Published online Mar 18, 2020. doi: 10.5312/wjo.v11.i3.177
Peer-review started: September 19, 2019
First decision: October 13, 2019
Revised: November 13, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: March 18, 2020
Electrosurgical methods, including electrocautery, laser ablation, and ultrasonic scalpel dissection, are widely being used in routine surgeries to cut tissues and to control bleeding at the same time. The smoke released from electrosurgical cutting may contain biological by-products which are toxic and carcinogenic. No study has been performed to compare the hazardous compounds released from the electrocautery of tissues frequently cut in orthopedics, which is the main purpose of this study.
The operating room staff is frequently exposed to the electrocautery smoke released from different tissue types. Analysis of the toxicity and carcinogenicity of this smoke is necessary to avoid this health-endangering condition. For tissues releasing a high number of toxic and carcinogenic compounds, other electrosurgical devices could be suggested.
In this study, we compared the toxic and carcinogenic compounds released in the electrocautery smoke of five different tissues frequently cut in orthopedics, including meniscus, ligament, adipose, muscle, and synovium, to find which tissues produce the most hazardous smoke.
The smoke released during the electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons using gas chromatography-mass spectrometry.
None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). However, the highest percentage of toxic and/or carcinogenic substances was detected in the meniscus tissue with the lowest number of VOCs. In this regard, three out of 11 VOCs (27.3%) detected in meniscus were toxic and/or carcinogenic (Toluene, Ethylbenzene, and Styrene). The same toxic and/or carcinogenic VOCs were also detected in the muscle tissue (3/17: 17.6%). Toluene was the only toxic and/or carcinogenic substance detected in the synovium (1/21: 4.8%). No toxic and/or carcinogenic substance was detected in the electrocautery smoke released from ligament and adipose tissue.
The quality of released compounds in the electrocautery smoke is more important than the quantity of them so that the potential hazard of electrocautery smoke could be more in tissues with less released VOCs. In the present study, the highest number of toxic and/or carcinogenic substances was detected in meniscus and muscle tissue with the lowest number of VOCs.
Further preventive strategies are required to be provided for the safety of operating room personnel who are exposed to electrocautery smoke released from these tissues. In this regard, we recommend using a knife for cutting meniscus and muscle tissue instead of electrocautery.