Study On The Composition Of Toxic Substances In Smoke During Laparoscopy And The Effect Of Self-made Fume-extracting Device

ObjectiveTo explore the dynamic variations of concentration and composition of harmful substances in surgical smoke during the whole process of laparoscopic cholecystectomy to provide the basis for the measures of eliminating the surgical smoke sufficiently.Furthermore,to investigate the effect of self-made fume-extracting device on reducing the concentration of chemical components in surgical smoke,and to provide evidence for purifying the air in the operation room which can reduce the harm of surgical smoke to surgeons,nurses and other medical workers in operation room.Methods1.The concentration of carbon monoxide and carbon dioxide was measured at six different time during operation from the beginning of using electro surgery unit cutting tissue to 5min,10min,15min,20min and the end of operation.The detecting instruments were the detector of carbon monoxide and the portable detector of carbon dioxide.The measuring point is at the height of 1.5m to the ground and 30cm from the surgical incision.The PM2.5 and PM 10 concentration were also monitored every second in 10 seconds from opening the switch of trocar by air detecting instrument.Meanwhile,the air sampling were collected by particular tube which for two minutes after opening the trocar switches connects sampling instrument.The organic components in surgical smoke were detected by gas chromatography.2.The self-made fume-extracting device consisted of three suction glass bottles which contained water,activated carbon and calcium lime respectively.The self-made fume-extracting device was applied to the patients undergoing laparoscopic cholecystectomy.50 eligible patients were divided into experimental and control groups randomly.In the experimental group,one end of a pneumoperitoneum tube was connected to the trocar valve switch and the other end of which was connected to the self-made fume-extracting device.The detector probe was attached at the end of the device.In the control group,one end of a pneumoperitoneum tube was connected to the trocar switch,and the other end of that was connected to the probe of the detector.The concentrations of CO,CO2,PM2.5,PM10,and organic components of surgical smoke were detected and analyzed between two groups.Results1.The concentration of CO and CO2 began to increase at the beginning of tissue cutting immediately and continuously increased during the laparoscopic cholecystectomy.The concentration of PM2.5 and PM 10 increased rapidly after opening the trocar switches,the highest being 659.42±26.29 ug/m3 and 735.41 ± 17.09 ug/m3 separately at the forth second after opening the trocar switches.Several harmful substances are detected in surgical smoke,such as sevoflurane,benzene,phenylpropionicacid,octamethylcyclotetrasiloxane,cyclohexanone,n-Decane,1,4-dichlorobenzene,ethanol and so on.2.The concentration of CO in the control group reached the highest value of 70 ppm,while in the experimental group,which decreased to 28.63±2.40 ppm(P<0.05)by self-made fume-extracting device.The average clearance rate was 60.30%.The concentration of CO2 in the control group was higher than 4500 ppm,and that in the experimental group decreased to 1000 ppm(P<0.05).The average clearance rate was 80.88%.The concentration of PM2.5 and PM 10 in the control group reached a highest value of 795.10±68.48 ug/m3 and 850.79±44.81 ug/m3 separately,which can cause serious pollution in operation room.In contrast,the concentration of PM2.5 and PM10 in the experimental group decreased significantly to a very low level which is enough to meet the air quality standard.The average clearance rate was 98%.The concentrations of organic components in the experimental group were obviously lower than that in the control group.The average clearance rate of self-made fume-extracting device adsorbing organic components was 73.22%.Conclusions1.The surgical smoke contains various harmful substances,which of them do not conform to the environmental protection standard.Long-term contacts with these substances are dangerous to human health,and all effective measures should be taken to reduce the harm.2.The self-made fume-extracting device can safely and effectively filter the surgical smoke and provide quality air in operation room for the medical staff.