Related Experiment Video
Updated: Jun 16, 2026
Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
Published on: October 17, 2025
Surgical smoke exposure in minimally-invasive vs. open spine surgery
John Paul G Kolcun1, Dustin Kim1, Ryan M Kelly1
1Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
Background:
"Surgical smoke" is a hazardous vapor produced during surgical dissection with electrocautery or high-speed drills. Prior literature has evaluated smoke exposure during spine surgery, but no study to-date has compared open and minimally-invasive spine surgery (MISS). This study aimed to determine whether the use of MISS techniques reduces operating room staff exposure to surgical smoke.
Methods:
Ambient surgical smoke was measured for MISS and open spine cases over a two-month period, using industrial particle detectors in standardized positions at the head and foot of the operating table. Ambient smoke was measured as particulate matter (PM) in mg/m3. Measurements were normalized for time (mg/m3/min) and number of surgical levels per case. Operative periods were defined as "exposure" (principal electrocautery phase) and "drilling" (principal drilling phase). PM measurements were compared between MISS and open cases.
Results:
We collected PM data for 81 cases: 40 MISS and 41 open. Most cases were thoracolumbar, with a higher predominance in the MISS cohort. MISS cases had lower overall PM and average PM per minute (P<0.01). During the exposure phase, MISS cases had lower PM overall, per minute, and per level operated (P<0.01). During the drilling phase, MISS cases had lower overall PM (P<0.01).
Conclusions:
Occupational particulate exposure is significantly reduced during MISS as compared to conventional open surgery. This effect is most pronounced during primary exposure with electrocautery.
