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Quality Indicators in Endometriosis Surgery
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Caryl M. Thomas, Richard J. Penketh
Concerns were also raised about the risks posed to healthcare workers from potential horizontal transmission of COVID-19 during surgery, secondary to aerosol-generating procedures (AGP) and the presence of the virus in blood and stool (53). Dissemination of viral particles may have the potential to spread by air droplets from released carbon dioxide or within surgical smoke produced during minimal access surgery (54). The use of electrosurgical devices during laparoscopic surgery has been associated with generating higher particle concentrations of smoke compared with open surgery, leading to potential exposure risks during tissue extraction, non-airtight exchange of instruments and opening of trocar valves (55). However, surgical smoke is collected and contained intra-abdominally during laparoscopic surgery which allows for safe and controlled evacuation as compared with open surgery (56).
Complications in Mohs Surgery
Published in Alexander Berlin, Mohs and Cutaneous Surgery, 2014
Jordan B. Slutsky, Scott W. Fosko
Another consideration with electrosurgical devices is the growing body of evidence that indicates the vapor or smoke plume generated not only is irritating to the respiratory tract but also may contain infectious particles (particularly human papilloma virus) and has in vitro mutagenic potential. Standard surgical masks alone do not provide adequate protection against this occupational hazard; however, smoke evacuators or filters offer additional safety for the surgeon, staff, and patient.29,30,31 The United States Department of Labor’s Occupational Safety and Health Administration (OSHA) recognizes the potential risks of surgical smoke plumes but does not currently have specific standards for regulation or prophylaxis against their hazards.32 The authors find that biterminal forceps emit less of a smoke plume than monoterminal devices.
Energy Sources in Urology
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Smoke. Surgical smoke is created when tissue is heated and cellular fluid is vaporized by the thermal action of the energy source. Viral DNA, bacteria, carcinogens, and irritants are known to be present in electrosurgical smoke, and where possible a smoke evacuation system should be used (10).
Adopting a portfolio of ultrasonic and advanced bipolar electrosurgery devices from a single manufacturer compared to currently used ultrasonic and advanced bipolar devices: a probabilistic budget impact analysis from a Spanish hospital perspective
Published in Journal of Medical Economics, 2023
Alessandra Piemontese, Lucas Cohen, George W. J. Wright, Natalia Robledinos-Antón, Nadine Jamous, Giovanni A. Tommaselli, Thibaut Galvain
Hospitals are also concerned about OR safety. The application of energy devices to heat and cut tissue can produce surgical smoke, which is a potential hazard to operating room staff10,11. This gaseous byproduct can be absorbed through the skin, lungs, and eyes of the surgical staff and may result in symptoms such as nausea, headache, weakness, and dizziness, among others11. Many organizations have guidelines recommending the use of smoke evacuation systems during electrosurgery procedures to reduce the risk of staff exposure to surgical smoke11–14. A smoke evacuator is a hand-held or trocar-compatible device that allows for the removal of surgical smoke when connected to a smoke evacuation system that filters the smoke particles from the air drawn in by the device. One element to improve patient safety in the OR during electrosurgery is through the use of non-adhesive reusable dispersive patient return electrodes, which reduce the risk of pad site burns compared to adhesive dispersive electrodes15. The large surface area of a reusable capacitive patient return electrode limits the current density at the site of contact thus preventing increases in temperature that could lead to burns, which can occur when smaller adhesive electrodes lose contact with the patient’s skin15. Another benefit of dispersive electrode pads is their reusability, which can help reduce OR waste compared to using disposable dispersive electrodes.
A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis
Published in Journal of Medical Economics, 2021
Nicole Ferko, George W. J. Wright, Imran Syed, Elena Naoumtchik, Giovanni A. Tommaselli, Gaurav Gangoli
Surgical smoke evacuation technologies can be used to help remove byproducts of electrosurgery and potential risks to healthcare workers, which could also contribute to healthcare resource efficiencies21. This topic has become especially relevant during the COVID-19 pandemic, where the theoretical aerosolization of viable pathogens during surgery is an ongoing area of research22–26. Several viruses have been identified in surgical smoke including HBV, HPV, and HIV, mainly in experimental settings, however the only evidence of a direct virus transmission refers to surgeons infected by HPV while operating with laser in an open setting on genital warts25,27–29. Wall suction units alone may not provide the same protection that hand-held or portable smoke evacuators do, and similarly, only certain masks may provide some protection against the dangers of surgical smoke25,30–34. For this reason, smoke evacuation technology is defined in this study as those involving smoke evacuation systems that are directed toward the surgical-field, such as hand-held units, rather than conventional wall suction units or protective masks33–35. This is aligned with surgical societies that have advocated for the use of dedicated smoke evacuation units in open and laparoscopic procedures36–39. Multiple studies have found that adopting smoke evacuation systems can effectively reduce contaminants in a cost-efficient manner40,41. Additionally, smoke evacuation technologies also have a strategic advantage over traditional personal protective equipment (PPE), which can be insufficient to prevent exposure to surgical aerosols generated which may be inhaled with smoke42.