Surgical Smoke Management in Perioperative Environments

Surgical smoke is the airborne by-product generated during tissue dissection and haemostasis when energy-based devices are used in operating theatres. It comprises a complex mixture of ultrafine particles, volatile organic compounds, aerosols of cellular debris and, in rare cases, viable pathogens. Exposure has been linked to acute irritant effects on the eyes, skin and respiratory tract, as well as potential long-term carcinogenic and mutagenic hazards for surgical teams. Effective management blends local exhaust with integrated theatre ventilation systems, high-efficiency particulate and gas-phase filtration, and standard personal protective equipment. Practical guidelines emphasise the correct positioning and maintenance of smoke evacuators, meticulous control of pneumoperitoneum during minimally invasive procedures and structured training for all perioperative staff. Globally, adoption of these measures contributes to safer working environments, supports the continued use of minimally invasive surgery and reduces environmental contamination.

Research from Nature Portfolio

A prospective clinical trial in patients with active viral infection compared surgical smoke from open and minimally invasive procedures. Air-sample collectors positioned at the incision site and within the pneumoperitoneum captured condensate for molecular analysis. Despite initial concerns about pathogen transmission, no viral genetic material was detected in any smoke samples. The findings reinforce the low probability of airborne viral dissemination via energy devices when standard smoke evacuation and air-exchange protocols are in place, supporting the safety of laparoscopic approaches even during infectious outbreaks.

Surgical Smoke Management in Perioperative Environments publication trend

The graph below shows the total number of articles in surgical smoke management in perioperative environments across all publications each year (not limited to Nature Index journals).

Technical terms

Perioperative environment: The clinical setting covering preoperative preparation, intraoperative management and postoperative care.

Electrocautery: A technique that uses electrical current to cut tissue or achieve haemostasis, generating thermal plume.

Ultrafine particles: Particulate matter under 100 nm in diameter, capable of deep pulmonary penetration and systemic distribution.

Smoke evacuation system: A local exhaust device equipped with high-efficiency filters designed to remove particulate and gaseous contaminants at source.

Volatile organic compounds (VOCs): Carbon-based chemicals in surgical smoke that readily vapourise and may irritate mucous membranes or pose long-term health risks.

References

1. Viral load of SARS-CoV-2 in surgical smoke in minimally invasive and open surgery: a single-center prospective clinical trial. Scientific Reports (2023).
2. Safe management of surgical smoke in the age of COVID-19. British Journal of Surgery (2020).
3. The characterization of surgical smoke from various tissues and its implications for occupational safety. PLOS ONE (2018).
4. In vitro toxicological evaluation of surgical smoke from human tissue. Journal of Occupational Medicine and Toxicology (2018).
5. Prospective randomized study evaluating the usefulness of a surgical smoke evacuation system in operating rooms for breast surgery. Journal of Occupational Medicine and Toxicology (2020).