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High Speed Photographic Detection of Particle Distribution During Aerosol and Smoke Generating Surgical Procedures: Effects of Surgical Site Evacuation

Abstract Objective: Determine the effectiveness of evacuation systems designed to clear bioaerosols and smoke from the surgical field. Study design: High-speed photographic evaluation of aerosol and smoke generated in simulated surgical fields. Materials and methods: Surgical site aerosol clearance was evaluated using a model of the anterior neck and prototypes for surgical site evacuator ports created using 3D printing. A commercially available electrocautery handpiece fitted with an evacuator was tested on animal tissue for smoke clearance. Both systems were connected to a commercial vacuum powered evacuation system. High speed photography was used to record videos of the aerosols and plumes. Fields were recorded with and without evacuation. Results: Efficient aerosol clearance from an open surgical field using an evacuator port is dependent upon the port design, airflow velocity, and placement relative to the aerosol generating site. The size and surface geometry of the surgical field are also important. Surgical smoke generated with electrocautery is cleared from the field by the evacuation enclosure around the handpiece, even at high electrocautery power settings. Except for device noise, there appears to be no reason for using evacuator flow rates below the maximum setting. Conclusions: Bioaerosol and smoke generated during surgery are potential sources of respiratory pathogens and pose a threat to operating room personnel. Surgical site evacuation can significantly reduce the volume of airborne particles in the field but requires careful design and deployment considerations.