Removal of Hazardous Surgical Smoke Using a Built-in-Filter Trocar: A Study in Laparoscopic Rectal Resection

Surgical smoke containing potentially carcinogenic and harmful materials is an inevitable consequence of surgical energy devices, and constitutes a substantial occupational hazard in the operating room. This study aimed to evaluate the efficacy of a built-in-filter trocar in eliminating hazardous surgical smoke during laparoscopic and robotic rectal surgery.

Ten patients who underwent rectal cancer resection were enrolled. Five patients underwent surgery utilizing a nonfiltered trocar, and the remaining 5 utilized a built-in-filter trocar. Gas samples were aspirated from the peritoneal cavity over 30 minutes of electrocauterization and collected in a Tedlar bag. Concentrations of surgical smoke were measured using ultraperformance liquid chromatography and gas chromatography.

Eleven hazardous chemical compounds (benzene, toluene, ethylbenzene, xylene, styrene, formaldehyde, acetaldehyde, propionaldehyde, butyraldehyde, isovaleraldehyde, and valeraldehyde) were identified in the surgical smoke. With the built-in-filter trocar, removal rates of 69% for benzene (P=0.028), 72% for toluene (P=0.009), 67% for butyraldehyde (P=0.047), 46% for ethylbenzene (P=0.092), 44% for xylene (P=0.086), 35% for styrene (P=0.106), 39% for formaldehyde (P=0.346), and 33% for propionaldehyde (P=0.316) were achieved.

This study confirmed the presence of harmful materials in surgical smoke. Evacuation of surgical smoke through a disposable built-in-filter trocar is a simple and effective way in reducing volatile organic compounds concentrations.