Time-resolved Impact of Smoke Evacuation on Particulate Exposure During Laparoscopic Cholecystectomy

Surgical smoke generated during electrocauterization contains hazardous particulate matter (PM) that may adversely affect the respiratory health of operating room personnel. Although current guidelines recommend the use of vacuum-assisted smoke evacuation (Vac) systems, their real-world, time-resolved impact across procedural phases remains underexplored. In this study, we evaluated the impact of continuous Vac use on PM concentrations during laparoscopic cholecystectomy (LC), with particular focus on temporal dynamics, particle-size fractions, and procedural complexity.

Real-time PM monitoring was conducted during 60 LC procedures performed in a single operating room. Procedures were categorized into continuous Vac (n = 35) and non-Vac (n = 25) groups. Concentrations of PM₁, PM_2.5, PM₁₀, and total PM were measured and analyzed. Surgical timelines were normalized into 100 equal intervals to characterize time-resolved exposure dynamics. Subgroup analyses were further conducted to compare simple versus complex LC procedures.

Between the Vac and non-Vac groups, comparisons based on overall average PM concentrations showed only a nonsignificant trend toward lower values with Vac use. However, analyses accounting for temporal variation revealed significant reductions in PM concentrations across all particle sizes with Vac use. When stratified by procedural complexity, estimated reductions associated with Vac use were greater for complex LC than for simple LC procedures: -0.48 versus -0.40, -0.46 versus -0.39, and -0.25 versus -0.23 μg/m³ for PM₁, PM_2.5, and PM₁₀, respectively (all P < 0.0001).

Continuous Vac use was associated with lower intraoperative PM concentrations with greater reductions in complex LC procedures.