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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries
Ali Yeganeh, Mikaiel Hajializade, Alireza Pahlevan Sabagh, Babak Athari, Mahbobeh Jamshidi, Mehdi Moghtadaei
Ali Yeganeh, Mikaiel Hajializade, Alireza Pahlevan Sabagh, Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
Babak Athari, Department of Orthopaedics Surgery, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Hormozgan, Bandarabbas 1445613131, Iran
Mahbobeh Jamshidi, Department of Chemistry, Payam-e-Nour University, Ghazvin 1445613131, Iran
Mehdi Moghtadaei, Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Tehran âProvince, Tehran, Satarkhan 1445613131, Iran
Author contributions: Yeganeh A designed research; Moghtadaei M and Pahlevan sabagh A performed research; Athari B contributed new reagents or analytic tools; Jamshidi M analyzed data; Hajializade M wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Iran University of Medical Sciences.
Informed consent statement: The patients provided written consent before participation in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: All data requests should be submitted to the corresponding author for consideration. Access to anonymized data may be granted following review.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mehdi Moghtadaei, MD, Associate Professor, Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Tehran Province, Tehran, Satarkhan St. 1445613131, Iran. medicine.ortho@yahoo.com
Received: September 19, 2019
Peer-review started: September 19, 2019
First decision: October 13, 2019
Revised: November 13, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: March 18, 2020
BACKGROUND
Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut.
AIM
To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries.
METHODS
The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min.
RESULTS
None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (Toluene, Ethylbenzene, and Styrene). No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue.
CONCLUSION
Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.
Core tip: No toxic and carcinogenic volatile organic compounds was detected in electrocautery smoke released from ligament and adipose tissue, while electrocautery smoke released from meniscus and muscle tissue contains significant toxicity and carcinogenicity. Therefore, we recommend that surgeons to use other electrosurgical techniques for cutting these tissues.
