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. 2022 Oct;10(19):1053.
doi: 10.21037/atm-22-608.

Smoke analysis of a new surgical system that applies low-temperature plasma

Boya Zhang  1   2 , Qingyu Guan  1   2 , Yunsheng Zhu  2 , Jingjin Zhu  1   2 , Xiaohan Liu  1   2 , Shuaiqi Li  1   2 , Rungong Yang  3 , Xiru Li  2
Affiliations

Smoke analysis of a new surgical system that applies low-temperature plasma

Boya Zhang et al. Ann Transl Med. 2022 Oct.

Abstract

Background: The high-frequency electrotome (ES), which is widely used in surgical procedures, generates surgical smoke that is potentially hazardous to operating personnel. Previous research shows that the PlasmaBlade (PB) may be able to overcome this problem. The present study set out to analyze potentially hazardous surgical smoke generated during electrosurgery by the ES, the PB, and. a new surgical system that applies low-temperature plasma, the NTS-100.

Methods: In vitro and in vivo healthy porcine models were used to compare volatile organic compounds (VOCs) and particulate matter (PM) in smoke generated by the NTS-100, the PB, and the conventional ES when cutting liver, muscle, and skin and subcutaneous tissues. The detected indexes included the VOCs in surgical smoke, the concentration and percentage of each part, the PM2.5 concentration, the mass of particles, and the diameter distribution of particles.

Results: The smoke generated by the NTS-100 contained fewer hazardous components than that generated by the ES (P<0.05) and a comparable amount to that generated by the PB (P>0.05). The PM2.5 concentration and mass of particles in the smoke generated by the NTS-100 were lower than those with the ES (P<0.05 and P<0.01, respectively) and similar to those with the PB (P>0.05). The NTS-100 generated larger particles than did the ES and the PB (P<0.05).

Conclusions: Surgical smoke contains harmful VOCs and PM, but the NTS-100 generated less hazardous surgical smoke than did the conventional ES and performed comparably to the PB. Therefore, using the NTS-100 may reduce the potential hazard of surgical smoke to operating room personnel.

Keywords: High-frequency electrotome; PlasmaBlade (PB); low-temperature plasma; surgical smoke.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-608/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
New surgical system that applies low-temperature plasma (NTS-100) and its electrode.
Figure 2
Figure 2
Incision design of in vivo experiment. (A) Incision of skin and subcutaneous; (B) incision of muscle; (C) incision of liver. (D) Incision design of skin and subcutaneous; (E) incision design of muscle; (F) incision design of liver. a, PEN site; b, PM2.5 sensor sampling site. PEN, portable electronic nose.
Figure 3
Figure 3
Experimental settings for in vitro experiments. (A) Surgical device (e.g., the new surgical system that applies low-temperature plasma) used in in vitro experiment. (B) Layout of surgical analysis system. (C) Plan view of the experimental setting. a, electrosurgical equipment main unit; b, closed container; c, GC-MS; d, TD instrument; e, negative electrode plate wiring; f, electrosurgical equipment wiring; g, gas transportation wiring. GC-MS, gas chromatography-mass spectrometry; TD, thermal desorption.
Figure 4
Figure 4
In vitro experiment particle size distribution of three electrosurgical devices on liver, skin, and muscle tissues. (A) Liver dissected by ES; (B) liver dissected by PB; (C) liver dissected by NTS-100; (D) skin dissected by ES; (E) skin dissected by PB; (F) skin dissected by NTS-100; (G) muscle dissected by ES; (H) muscle dissected by PB; (I) muscle dissected by NTS-100. ES, high frequency electrotome; PB, PlasmaBlade; NTS-100, new surgical system that applies low-temperature plasma.
Figure 5
Figure 5
In vitro experiment particle mass of three electrosurgical devices on liver, skin, and muscle tissues. ES, electrotome; PB, PlasmaBlade; NTS-100, new surgical system that applies low-temperature plasma.
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Comment in

  • Do we need to reduce surgical smoke?
    Stewart CL. Stewart CL. Ann Transl Med. 2022 Dec;10(24):1304. doi: 10.21037/atm-22-5652. Ann Transl Med. 2022. PMID: 36660628 Free PMC article. No abstract available.
  • Surgical smoke and occupational health.
    Canicoba ARB. Canicoba ARB. Ann Transl Med. 2022 Dec;10(24):1303. doi: 10.21037/atm-22-5631. Ann Transl Med. 2022. PMID: 36660725 Free PMC article. No abstract available.

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Cited by

  • Do we need to reduce surgical smoke?
    Stewart CL. Stewart CL. Ann Transl Med. 2022 Dec;10(24):1304. doi: 10.21037/atm-22-5652. Ann Transl Med. 2022. PMID: 36660628 Free PMC article. No abstract available.
  • Surgical smoke and occupational health.
    Canicoba ARB. Canicoba ARB. Ann Transl Med. 2022 Dec;10(24):1303. doi: 10.21037/atm-22-5631. Ann Transl Med. 2022. PMID: 36660725 Free PMC article. No abstract available.

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