Evaluating surgical smoke in laser-assisted laparoscopic partial nephrectomy with a novel handle: anin Vitrostudy

Lasers show promising application in partial nephrectomy due to their excellent hemostatic effect. This study aimed to evaluate the suction effect of the novel laser operating handle on the smoke generated by a 980-nm diode laser (DL) and a 532-nm potassium-titanyl-phosphate (KTP) green laser (GL) in laparoscopic partial nephrectomy (LPN) and to analyse the surgical smoke generated by the laser treatment.

Fresh porcine kidneys were purchased from a slaughterhouse. Electrocoagulation knife (EK), ultrasonic knife (UK), DL, and GL were utilised in LPN. The operation time and the composition and concentration of the surgical smoke were recorded. HE staining was performed to observe the degree of thermal damage.

In terms of smoke generation, the 532-nm KTP laser results in the largest amount of smoke. The surgical field of DL-LPN was adequately improved with the aid of the instrument with the novel handle. The thickness of the coagulation layer, which ranged from thick to thin, was DL, GL, EK, and UK. The coagulation of EK, UK, DL, and GL was 0.35 ± 0.08 mm, 0.52 ± 0.08 mm, 4.16 ± 0.21 mm, and 1.55 ± 0.21 mm, respectively. For formaldehyde, total volatile organic compounds (TVOC), and carbon monoxide (CO), there was a marked reduction after the application of the aspirator. For the DL group, the Formaldehyde TVOC and CO were 4.95 ± 0.48 mg/m3 and 1.69 ± 0.46 mg/m3, 8.34 ± 0.72 mg/m3 and 1.11 ± 0.33 mg/m3, 124.14 ± 9.58 PPM and 23.71 ± 3.9 PPM, respectively.

As shown in the present study, though a large amount of harmful smoke was generated during laser-assisted laparoscopic partial nephrectomy (LALPN), the novel laser handle can be sucked effectively and provides a clear surgical field. As to the harmful gases released, an effective protective mask is needed.