Occupational Hazards of Surgical Smoke in the Operating Room (OR)

Anil Heroor

Anil Heroor

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Anil Heroor is the Director, Surgical Oncology at the Advanced Oncology Surgery Unit at Fortis Hospitals, Mumbai. He is also a Consultant Oncosurgeon as part of his independent practice in the city suburbs. At Fortis Hospital – Mulund in Mumbai, he trains junior residents in the field of Laparoscopic Minimal Access Oncosurgery. He also serves as a faculty member at Johnson and Johnson Institute India. His experience includes working with international hospitals in Japan and the USA. Performing an average of 600 supramajor procedures a year, Dr Heroor has been involved in over 25 publications across several surgical fields including thoracoscopy and oncology

Surgeons and medical personnel face growing health risks in the operating room (OR) from prolonged exposure to surgical smoke which can cause acute and chronic health effects. To address this, for the first time in Asia, a consensus statement based on the expert opinions of 10 leading surgeons from Singapore, Hong Kong, and India; and one leading surgeon from the United States, was developed. The purpose of this consensus statement is to discuss the key issues regarding surgical smoke and share recommendations based on the current scientific evidence.

1. What are the potential risks of surgical smoke exposure?

Energy devices used during surgeries, regardless of open or laparoscopic procedures, can generate surgical smoke. The presence of over 80 potentially hazardous chemicals, blood and tissue particles, bacteria, and virus particles, as well as carcinogenic compounds that can be found in surgical plume has made this a growing concern.

A recent study which investigates the results of exposure to surgical smoke revealed that OR personnel experienced headaches, dizziness, watery eyes, coughs, and several other complications. During the expert panel discussion, there was also a consensus that the compounds found in surgical smoke are above recommended levels of acute exposure limits that have been set by national health organisations. Healthcare professionals need to be aware of such risks and ensure they take the necessary precautions to avoid longterm complications.

2. How are current guidelines and recommendations in the region addressing this?

Despite increasing awareness and a mounting body of evidence around risks associated with long-term exposure to surgical smoke for OR personnel, there are still limited standards on addressing these hazards in Asia. This could be due to the lack of studies that investigate the long-term effects of surgical smoke exposure, preventive measures and associated adverse events.

There are guidelines such as the Occupational Safety and Health Act and the Center for Disease Control and Prevention-National Institute for Occupational Safety and Health (CDC-NIOSH) that speak to recommendations and preventive measures. However, there are still no specific guidelines from Asia including the National Accreditation Board for Hospitals and Healthcare Providers from India.

3. What are the key factors that surgeons and OR personnel need to consider with regards to surgical smoke?

During the panel discussion, we concluded that there are several factors that need to be considered to determine the right mitigation approach. Firstly, the type of surgical approach—Open, Laparoscopic or Robotic—can have an impact on the amount of surgical smoke exposure. Secondly, the duration of exposure is an absolute factor that can have a hazardous effect on OR Personnel. Lastly, it is critical to measure air quality in the OR as an important safety measure. Surgeons and OR personnel should keep these factors in mind and adjust techniques accordingly.

4. What are the recommendations around achieving a smoke-free OR environment?

The panel came to a consensus that a multidisciplinary approach involving engineering, work-practice and administrative controls is key to achieving a smoke-free OR.

Engineering controls are important to ensure ORs are adequately ventilated and maintain air quality at safe levels. This includes the use of local exhaust ventilation, which has shown to be effective in mitigating smoke exposure by reducing airborne particles and volatile organic compounds.

The panel also recommends implementing adequate work practice controls and a reasonable smoke management system to minimise the exposure. Such measures include policies around surgical attire, implementing scheduled breaks and the use of smoke evacuator systems specially designed to remove smoke near the source. Smoke evacuator devices also offer options to adjust the run time and flow rate based on the type of surgery being performed to effectively mitigate the risk.

With varied approaches required across hospitals and regions, setting in place stringent administrative measures and national policies is the need of the hour for OR safety. During the discussion we agreed that enhancing the safety of OR personnel is a shared responsibility between hospital administrators, nursing staff, operating surgeons and others.


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6 https://osha.europa.eu/de/legislation/directives/the-osh-framework-directive/1
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8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460469/

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