Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
BSI, Environmental, Health, and Safety Services and Solutions, San Jose, CA, USA.
Spine J. 2020 Feb;20(2):166-173. doi: 10.1016/j.spinee.2019.09.014. Epub 2019 Sep 19.
Exposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries.
To examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery.
A prospective self-controlled study.
After the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019.
Two outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm, ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded.
Consecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a "para incisional evacuator," which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a "surgical smoke evacuation pencil" which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides.
The para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% (287 [interquartile range {IQR}: 126, 526] vs. 1,177 [IQR: 395, 2,702], p<.001). The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% (917 [IQR: 448, 1936] vs. 1,605 [IQR: 775, 4,280], p<.001). Both evacuators significantly reduced peak smoke levels as well.
This study provides evidence supporting the utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery. Such technology may help to improve the occupational health protection for spine operating room workers.
手术烟雾暴露仍然是脊柱手术室人员潜在的职业健康问题。使用烟雾抽吸器（局部排气通风）目前被认为是主要的保护手段，但很少有研究评估其在实际手术中的效用。
研究两种常见的局部烟雾抽吸器，即切口旁抽吸器和烟雾抽吸铅笔，在减少脊柱手术中手术烟雾暴露的效果。
前瞻性自身对照研究。
在估计样本量后，2018 年 2 月至 2019 年 3 月期间，连续纳入 51 例脊柱手术（25 例和 26 例分别使用切口旁烟雾抽吸器和烟雾抽吸铅笔）。
使用两种手术烟雾暴露水平的评估指标，定义为手术台周围空气中超细烟雾颗粒的浓度（每立方厘米的颗粒数，ppc）：（a）平均烟雾水平为手术期间记录的所有测量值的算术平均值；（b）峰值烟雾水平为记录的最高值。
连续评估通过后路中线切口双侧对称暴露脊柱的手术。电烙烟雾用两种烟雾抽吸器抽吸：一种是“切口旁抽吸器”，使用一个紧贴切口的扁平宽吸垫（25 例）；另一种是“手术烟雾抽吸铅笔”，它是电烙器的一部分（26 例）。当在脊柱两侧进行手术暴露时，分别测量烟雾暴露水平：首先在一侧（随机确定）打开烟雾抽吸器，然后在另一侧关闭烟雾抽吸器。比较两侧的结果。
切口旁烟雾抽吸器可显著降低平均烟雾水平，平均降低 59.7%（287[四分位距 {IQR}：126，526] vs. 1,177[IQR：395，2,702]，p<.001）。手术烟雾抽吸铅笔也可平均降低 44.1%的平均烟雾水平（917[IQR：448，1936] vs. 1,605[IQR：775，4,280]，p<.001）。两种抽吸器都能显著降低峰值烟雾水平。
本研究提供了支持局部烟雾抽吸在减少脊柱手术中手术烟雾暴露的证据。这种技术可能有助于改善脊柱手术室工作人员的职业健康保护。
