectious vector. In addition, particulate matter in smoke is known to have health risks related to inducing inflammatory and allergic responses in susceptible people.

Laparoscopic procedures using laser for tissue combustion processes generate smoke. This biphasic aerosol is confined to the abdominal cavity. Respiratory absoption of carbon monoxide causes changes in carboxyhemoglobin levels. Absorption of smoke components throught the peritoneum has not been evaluated.

Electrosurgical smoke has been recognized as a definite nuisance in the OR for at least a decade and serveral studies imply that viable human bloodborne pathogens can be transferred via smoke plume particulate. These particulates include not only HIV and human papilloma virus, but the probably more pervasive hepatitis and increasingly antibiotic-resistant tuberculosis.

The effect on cell viability of smoke produced during high - frequency electro - surgery has not been previously reported. The aim of this study was to produce smoke in vitro , in a closed environment similar to that encountered in minimal access surgery , and to test its cytotoxic effects on cultured cells.

While the word has been out for many years about the dangers of laser plme, there's a new alarm being sounded about the plume generated by electrocautery and other thermal cutting methods: That plume may be equally hazardous -- or mor so, researchers warn. The problem with smoke from laser and electrical surgical procedures is so serious that NIOSH sent out a Hazard Controls notice.

The observed occurrence of port site recurrence in laparoscopic surgery for malignant disease has stimulated interest in the dissemination of tumor cells during surgery. Study of electrocautery smoke has revealed the presence of large particles and viable viruses. The purpose of this study was to determine if viable malignant cells are present in suspension within the electrocautery plume.

In a previous issue of this journal (Volume 5, Number 4), I wrote an editorial about the need to approach the resurgence of electrical surgery with caution so as not to repeat the history of past mistakes. I now take the opportunity to expand this admonition and also to eat some of my own words.

Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator saftey. We therefore have studied a group of human and bovine warts to define further the potential risk of wart therapy and to test whether a surgical mask could reduce exposure.