Development of an effective simulation model for evaluating smoke leakage during laparoscopic surgery

The leakage of surgical gas and smoke from the peritoneum during laparoscopy may release noxious aerosols, including potential carcinogens, viruses and other contaminants, into the operating theatre, especially into the breathing zone of the surgical team. Reliable and realistic models and methods that develop and detect surgical smoke in simulated settings are necessary to effectively test devices and strategies intended to reduce such leaks. Here, we report a novel high-fidelity laparoscopic smoke model with innovative imaging methods applicable to the theatre setting, followed by an assessment of the usefulness of commercial laparoscopic trocars and smoke evacuation methods in mitigating gas leaks. Various smoke production methods (including tissue cautery and industrial smoke machinery) and detection methods (including schlieren imaging, laser videography, intraperitoneal video recording, and an aerosol detector) were tested, with the smoke machine model proving the most reproducible. Schlieren imaging, laser videography and intraperitoneal video recording were all effective methods of surgical smoke quantification. Following model establishment, laparoscopic trocars (VersaOne TM , Medtronic, Ireland) and smoke evacuation systems (EVA15 smart insufflator and evacuator, Palliare, PlumePort Activ® Smoke Filtration Device, Conmed and Valleylab TM Smoke Evacuation System, Medtronic) were examined in a standardized way with performance assessment by three surgeons independently using a boutique scoring system. The EVA15 outperformed other smoke systems in clearing surgical smoke from the operative field and in reducing trocar leaks during instrumentation. This method of simulated surgical smoke production and assessment can benchmark other laparoscopic equipment regarding smoke management strategies in a similar fashion.