Boland Patrick A, McEntee Philip D, Moynihan Alice, Nolan Kevin, Cahill Ronan A
UCD Center for Precision Surgery, Dublin, Ireland.
School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland.
Med Gas Res. 2025 Sep 1;15(3):404-408. doi: 10.4103/mgr.MEDGASRES-D-24-00084. Epub 2025 Feb 8.
The leakage of surgical gas and smoke from the peritoneum during laparoscopy may release noxious aerosols, including potential carcinogens, viruses and other contaminants, into the operating theatre, especially into the breathing zone of the surgical team. Reliable and realistic models and methods that develop and detect surgical smoke in simulated settings are necessary to effectively test devices and strategies intended to reduce such leaks. Here, we report a novel high-fidelity laparoscopic smoke model with innovative imaging methods applicable to the theatre setting, followed by an assessment of the usefulness of commercial laparoscopic trocars and smoke evacuation methods in mitigating gas leaks. Various smoke production methods (including tissue cautery and industrial smoke machinery) and detection methods (including schlieren imaging, laser videography, intraperitoneal video recording, and an aerosol detector) were tested, with the smoke machine model proving the most reproducible. Schlieren imaging, laser videography and intraperitoneal video recording were all effective methods of surgical smoke quantification. Following model establishment, laparoscopic trocars (VersaOne TM , Medtronic, Ireland) and smoke evacuation systems (EVA15 smart insufflator and evacuator, Palliare, PlumePort Activ® Smoke Filtration Device, Conmed and Valleylab TM Smoke Evacuation System, Medtronic) were examined in a standardized way with performance assessment by three surgeons independently using a boutique scoring system. The EVA15 outperformed other smoke systems in clearing surgical smoke from the operative field and in reducing trocar leaks during instrumentation. This method of simulated surgical smoke production and assessment can benchmark other laparoscopic equipment regarding smoke management strategies in a similar fashion.
腹腔镜手术期间,手术气体和烟雾从腹膜泄漏可能会将有害气溶胶,包括潜在致癌物、病毒和其他污染物释放到手术室,尤其是手术团队的呼吸区域。在模拟环境中开发和检测手术烟雾的可靠且现实的模型和方法对于有效测试旨在减少此类泄漏的设备和策略是必要的。在此,我们报告一种新型的高保真腹腔镜烟雾模型及适用于手术室环境的创新成像方法,随后评估商用腹腔镜套管针和烟雾清除方法在减轻气体泄漏方面的效用。测试了各种烟雾产生方法(包括组织烧灼和工业烟雾机械)和检测方法(包括纹影成像、激光摄像、腹腔内视频记录和气溶胶探测器),结果表明烟雾机模型的可重复性最高。纹影成像、激光摄像和腹腔内视频记录都是手术烟雾量化的有效方法。模型建立后,对腹腔镜套管针(VersaOne TM,美敦力公司,爱尔兰)和烟雾清除系统(EVA15智能气腹机和抽气机、Palliare、PlumePort Activ®烟雾过滤装置、康美公司以及Valleylab TM烟雾清除系统,美敦力公司)进行了标准化检查,由三名外科医生独立使用一种精细评分系统进行性能评估。EVA15在清除手术区域的手术烟雾以及减少器械操作期间套管针泄漏方面优于其他烟雾系统。这种模拟手术烟雾产生和评估的方法可以以类似方式为其他腹腔镜设备在烟雾管理策略方面提供基准。