Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures

The objective of this preliminary study was to describe the particles contained in cautery smoke produced during five laparoscopic procedures and verify the collection method during three laboratory experiments on ex vivo animal tissue. A cascade impactor collected the smoke according to particle size, and particle weights were calculated on an electronic microbalance. Electron microscopic analysis and energy dispersive X-ray evaluation were used to determine particle morphology and elemental composition. The particles, distributed according to size on the seven rotating trays of the impactor, had diameters ranging from 0.05 to >25 micro m, with most being 0.1-1 micro m. In vitro experiments yielded more particles, especially larger (>5 micro m) ones, than the surgical procedures, because the cauterized specimens could be placed much closer to the cascade impactor in the laboratory environment, eliminating most obstacles to particle recovery. In the laparoscopic surgery patients, larger particles, because of their physical properties, were more likely to remain trapped in the abdomen or to drop off in the collection apparatus. Uniformly, two populations of particles were demonstrated--either large, irregular fragments (2-25 micro m) rich in carbon and oxygen, suggesting structural cellular components, or small homogeneous spheres (0.1-0.5 micro m) composed of sodium, magnesium, calcium, and potassium salts. This study demonstrates the presence of breathable aerosols and cell-size fragments in the cautery smoke produced during laparoscopic procedures. Their exact chemical composition and potential adverse effects for patients and personnel are not known.