Concerns have been voiced regarding the possibility of health risks to the operating room personnel from exposure to surgical smoke generated from electrocautery.
Ovid Medline was queried using ...search terms “surgical smoke”, “electrosurgery,” “smoke evacuator”. The NIOSH Health Hazard Evaluations Database was searched using terms, “hospital”, “operating room”, “Ames”, “mutagen”, and “salmonella".
Levels of pollutants in the breathable airspace within the operating room have been repeatedly shown to be very low. Absolute counts of particulate matter in the operating room are low when compared to other environments. The possibility for virus transmission with electrocautery in the operating room is unknown.
The risks related to the exposure to electrocautery surgical smoke have been overstated. Rigid mandates requiring smoke evacuators in all situations are not justified at this time.
•Regulations on Surgical Smoke that supersede the best judgement of the surgeon are not warranted.•Drawing parallels between exposure to surgical smoke and cigarette smoking is not remotely justified.•Numerous studies consistently report negligible levels of pollutants associated with surgical smoke within the operating room's breathable air.•The extent of particulate pollution from surgical smoke has been overstated.•While transmission of HPV is a theoretical concern, conclusive evidence is yet to be established.
There is a long history of personal protective equipment (PPE) used by the surgeon to minimize the transmission of various pathogens. In the context of the present coronavirus disease 2019 pandemic ...there is significant controversy as to what forms of PPE are appropriate or adequate. This review aims to describe the pathogenic mechanism and route of spread of the causative virus, severe acute respiratory syndrome coronavirus, as it pertains to accumulated published data from experienced centers globally. The various forms of PPE that are both available and appropriate are addressed. There are options in the form of eyewear, gloves, masks, respirators, and gowns. The logical and practical utilization of these should be data driven and evolve based on both experience and data. Last, situations specific to surgical populations are addressed. We aim to provide granular collective data that has thus far been published and that can be used as a reference for optimal PPE choices in the perioperative setting for surgical teams.
: There is a long history of personal protective equipment (PPE) used by the surgeon to minimize the transmission of various pathogens. In the context of the present coronavirus disease 2019 pandemic ...there is significant controversy as to what forms of PPE are appropriate or adequate. This review aims to describe the pathogenic mechanism and route of spread of the causative virus, severe acute respiratory syndrome coronavirus, as it pertains to accumulated published data from experienced centers globally. The various forms of PPE that are both available and appropriate are addressed. There are options in the form of eyewear, gloves, masks, respirators, and gowns. The logical and practical utilization of these should be data driven and evolve based on both experience and data. Last, situations specific to surgical populations are addressed. We aim to provide granular collective data that has thus far been published and that can be used as a reference for optimal PPE choices in the perioperative setting for surgical teams.
•Survival with metastatic colorectal cancer is often based on liver resectability.•Cytoreduction for metastatic colorectal cancer can cure and prolong survival.•Treatment of metastatic colorectal ...cancer should be multidisciplinary.
We hypothesized that operating room (OR) airborne particulate matter (PM) was different in quantity and mutagenic potential than office air and cigarette smoke.
Exposure to surgical smoke has been ...equated to cigarette smoking and thought to be hazardous to health care workers despite limited data.
PM was measured during 15 operations in ORs with 24.8 ± 2.0 air changes/hour, and in controls (cigarettes, office air with 1.9-2.9 air changes/hour). Mutagenic potential was assessed by γH2AX staining of DNA damage in small airway epithelial cells co-cultured with PM.
Average PM concentration during surgery was 0.002 ± 0.002 mg/m3 with maximum values at 1.08 ± 1.30 mg/m3. Greater PM correlated with more diathermy (ρ = 0.69, p = 0.006). Values were most often near zero, resulting in OR average values similar to office air (0.002 ± 0.001 mg/m3) (p = 0.32). Cigarette smoke average PM concentration was significantly higher, 4.8 ± 5.6 mg/m3 (p < 0.001). PM collected from 14 days of OR air caused DNA damage to 1.6 ± 2.7% of cultured cells, significantly less than that from office air (27.7 ± 11.7%, p = 0.02), and cigarette smoke (61.3 ± 14.3%, p < 0.001).
The air we breathe during surgery has negligible quantities of PM and mutagenic potential, likely due to low frequency of diathermy use coupled with high airflow. This suggests that exposure to surgical smoke is associated with minimal occupational risk.
Background
Anastomotic leak after esophagectomy is associated with significant morbidity and mortality. Our institution began performing laparoscopic gastric ischemic preconditioning (LGIP) with ...ligation of the left gastric and short gastric vessels prior to esophagectomy in all patients presenting with resectable esophageal cancer. We hypothesized that LGIP may decrease the incidence and severity of anastomotic leak.
Methods
Patients were prospectively evaluated following the universal application of LGIP prior to esophagectomy protocol in January 2021 until August 2022. Outcomes were compared with patients who underwent esophagectomy without LGIP from a prospectively maintained database from 2010 to 2020.
Results
We compared 42 patients who underwent LGIP followed by esophagectomy with 222 who underwent esophagectomy without LGIP. Age, sex, comorbidities, and clinical stage were similar between groups. Outpatient LGIP was generally well tolerated, with one patient experiencing prolonged gastroparesis. Median time from LGIP to esophagectomy was 31 days. Mean operative time and blood loss were not significantly different between groups. Patients who underwent LGIP were significantly less likely to develop an anastomotic leak following esophagectomy (7.1% vs. 20.7%,
p
= 0.038). This finding persisted on multivariate analysis odds ratio (OR) 0.17, 95% confidence interval (CI) 0.03–0.42,
p
= 0.029. The occurrence of any post-esophagectomy complication was similar between groups (40.5% vs. 46.0%,
p
= 0.514), but patients who underwent LGIP had shorter length of stay 10 (9–11) vs. 12 (9–15),
p
= 0.020.
Conclusions
LGIP prior to esophagectomy is associated with a decreased risk of anastomotic leak and length of hospital stay. Further, multi-institutional studies are warranted to confirm these findings.
OBJECTIVERobotically assisted surgery has become more common in general surgery, but there is limited guidance from the Accreditation Council for Graduate Medical Education (ACGME) regarding this ...type of training. We sought to determine common elements and differences in the robotic educational curricula developed by general surgery residency programs.DESIGNRobotic educational curricula were obtained from the 7 individuals who presented at the workshop, "Robotic Education in General Surgery" at the 2023 Association of Program Directors in Surgery annual meeting.RESULTSAll 7 general surgery programs had training beginning intern year, required online robotic modules, had at least 1 dedicated simulation training console not used for clinical purposes, and ran dry and wet (tissue) robotic labs at least annually. All programs had bedside and console surgeon case minimums and had administrative support to run the educational programs. Differences existed regarding how training intern year was executed, the simulations required, clinical practice minimum requirements, how progress was monitored over time, and how case numbers were tracked. Some programs had salary support for a director of robotic education.CONCLUSIONSThere are several common elements to robotic educational curricula in general surgery, however significant variation does exist between programs. Given the frequency of robotic use in general surgery and current lack of standardization, formal guidance from the ACGME specifically regarding robotic education in general surgery residency is warranted.
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