Hazards of Surgical Smoke

Surgical smoke and aerosol, or plume, is created when energy is imparted to tissue cells during surgery. When laser or electrosurgical energy is delivered to a cell, heat is created. The heat vaporizes the intracellular fluid, which increases the pressure inside the cell and eventually causes the cell membrane to burst. When this happens, a plume of smoke containing mostly water vapor is released into the atmosphere of the operating room. At the same time, the intense heat created chars the protein and other organic matter within the cell, and causes thermal necrosis in adjacent cells. The charring of cells, like grilling on a bar-be-que, releases other harmful contaminants, such as carbonized cell fragments and gaseous hydrocarbons.

During laparoscopic or endoscopic surgery, smoke is produced in the closed space of the peritoneal or thoracic cavity, where it remains until it is evacuated through the ports or a suction device.

In laparoscopic procedures, smoke evacuation is critical to the surgeon’s visibility as well as to prevent absorption through tissue into the patient’s bloodstream. The absorptive capacity of the peritoneal cavity is well known, and the increased intra abdominal pressure caused by laparoscopic pneumoperitoneum can cause a significant increase in the absorption rate. During laparoscopic surgery, the harmful constituents of surgical smoke and aerosol can remain in contact with the patient’s mucous membranes for a long time, allowing for peritoneal absorption of toxic chemicals. Later, rapid decompression through a large trocar valve may result in the release of biological contaminants into the atmosphere of the OR.

Our INNOVATION which we now call as the “Kalhan’s Technique” involves a simple use of under water collection of the gaseous toxic waste into a bottle filled with distilled water (we use the empty 3 litre glycine bottle for this purpose), to have a controlled effluent and a relatively cleaner environment. This evolution took place after developing bronchitis from performing almost 3–4 laparoscopic surgeries daily for over last 13 years and a personal series of over 12,000 laparoscopic surgeries.

Carbon dioxide being relatively water soluble under pressure gets absorbed to some extent by this technique when released under pressure from the abdomen via the 5mm port exit valve. Also there is collection of the suspended toxic particles.