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.
Anthropogenic change exposes populations to environments that have been rare or entirely absent from their evolutionary past. Such novel environments are hypothesized to release cryptic genetic ...variation, a hidden store of variance that can fuel evolution. However, support for this hypothesis is mixed. One possible reason is a lack of clarity in what is meant by ‘novel environment’, an umbrella term encompassing conditions with potentially contrasting effects on the exposure or concealment of cryptic variation. Here, we use a meta‐analysis approach to investigate changes in the total genetic variance of multivariate traits in ancestral versus novel environments. To determine whether the definition of a novel environment could explain the mixed support for a release of cryptic genetic variation, we compared absolute novel environments, those not represented in a population's evolutionary past, to extreme novel environments, those involving frequency or magnitude changes to environments present in a population's ancestry. Despite sufficient statistical power, we detected no broad‐scale pattern of increased genetic variance in novel environments, and finding the type of novel environment did not explain any significant variation in effect sizes. When effect sizes were partitioned by experimental design, we found increased genetic variation in studies based on broad‐sense measures of variance, and decreased variation in narrow‐sense studies, in support of previous research. Therefore, the source of genetic variance, not the definition of a novel environment, was key to understanding environment‐dependant genetic variation, highlighting non‐additive genetic variance as an important component of cryptic genetic variation and avenue for future research.
In this graphical , a flow chart on the left outlines the criteria used to classify novel environments. On the right, two forest plots are presented: one comparing effect sizes (standardized mean difference in total genetic variance, SDV) between extreme and absolute novel environments, and the other comparing effect sizes between broad‐sense and narrow‐sense study designs.
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.
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