A systematic review of the harmful effects of surgical smoke inhalation on operating room personnel

Background Surgical smoke refers to the plume produced by usage of energy-generating surgical equipment on tissues. This review aimed to assess the potential of this smoke to be a serious occupational hazard to theatre staff due to its composition, particularly during the COVID-19 pandemic. Method A search of Ovid MEDLINE, EMBASE, and PubMed databases was undertaken for publications reporting plume composition, presence of infectious material, carcinogenic potential and comparisons between production in laparoscopic versus open surgery. All human in-vivo and ex-vivo primary studies were included, provided English language translation was available. A narrative synthesis was conducted due to the methodologic heterogeneity of the studies. Results 25 studies resulted from the primary search, and an additional 3 from cross-referencing, leading to 28 included studies. Studies addressing particle size found that smoke particles were respirable in size. Viral DNA was present in 3 studies, while 1 study demonstrated the ability for surgical smoke to produce clinically important infection. Chemical composition was explored in 8 studies, revealing the presence of carcinogenic compounds in concentrations above occupational safety limits. Open surgery was found to generally produce less smoke than laparoscopic. Conclusion Surgical smoke contains a myriad of hazardous constituents, such as carcinogenic compounds and infectious materials, however, the extent to which inhalation of these plumes may be harmful remains unknown due to the lack of high-level evidence regarding infectivity and carcinogenicity. Safety measures such as extraction of plumes using local exhaust ventilation, and usage of protective equipment such as N95 masks should be instilled.