Randomized clinical trial of suction versus standard clearance of the diathermy plume

Abstract

Abstract Background Diathermy smoke contains complex hydrocarbons and organic material, and may contain viable tumour cells or viral particles. These particles measure from 0·05 to more than 25 µm, and long-term exposure to such particles may have adverse effects on health. This study investigated whether a suction clearance device reduces the amount of smoke reaching the surgeon's mask. Methods This was a randomized clinical trial in which subjects were randomized to standard diathermy equipment (group 1) or a diathermy smoke extraction system (group 2). All patients underwent thyroid or parathyroid surgery with standard anterior cervical collar incision and division of the strap muscles. The difference in the amount of smoke reaching the level of the operator's mask was measured by means of an aerosol monitor. Results Fifteen patients were randomized to each group. The mean amount of smoke detected at the level of the operator's mask was 0·137 mg/m3 in group 1 and 0·012 mg/m3 in group 2 (P < 0·001). The maximum amount detected was 2·411 and 0·255 mg/m3 respectively (P < 0·001). There were no significant differences between the groups in terms of incision time or background particles measured before and after surgery. There was no correlation between gland weight and incision time or amount of smoke detected. Conclusion Suction clearance of the diathermy plume resulted in a significant reduction in the amount of smoke reaching the level of the operator's mask. Although the risk of diathermy smoke inhalation is currently unknown, use of such a system appears advisable.