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A knowledge gap unmasked: viral transmission in surgical smoke: a systematic review

Connal Robertson-More1, Ted Wu2

  • 1Department of Surgery, North Island Hospital, Vancouver Island Health Authority, 375 2 Ave, Campbell River, BC, V9W 3V1, Canada. crobertsonmore@yahoo.com.

Surgical Endoscopy
|January 26, 2021
PubMed
Abstract

Insights

Surgical smoke (SS) may contain viral particles, raising concerns during the COVID-19 pandemic. While evidence suggests viral transmission via SS, current data does not indicate an increased risk in minimally invasive surgery (MIS).

Area of Science:

  • Virology
  • Surgical Safety
  • Infectious Disease Transmission

Background:

  • Surgeons express apprehension regarding aerosolized SARS-CoV-2 transmission via surgical smoke (SS) during the COVID-19 pandemic.
  • Limited studies indicate viral material in SS, but a comprehensive systematic review on viral transmission in SS is lacking.

Purpose of the Study:

  • To systematically review the literature on the presence of viral particles in surgical smoke.
  • To assess the potential for viable virus particle transmission from surgical smoke leading to clinically significant infection.

Main Methods:

  • A systematic literature review adhering to PRISMA guidelines.
  • Searched MEDLINE, EMBASE, and CENTRAL databases for relevant human, animal, and in vitro studies.
  • Focused on primary outcomes of viral particle presence in SS and secondary outcomes of transmission potential.

Main Results:

  • Nineteen of 23 publications (83%) detected viral particles in surgical smoke.
  • Nine of 21 publications (43%) demonstrated the potential for viral transmission from surgical smoke to induce clinically relevant infections.

Conclusions:

  • Evidence supports the potential for viral transmission via surgical smoke.
  • Human Papillomavirus (HPV) is the only virus documented for transmission to humans through SS.
  • No evidence suggests an increased risk associated with minimally invasive surgery (MIS) despite challenges in translating findings into practical COVID-19 pandemic guidelines.
Keywords:
AerosolsCOVID19InfectionPlumeSurgical smokeVirus

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