According to a medical article published in 2019 in the Journal of Cancer:
Surgical smoke is the gaseous by-product produced when tissue is dissected or cauterized by heat generating devices such as lasers, electrosurgical units, ultrasonic devices, and high speed burrs, drills and saws. Among these devices, the most common sources are electrocautery ablation and laser ablation.
During the surgical procedures, the heat of a diathermy causes the target cell membranes to rupture to its boiling point, and subsequently generates a plume of smoke containing mostly water vapor and then releases into the atmosphere of the operating room. At the same time, the intense heat created by chars protein and other organic matter within the cells causes thermal necrosis in the adjacent cells. The charring of cells also releases other harmful contaminants, such as carbonized cell fragments and gaseous hydrocarbons. Surgical smoke is made up of 95% water or steam and 5% cellular debris in the form of particulate material which is composed of chemicals, blood and tissue particles, viruses, and bacteria.
The most abundant chemicals in electrocautery smoke are hydrocarbons, nitriles, fatty acids and phenols. The plumes generated by laser tissue ablation include benzene, formaldehyde, acrolein and polycyclic aromatic hydrocarbons. A recent study conducted by Sisler et al. collected 36 surgical smoke samples by using an electrocautery surgical device to cut human breast tissues and characterized the particles from plumes. They detected 17 different volatile organic compounds in all the 36 surgical smoke samples, and high concentrations of acetaldehyde, ethanol and isopropyl alcohol were detected in every sample predominantly.
There are many disadvantages of surgical smoke, such as hindering the vision of the surgeon, producing an unpleasant odor, and releasing hazardous chemicals that include mutagens and carcinogens into the environment of operating room. A current study that was carried out in the operating rooms with 45 nurses and 36 doctors demonstrated that all of the 81 nurses and doctors exposed to surgical smoke experienced headaches, watery eyes, coughs, burning throats, nausea, bad odors absorbed in the hair, drowsiness, dizziness, sneezing and rhinitis. In addition to the harmful chemicals, surgical smoke has been demonstrated to harbor contagious, viable malignant cells, and even to contain live bacteria and viruses, including HPV and human immunodeficiency virus, all of which may induce great damage to the persons in the operation rooms. For example, 80% smoke plumes were found to be positive for HPV from patients with HPV-positive CIN after LEEP treatment, suggesting that stringent control procedures could be required to protect gynecologist. Each year, in America, a total of approximately 500,000 personnel including surgeons, nurses, anesthesiologists, and technicians were exposed to surgical smoke in the operating rooms, and these exposures were cumulative over their lifetimes. Even though surgical smoke is not an immediate health hazard, operating room personnel should be aware of the potential long-term health risks.
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