Surgical Smoke As An Occupational Hazard
Surgical plume is smoke generated from electrocautery and laser procedures, and poses a significant occupational health risk to healthcare professionals. While the dangers of surgical plume are well-documented, the implementation of smoke evacuators in specialty clinics and primary care settings remains scarce.
A recent case study, "Laryngeal Squamous Cell Carcinoma and Diathermy Plume" by Lachlan J. Warren and Suren Krishnan [1] published in the Australasian Journal of Dermatology, highlights the potential link between chronic exposure to surgical plume and the development of squamous cell carcinoma and the need for smoke evacuators outside the operating room.
A Case Highlighting the Dangers of Surgical Smoke
The case involved a 68-year-old dermatologist presenting with persistent voice changes and a cough. Following a flexible laryngoscopy, an 8-mm exophytic vocal cord nodule with malignant features was discovered. Following microlaryngoscopy and laser removal, histopathology confirmed “invasive, well-differentiated squamous cell carcinoma arising from dysplastic keratinizing mucosa”.
Notably, there were no cytological features suggestive of human papillomavirus (HPV) infection. The patient recovered well, and one year of follow-up laryngoscopy showed no recurrence.
A non-smoker with minimal alcohol consumption, the dermatologist had spent over four decades as a rural general practitioner and then as a specialist performing over 20,000 of outpatient skin lesion excisions using diathermy without any form of surgical plume evacuation.
As the report point out, "In Australia, the vast majority of melanomas and keratinocyte cancers are managed by primary care practitioners and in private rooms rather than hospitals."
Surgical plume is far from benign, and "is acknowledged to contain a hazardous mix of particles, aerosols, cellular debris, bacteria, viruses, gases, fumes and vapours [2]", according to the report.
The Need for Surgical Plume Evacuation In Clinical Settings
This widespread use of electrosurgery, coupled with the absence of plume control, creates a significant occupational health risk for healthcare professionals[3]. Warren and Krishnan highlight mention that the adoption of surgical plume evacuators in clinical settings remains alarmingly low.
Surgical plume evacuators are "uncommon and usually unavailable in primary care and specialist procedural rooms." This is despite the availability of commercial plume removal systems with ultra-particulate filters and handpiece connectors like ConMed’s ViroVac Surgical Smoke Evacuator.
The authors of the report strongly recommend "limiting diathermy, biterminal devices, use of lower power settings and the wider adoption of plume removal systems in general practice and specialist outpatient procedural settings."
Protecting Healthcare Professionals
This case highlights the potential link between long-term exposure to surgical plume and Laryngeal Squamous Cell Carcinoma. While the risks of surgical plume need to be investigated further, the implementation of surgical plume evacuators provides healthcare professionals with an added method of protection against harmful carcinogens.
Warren and Suren Krishnan suggest that "diathermy plume removal systems devised for outpatient procedures are readily available and should be a standard of care in the interest of patients and health care professionals."
Exposure to surgical plume can present in a variety of ways, depending on the level and duration of exposure. These can include respiratory issues, headaches and nausea. The potential long-term risks are still to be determined, with concerns that extended exposure increases the chance of certain cancers.
The report strongly emphasises that "voice change in health care professionals who have been exposed to occupational plume is the best predictive symptom for laryngeal carcinoma and should prompt urgent consideration of laryngoscopy."
Protect your team by exploring our range of smoke evacuators and surgical safety equipment.
References
[3] https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2023_018.pdf
