OP E R ATING THEATR E S
Eliminating the hazards of surgical plume
Steve Veck, an electro surgery consultant, discusses the dangers associated with surgical plume and the need for plume evacuation devices. He argues that the UK is lagging behind other countries in implementing statutory legal requirements.
Surgical plume is an inevitable result of interventional procedures where electrosurgery (diathermy), laser and ultrasonic devices cut into tissue. It can release an unpleasant odour but, more importantly, can contain toxic, infectious or carcinogenic material – such as hydrogen peroxide gas, human papillomavirus (HPV) or SARS-CoV-2 – that could be hazardous to theatre staff or indeed the patient. As a result, exposure to surgical plume has been linked to eye, nose and throat irritation, nausea, headaches, coughs, nasal congestion, asthma, and asthma-like symptoms.
Several plume evacuation devices designed to capture and remove the surgical plume from the operating site have emerged in an attempt to overcome its dangers and, while they offer a safe solution for many operating procedures,
not all countries mandate their use, and they are not used routinely in the majority of surgical specialties – the one exception being gynaecology. This article explores the incidence of surgical plume and discusses how and why this issue should be efficiently and consistently eradicated from surgical departments everywhere.
What is surgical plume?
Surgical plume is a term used to describe the gaseous product that is created when heat- generating methods such as electrosurgery, laser, drills, shavers and ultrasonic devices are employed to dissect tissue. The process of using heat to cut through tissue ruptures cell walls and, in doing so, releases a plume containing particulate matter from the cells’ contents. This often produces an unpleasant odour and may also obstruct the surgeon’s field of view. More importantly, however, the
plume that is released can contain potential hazards, for example, carcinogenic or infective agents.
The dangers of surgical plume Surgical plume poses a significant risk to surgeons, anaesthetists and theatre staff present in the operating room on a daily basis, as well as to patients themselves who are effectively breathing in their own surgical waste. A range of adverse health effects have been reported resulting from the plume directly irritating the eyes, nose and mouth and the respiratory tract; headaches, drowsiness, and dizziness are also known to occur.
While the short-term effects are increasingly well-recognised, the long-term consequences of persistent exposure to these noxious chemicals are still largely unknown and poorly understood. For example, studies have shown that operating staff suffer from chronic lung conditions more frequently compared to the general population, but the link to occupational exposure to surgical plume needs further investigation. A significant proportion of gynaecological procedures also face an additional infectious hazard from the surgical plume because they are used to target cervical pathology caused by HPV infection. The most common of these conditions is cervical intraepithelial neoplasia (CIN), a condition that in some cases may progress to cervical cancer. HPV’s carcinogenic properties are also known to be implicated in the pathogenesis of oropharyngeal cancers and there is substantial evidence demonstrating that traces of the virus can be identified in the nasal and oral mucosa of staff following their involvement in gynaecological surgery. Inhaling the plume during these procedures, therefore, carries a very real threat of serious disease in exposed individuals. The current practice for most clinical staff in operating rooms is typically to wear a simple surgical mask and perhaps eye
MARCH 2021
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