Surgeons Take Care of Us. But Who Takes Care of the Surgeons?

Surgeons operate to save the lives of patients and make them feel better. However, quite unfortunately, due to their central dedicated focus on patients, they themselves ignore their health by getting afflicted with smoke which emanates from certain surgical devices and procedures. This smoke is known as surgical smoke.

According to reports, approximately 85% of surgical operations include the use of electrosurgical units (ESUs), which are the main sources of surgical smoke. As per a 2018 research bulletin titled, “Status of Surgical Smoke: Risks, Remediation and Regulation,” around 500,000 healthcare workers are affected by the toxic surgical smoke every year in the United States. The number is more in India.

It is said that during electro-surgery when a high-frequency electric current is used to operate on one gram of tissue of the human body, it results in surgical smoke which is equal to smoking six unfiltered cigarettes that surgeons inhale during the procedure. Also, terms like smoke plumes, aerosols, cautery smoke are used alternatively to describe surgical smoke.

All the above mentioned surgical devices are medical equipment which generates a lot of energy when used. So whenever they are operational, smoke is an obvious by-product. When surgical procedures such as electro surgeries are conducted, human tissue is vaporized as a part of the operation. The vaporization of the tissues produces surgical smoke. Surgical smoke consists of poisonous gasses along with biological/viral products which can result in a number of health risks for both involved parties; the surgery team members present in the Operating Room (OR) and the patients on whom the operation is being performed.

 Surgery smoke mainly consists of water vapor. However, reports say that the smoke also contains more than 150 chemicals. Out of these, 16 chemicals are enlisted as “priority pollutants” by the United States Environmental Protection Agency (EPA). Priority pollutants is a list of chemicals formulated by the EPA which exists as a subdivision under the “toxic pollutants list” under the Clean Water Act in the United States of America.

It should be noted here that although the technology required for electro-surgery was invented in the early 20th century, surgical smoke was not identified as a health hazard until the National Institute for Occupational Safety and Health (NIOSH), a sub-department of Centers for Disease Control and Prevention (CDC) in the United States drafted and published a Health Hazard Evaluation report in 1985.

 In more recent times, the potential health hazards caused by surgical smoke has been a matter of intense debate.

Researches have stated that surgical smoke can contain dangerous substances which include bacteria, viruses, alive and dead cellular substances, carbon monoxide and particles which can cause lung deterioration. The substance compositions in a smoke plume depend heavily on the type and size of the particles which are present in it. The types of particles which are present in surgical smoke, in turn, depend on what type of surgical procedure is being performed, the nature of energy which is being generated and the power level of the energy. However, some of the health hazards which are associated with surgical smoke are as follows:

– Respiratory problems: sneezing, asthma, throat inflammation and nasopharyngeal lesions

– Blood disorder: leukemia and anemia

– Gastrointestinal system: vomiting, a feeling of nausea, colic

– Skin: dermatitis

– Infections: human immunodeficiency virus (HIV), human papilloma virus (HPV) and hepatitis

– Other potential health risks include light headedness, headache, anxiety, and dizziness

 The surgeons who are performing the operations and using the surgical appliances are the ones who inhale the maximum amount of surgical smoke. It is a fact that the members of the surgical team which includes the circulating nurse (who prepares the OR for operations and is in charge of cleaning post-operation), and the anesthesiologist (who provides anesthesia to the patient) are at risk of inhaling surgical smoke on a more regular basis as they have to be present in the OR for multiple operations. Even the scrubbing members (the members who organize the operation instruments and provide them to the surgeon during the operation) of a surgery team are more prone towards inhaling the smoke than the members who are standing some distance away from the operating table. On the other hand, surgeons, who are mostly experts in certain types of procedures might be exposed to surgical smoke at a lesser frequency as they don’t perform surgeries every day.

One of the most efficient methods through which surgical smoke can be removed is the installation of smoke evacuation equipment. Smoke evacuation machines which can eradicate smoke plumes from its source should be deployed at ORs. Surgical smoke evacuation devices like ViroVac and PlumeSafe Turbo by companies like Buffalo Filter are said to be quite effective in reducing smoke plume levels.

Dr. Abraham Peedicayil, Professor and Head, Department of Gynecologic Oncology at Christian Medical College (CMC) & Hospital Vellore shed some light on the same. He said, “Surgical smoke during surgeries is a concern as it can not only harm the patient and the doctors in the OR, but smoke in any room can cause hindrances while working. Any obstruction during surgeries can be fatal.”

 “Smoke evacuators are very efficient in getting rid of the smoke helping us work better and of course clearing the toxic smoke,” he added.

Dr. Ninad V. Katdare, a leading surgical oncologist from Mumbai echoed similar thoughts about the benefits of smoke evacuators.

“I have been using smoke evacuators and it is a great solution to the problem of surgical smoke which we doctors face when operating on patients. Hospitals need to be safe for both patients and doctors and this machine helps us keep it that way by getting rid of the poisonous smoke,” said Dr. Katdare.

He added, “Additionally, the device is also very helpful during open HIPEC procedures as advocated by the renowned American surgeon Dr. Paul Sugarbaker.”

With regards to practices in OR, surgical smoke evacuation strategies should be in place regardless of how much smoke is generated during surgical procedures. Even if the amount of surgical smoke is less, inhalation of small amounts can also lead to health risks.

Till now, the major contributors for not addressing this problem was the unavailability of specific devices and technologies to hospitals in India. However, companies like Medikabazaar are bringing innovative medical devices like ViroVac and PlumeSafe Turbo surgical smoke evacuation systems to name a few, making medical establishments safe for both doctors and patients.

High-grade technological devices are now available to tackle the issue of surgical smoke. If there is a collective effort towards establishing efficient smoke evacuating systems, then the potential health hazards emanating from surgical smoke can be reduced.

The article was published in the June 2019 edition of Medgate today Magazine

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