Surgical smoke management for minimally invasive (micro)endoscopy: an experimental study
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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.
KeywordsSurgical smoke Endoscopy Minimally invasive surgery Pressure control Smoke evacuation
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.
Video 1 Experimental smoke generation in the transparent cavity model without and with the new sucking device (AVI 12223 kb)
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