The visualisation of surgical smoke produced by energy delivery devices: Significance and effectiveness of evacuation systems

Devices delivering energy to biological tissues (eg lasers, RF and ultrasound) can induce surgical smoke consisting of particles, vapor, gasses and aerosols. Besides interfering with the view of the surgeon, the smoke is a risk for the health of both the users and patients. In literature, it has been shown that surgical smoke can contain carcinogenic and harmful biological agents. However, the impact on health of the users and patients is widely debated. The use of smoke evacuation systems in the OR is usually governed by economical reason instead of safety issues. A special image enhancement technique is used to study the behavior of smoke and aerosols and the effectiveness of smoke evacuation systems. A back scatter illumination technique using 1 μs light flashes at video rate was applied to image the smoke production of various surgical devices without and with smoke evacuation while ablating biological tissues. The effectiveness of various smoke evacuation devices and strategies were compared. The ablative thermal devices produced smoke but also aerosols. If the thermal energy was delivered in high peak pulses, the presence of aerosols was more significant. Ultrasound based devices produce mainly aerosols. The distance to the target, the opening of the evacuation nozzle and the dimension of aerosols were leading for the effectiveness of the smoke evacuation. The smoke visualization technique has proven an effective tool for study the effectiveness of smoke and aerosols evacuation. The results can contribute to the necessity to use evacuation systems in the OR.