Characterisation of Exposure to Ultrafine Particles from Surgical Smoke by Use of a Fast Mobility Particle Sizer

Abstract

Introduction: Electrosurgery is a method based on a high frequency current used to cut tissue and coagulate small blood vessels during surgery. Surgical smoke is generated due to the heat created by electrosurgery. The carcinogenic potential of this smoke was assumed already in the 1980's and there has been a growing interest in the potential adverse health effects of exposure to the particles in surgical smoke. Surgical smoke is known to contain ultrafine particles (UFPs) but the knowledge about the exposure to UFPs produced by electrosurgery is however sparse. The aims of the study were therefore to characterise the exposure to UFPs in surgical smoke during different types of surgical procedures and on different job groups in the operating room, and to characterise the particle size distribution.

Methods: Personal exposure measurements were performed on main surgeon, assistant surgeon, surgical nurse, and anaesthetic nurse during five different surgical procedures [nephrectomy, breast reduction surgery, abdominoplasty, hip replacement surgery, and transurethral resection of the prostate (TURP)]. The measurements were performed with a Fast Mobility Particle Sizer (FMPS) to assess the exposure to UPFs and to characterize the particle size distribution. Possible predictors of exposure were investigated using Linear Mixed Effect Models.

Results: The exposure to UFPs was highest during abdominoplasty arithmetic mean (AM) 3900 particles cm(-3) and lowest during hip replacement surgeries AM 400 particles cm(-3). The different job groups had similar exposure during the same types of surgical procedures. The use of electrosurgery resulted in short term high peak exposure (highest maximum peak value 272 000 particles cm(-3)) to mainly UFPs. The size distribution of particles varied between the different types of surgical procedures, where nephrectomy, hip replacement surgery, and TURP produced UFPs with a dominating mode of 9nm while breast reduction surgery and abdominoplasty produced UFPs with a dominating mode of 70 and 81nm, respectively. Type of surgery was the strongest predictor of exposure. When only including breast reduction surgery in the analysis, the use of one or two ES pencils during surgery was a significant predictor of exposure. When only including hip replacement surgery, the operating room was a significant predictor of exposure.

Conclusion: The use of electrosurgery resulted in short-term high peak exposures to mainly UFPs in surgical smoke. Type of surgery was the strongest predictor of exposure and the different types of surgical procedures produced different sized particles. The job groups had similar exposure. Compared to other occupational exposures to UFPs involving hot processes, the personal exposure levels for UFPs were low during the use of electrosurgery.

Keywords: Fast Mobility Particle Sizer; diathermy; electrosurgery; mixed-effect linear model; nanoparticles; personal exposure assessment; predictors (determinants) of exposure; surgery; surgical smoke.