The aim of this study was to investigate the use of surgical smoke-producing procedures such as laser ablation or electrosurgery in minimally invasive microendoscopic procedures. This study proposes a technical solution to efficiently remove surgical smoke from very small endoscopic cavities using microports as small as 20 G (0.9 mm) in diameter.
The experimental laboratory study used small, rigid, transparent plastic cavity models connected with tubes and pressure sensors to establish an endoscopic in vitro laboratory model. A Kalium-Titanyl-Phosphate (KTP) laser with a 0.5-mm fiber optic probe was used to produce smoke from bovine scleral tissue in the cavity. Endoscopic gas insufflation into the model was generated by pressurized air and a microvalve. A laboratory vacuum pump provided smoke and gas suction via a microvalve. A self-built control and steering system was utilized to control intracavital pressure during experimental insufflation and suction.
Problems related to smoke-generating processes, such as laser vaporization or electrocautery, in small closed cavities were first analyzed. A theoretical and mechatronic laboratory model was established and tested. Intracavital pressure and gas flow were measured first without and then with smoke generation. A new construction design for the suction tube was proposed due to rapid obstruction by smoke particles.
Surgical smoke evacuation from endoscopic cavities that are as small as 2 cm in diameter via minimally invasive ports as small as 20 G (0.9 mm) in diameter may be safe and efficient if sufficient gas exchange is provided during smoke generation by laser or electrosurgical instruments. However, maintaining a low and constant pressure in the cavity during gas exchange and adopting a special construction design for the suction tube are essential to provide an excellent view during the surgical maneuver and to minimize potential toxic side effects of the smoke.
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Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23(7):1512–1518
Mintz Y, Horgan S, Cullen J, Stuart D, Falor E, Talamini MA (2008) NOTES: a review of the technical problems encountered and their solutions. J Laparoendosc Adv Surg Tech A 18(4):583–587
Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23(7):1419–1427
Gomes Ferreira C, Reinberg O, Becmeur F, Allal H, De Lagausie P, Lardy H, Philippe P, Lopez M, Varlet F, Podevin G, Schleef J, Schlobach M (2009) Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc 23(7):1650–1659
Moglia A, Menciassi A, Dario P, Cuschieri A (2009) Capsule endoscopy: progress update and challenges ahead. Nat Rev Gastroenterol Hepatol 6(6):353–362
Hensman C, Baty D, Willis RG, Cuschieri A (1998) Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment. An in vitro study. Surg Endosc 12(8):1017–1019
Barrett WL, Garber SM (2003) Surgical smoke: a review of the literature. Is this just a lot of hot air? Surg Endosc 17(6):979–987
Mawn LA, Shen JH, Jordan DR, Joos KM (2004) Development of an orbital endoscope for use with the free electron laser. Ophthal Plast Reconstr Surg 20(2):150–157
Joos KM, Shah RJ, Robinson RD, Shen JH (2006) Optic nerve sheath fenestration with endoscopic accessory instruments versus the free electron laser (FEL). Lasers Surg Med 38(9):846–851
Shah RJ, Shen JH, Joos KM (2007) Endoscopic free electron laser technique development for minimally invasive optic nerve sheath fenestration. Lasers Surg Med 39(7):589–596
Tomita Y, Mihashi S, Nagata K, Ueda S, Fujiki M, Hirano M, Hirohata T (1981) Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutat Res 89(2):145–149
Kokosa JM, Eugene J (1989) Chemical composition of laser tissue interaction smoke plume. J Laser Appl 2:59–63
DesCoteaux JG, Picard P, Poulin EC, Baril M (1996) Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc 10(2):152–158
Sagar PM, Meagher A, Sobczak S, Wolff BG (1996) Chemical composition and potential hazards of electrocautery smoke. Br J Surg 83(12):1792
Krones CJ, Conze J, Hoelzl F, Klinge U, Moeller M, Dott W, Schumpelick V, Hollender J (2007) Chemical composition of surgical smoke produced by electrocautery, harmonic scalpel and argon beaming—a short study. Eur Surg 39(2):118–121
Bigony L (2007) Risks associated with exposure to surgical smoke plume: a review of the literature. AORN J 86(6):1013–1020
Ulmer BC (2008) The hazards of surgical smoke. AORN J 87(4):721–734
Silajdzic E (2007) Konzeption eines Druckregelkreises für eine Absauganlage am Auge. Thesis (German), Department of Control Engineering and Automation, Graz University of Technology, Austria
Bockhorn H (1995) Soot formation in combustion: mechanisms and models, Springer series in chemical physics. Springer, Berlin
Ott D (1993) Smoke production and smoke reduction in endoscopic surgery: preliminary report. Endosc Surg Allied Technol 1(4):230–232
Ott DE (1998) Carboxyhemoglobinemia due to peritoneal smoke absorption from laser tissue combustion at laparoscopy. J Clin Laser Med Surg 16(6):309–315
Hensman C, Newman EL, Shimi SM, Cuschieri A (1998) Cytotoxicity of electro-surgical smoke produced in an anoxic environment. Am J Surg 175(3):240–241
Gatti JE, Bryant CJ, Noone RB, Murphy JB (1992) The mutagenicity of electrocautery smoke. Plast Reconstr Surg 89(5):781–784
Wenig BL, Stenson KM, Wenig BM, Tracey D (1993) Effects of plume produced by the Nd:YAG laser and electrocautery on the respiratory system. Lasers Surg Med 13(2):242–245
Thiébaud HP, Knize MG, Kuzmicky PA, Hsieh DP, Felton JS (1995) Airborne mutagens produced by frying beef, pork and a soy-based food. Food Chem Toxicol 33(10):821–828
Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, Büchler MW (2004) Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 21(2):95–105
Ott DE (2008) Laparoscopy and adhesion formation, adhesions and laparoscopy. Semin Reprod Med 26(4):322–330
Mattes D, Reich EM, Muellner K, Langmann G (2005) Evaluation of a KTP (potassium-titanyl-phosphate) 532 nm laser for endovaporization of choroidal melanomas. Lasers Surg Med 36(1):57–64
We gratefully acknowledge Annegret Theisl and Heimo Bauer, Medical University of Graz, Austria, as well as Herbert Monschein from Ebensee, Austria, for technical assistance. We also thank Dr. Claus Rebentisch from Ing. Neugebauer GmbH, Vienna, Austria, for providing free disposable filter elements. The present study was supported by a grant from “Land Steiermark, Abteilung Wissenschaft und Forschung, Austria” (Project No. A3-16M82/2006-1) and the Center for Medical Research (ZMF), Medical University of Graz (Project No. 2091).
D. Mattes, E. Silajdzic, M. Mayer, M. Horn, D. Scheidbach, W. Wackernagel, G. Langmann, and A. Wedrich have no conflicts of interest or financial ties to disclose, although the Medical University of Graz, Austria, has filed a patent application regarding the method of smoke evacuation described in this article.
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Mattes, D., Silajdzic, E., Mayer, M. et al. Surgical smoke management for minimally invasive (micro)endoscopy: an experimental study. Surg Endosc 24, 2492–2501 (2010). https://doi.org/10.1007/s00464-010-0991-4
- Surgical smoke
- Minimally invasive surgery
- Pressure control
- Smoke evacuation