Enhancing laparoscopic visibility: efficient surgical smoke clearance innovatively using nebulization technology.

Abstract

Background: Particulate matter (PM) in surgical smoke is known to influence operative vision and poses safety risks to operating personnel. Nebulization, which is effective in promoting the deposition of PM, has not been used to clear laparoscopic surgical smoke.

Methods: The novel nebulizer was tested for mechanical characteristics and applied to evaluate its feasibility for surgical smoke clearance. Nebulization (n = 6) or elimination (n = 6) procedures were performed to manage surgical smoke produced by electrocautery hook or ultrasonic scalpel on various tissues of twelve rabbits. Levels of PM in surgical smoke, including the PM1.0, PM2.5, PM10, and total suspended particulate were compared to evaluate emissions from both surgical instruments. In addition, pre-treatment, post-treatment and reduction in PM concentrations were compared between the nebulization and elimination groups.

Results: The spray cone angle was approximately 70°, and the median particle size was around 25 µm. Laparoscopic visibility was restored with clearance of surgical smoke within 8 s after nebulization. The electrocautery hook produced significantly higher levels of PM compared to the ultrasonic scalpel. The PM concentrations generated by electrocautery hook varied across different tissues, whereas only PM1.0 level differed with the ultrasonic scalpel. The pre-treatment PM concentrations were comparable between both groups. The nebulization group showed a greater reduction in PM concentrations compared to the elimination group, with statistical significance in PM1.0 levels. Consequently, post-treatment PM concentrations were significantly lower in the nebulization group. Similar trends were observed across all target tissues except for omentum.

Conclusions: Nebulization was an effective method for clearing laparoscopic surgical smoke thereby improving surgical vision and potentially mitigating risks associated with surgical smoke exposure.