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. 2021 Dec 16;21(1):422.
doi: 10.1186/s12893-021-01432-8.

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

Voraboot Taweerutchana  1 , Tharathorn Suwatthanarak  1 , Asada Methasate  1 , Thawatchai Akaraviputh  1 , Jirawat Swangsri  1 , Chainarong Phalanusitthepha  1 , Atthaphorn Trakarnsanga  1 , Thammawat Parakonthun  1 , Nicha Srisuworanan  1 , Thikhamporn Tawantanakorn  1 , Rosarin Ratanalekha  2 , Varut Lohsiriwat  1 , Vitoon Chinswangwatanakul  3
Affiliations

Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

Voraboot Taweerutchana et al. BMC Surg. .

Abstract

Background: The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers.

Methods: Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared.

Results: Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001.

Conclusions: Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.

Keywords: COVID-19; Contamination; Laparoscopic surgery; Particle count; Smoke evacuator; Surgical smoke.

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Conflict of interest statement

All authors declared there were no competing interests.

Figures

Fig. 1
Fig. 1
The subjects of this study (laparoscopic cholecystectomy—open cholecystectomy). OC open cholecystectomy without evacuator use, OCE open cholecystectomy with evacuator use, LC laparoscopic cholecystectomy without evacuator use, LCE laparoscopic cholecystectomy with evacuator use
Fig. 2
Fig. 2
The operative setup
Fig. 3
Fig. 3
The dynamic changes in total particle counts along the operation of all subgroups. OCE open cholecystectomy with smoke evacuator use, LC laparoscopic cholecystectomy without smoke evacuator use, LCE laparoscopic cholecystectomy with smoke evacuator use
Fig. 4
Fig. 4
Contaminated surgical areas in open versus laparoscopic appendectomy. The examples of photographs in the blinded-questionnaires consisted of 5 areas, skin incisions (1), surgical drapes (2), suctions (3), gloves (4), and face shields (5), respectively. The upper row (A) was from open appendectomy and the lower row (B) from laparoscopic appendectomy
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med. 2020;26(5):676–680. doi: 10.1038/s41591-020-0843-2. - DOI - PMC - PubMed
    1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory C 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(102):S65–164. doi: 10.1016/j.ajic.2007.10.007. - DOI - PMC - PubMed
    1. Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer. 2019;10(12):2788–2799. doi: 10.7150/jca.31464. - DOI - PMC - PubMed
    1. Li CI, Pai JY, Chen CH. Characterization of smoke generated during the use of surgical knife in laparotomy surgeries. J Air Waste Manag Assoc. 2020;70(3):324–332. doi: 10.1080/10962247.2020.1717675. - DOI - PubMed