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Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation.
Surg Endosc 2013; 27(8):2980-7SE

Abstract

BACKGROUND

Although its theoretical usefulness has been reported, the true value of automatic smoke evacuation system in laparoscopic surgery remains unknown. This is mainly due to the lack of objective evaluation. The purpose of this study was to determine the efficacy of the automatic smoke evacuator in laparoscopic surgery, by real-time objective evaluation system using an industrial smoke-detection device.

METHODS

Six pigs were used in this study. Three surgical ports were placed and electrosurgical smoke was generated in a standard fashion, using either a high-frequency electrosurgical unit (HF-ESU) or laparosonic coagulating shears (LCS). The smoke was evacuated immediately in the evacuation group but not in the control nonevacuation group. The laparoscopic field-of-view was subjectively evaluated by ten independent surgeons. The composition of the surgical smoke was analyzed by mass spectrometry. The residual smoke in the abdominal cavity was aspirated manually into a smoke tester, and stains on a filter paper were image captured, digitized, and semiquantified.

RESULTS

Subjective evaluation indicated superior field-of-view in the evacuation group, compared with the control, at 15 s after activation of the HF-ESU (P < 0.05). The smoke comprised various chemical compounds, including known carcinogens. The estimated volume of intra-abdominal residual smoke after activation of HF-ESU was significantly lower in the evacuation group (47.4 ± 16.6) than the control (76.7 ± 2.4, P = 0.0018). Only marginal amount of surgical smoke was detected in both groups after LCS when the tissue pad was free from burnt tissue deposits. However, the amount was significantly lower in the evacuation group (21.3 ± 10.7) than the control (75 ± 39.9, P = 0.044) when the tissue pad contained tissue sludge.

CONCLUSIONS

Automatic smoke evacuation provides better field-of-view and reduces the risk of exposure to harmful compounds.

Authors+Show Affiliations

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2-E2, Suita, Osaka 565-0871, Japan. htakahashi@gesurg.med.osaka-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23436084

Citation

Takahashi, Hidekazu, et al. "Automatic Smoke Evacuation in Laparoscopic Surgery: a Simplified Method for Objective Evaluation." Surgical Endoscopy, vol. 27, no. 8, 2013, pp. 2980-7.
Takahashi H, Yamasaki M, Hirota M, et al. Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation. Surg Endosc. 2013;27(8):2980-7.
Takahashi, H., Yamasaki, M., Hirota, M., Miyazaki, Y., Moon, J. H., Souma, Y., ... Nakajima, K. (2013). Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation. Surgical Endoscopy, 27(8), pp. 2980-7. doi:10.1007/s00464-013-2821-y.
Takahashi H, et al. Automatic Smoke Evacuation in Laparoscopic Surgery: a Simplified Method for Objective Evaluation. Surg Endosc. 2013;27(8):2980-7. PubMed PMID: 23436084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation. AU - Takahashi,Hidekazu, AU - Yamasaki,Makoto, AU - Hirota,Masashi, AU - Miyazaki,Yasuaki, AU - Moon,Jeong Ho, AU - Souma,Yoshihito, AU - Mori,Masaki, AU - Doki,Yuichiro, AU - Nakajima,Kiyokazu, Y1 - 2013/02/23/ PY - 2012/04/01/received PY - 2013/01/04/accepted PY - 2013/2/26/entrez PY - 2013/2/26/pubmed PY - 2014/3/13/medline SP - 2980 EP - 7 JF - Surgical endoscopy JO - Surg Endosc VL - 27 IS - 8 N2 - BACKGROUND: Although its theoretical usefulness has been reported, the true value of automatic smoke evacuation system in laparoscopic surgery remains unknown. This is mainly due to the lack of objective evaluation. The purpose of this study was to determine the efficacy of the automatic smoke evacuator in laparoscopic surgery, by real-time objective evaluation system using an industrial smoke-detection device. METHODS: Six pigs were used in this study. Three surgical ports were placed and electrosurgical smoke was generated in a standard fashion, using either a high-frequency electrosurgical unit (HF-ESU) or laparosonic coagulating shears (LCS). The smoke was evacuated immediately in the evacuation group but not in the control nonevacuation group. The laparoscopic field-of-view was subjectively evaluated by ten independent surgeons. The composition of the surgical smoke was analyzed by mass spectrometry. The residual smoke in the abdominal cavity was aspirated manually into a smoke tester, and stains on a filter paper were image captured, digitized, and semiquantified. RESULTS: Subjective evaluation indicated superior field-of-view in the evacuation group, compared with the control, at 15 s after activation of the HF-ESU (P < 0.05). The smoke comprised various chemical compounds, including known carcinogens. The estimated volume of intra-abdominal residual smoke after activation of HF-ESU was significantly lower in the evacuation group (47.4 ± 16.6) than the control (76.7 ± 2.4, P = 0.0018). Only marginal amount of surgical smoke was detected in both groups after LCS when the tissue pad was free from burnt tissue deposits. However, the amount was significantly lower in the evacuation group (21.3 ± 10.7) than the control (75 ± 39.9, P = 0.044) when the tissue pad contained tissue sludge. CONCLUSIONS: Automatic smoke evacuation provides better field-of-view and reduces the risk of exposure to harmful compounds. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/23436084/Automatic_smoke_evacuation_in_laparoscopic_surgery:_a_simplified_method_for_objective_evaluation L2 - https://dx.doi.org/10.1007/s00464-013-2821-y DB - PRIME DP - Unbound Medicine ER -