Açık ve laparoskopik abdominal kanser cerrahisinde partikül ölçümlerinin karşılaştırılması: prospektif bir çalışma

Öz

Amaç: Bu çalışmada, açık ve laparoskopik intra-abdominal kanser cerrahisi sırasında cerrahi ekibin ortalama baş seviyesindeki gerçek zamanlı partikül ölçümlerini karşılaştırdık. Gereç ve Yöntemler: Haziran 2022 ile Ocak 2023 tarihleri arasında, intra-abdominal kanser tanısı alan ve onkolojik cerrahi planlanan ardışık 83 hasta çalışmaya dahil edildi. Hastaların demografik ve operatif özellikleri; operasyon süresi, laparoskopik operasyonlardaki port sayısı, laparoskopik operasyonlardaki toplam insizyon uzunluğu ve açık operasyonlardaki insizyon uzunluğu dahil olmak üzere kaydedildi. 0,1 CF hacimdeki 0,3, 0,5, 1, 2, 5 ve 10 µm boyutundaki partikül sayısı (partikül/CF) belirlendi. Bulgular: Toplam 83 hastanın (ortalama yaş 58,4 ± 14,1 yıl) 38'i (%45,8) kadındı. Açık (n = 43) ve laparoskopik (n = 40) gruplar arasında yaş, cinsiyet, vücut kitle indeksi, vücut yüzey alanı veya operasyon süresi açısından anlamlı bir fark gözlenmedi. Kan kaybı açık cerrahi grubunda anlamlı derecede yüksekti (p < 0,001). Partikül seviyeleri açık cerrahi grubunda erken intraoperatif dönemde artarken, laparoskopik grupta azaldı; ancak bu fark sonraki ölçümlerde gözlenmedi. Açık cerrahi, erken intraoperatif dönemde daha yüksek partikül seviyeleri ile ilişkiliydi. Sonuç: Partikül seviyeleri açık cerrahide artarken laparoskopik cerrahide zamanla azaldı; bu durum laparoskopik yaklaşımın üstünlüğünü göstermektedir. Ancak yaklaşım ne olursa olsun, cerrahi süresinin minimize edilmesi ve yeterli kişisel koruyucu ekipman kullanımının sağlanması temel önemini korumaktadır.

Anahtar Kelimeler

• Laparoskopik Cerrahi
• Açık Cerrahi
• Partikül düzeyi
• Cerrahi duman
• Mesleki maruziyet

A comparative study of open with laparoscopy-related abdominal cancer surgery in particle measurements: a prospective study

Öz

Aim: In this study, we compared real-time particle measurements at the average head level of a surgical team during open and laparoscopic intra-abdominal cancer surgery. Materials and Methods: Between June 2022 and January 2023, 83 consecutive patients diagnosed with intra-abdominal cancer and scheduled for oncological surgery were included. We recorded the patients’ demographic and operative characteristics, including operation time, number of ports in laparoscopic operations, total incision length in laparoscopic operations, and incision length in open operations. The number of particles measuring 0.3, 0.5, 1, 2, 5, and 10 µm in a volume of 0.1 CF (particles/CF) was determined. Results: Of the 83 patients (mean age 58.4 ± 14.1 years), 38 (45.8%) were women. No significant differences were observed between the open (n = 43) and laparoscopic (n = 40) groups in age, sex, body mass index, body surface area, or operation time. Blood loss was significantly higher in the open surgery group (p < 0.001). Particle levels increased during the early intraoperative period in the open surgery group but decreased in the laparoscopic group; however, this difference was not observed in later measurements. Open surgery was associated with higher particle levels during the early intraoperative period. Conclusion: Particle levels increased with open surgery and decreased with laparoscopic surgery over time, indicating the superiority of the laparoscopic approach. However, regardless of the approach, minimizing surgical duration and ensuring adequate personal protective equipment use remain essential.

Anahtar Kelimeler

• laparoscopic surgery
• open surgery
• particle measurement
• surgical smoke
• occupational exposure

Kaynakça

1. Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, et al. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107: 1406-13.
2. Weld KJ, Dryer S, Ames CD, Cho K, Hogan C, Lee M, et al. Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility. J Endourol 2007; 21: 347-51.
3. Okoshi K, Kobayashi K, Kinoshita K, Tomizawa Y, Hasegawa S, Sakai Y. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel. Surg Today 2015; 45: 957-65.
4. Al Sahaf OS, Vega-Carrascal I, Cunningham FO, McGrath JP, Bloomfield FJ. Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci 2007; 176: 229-32.
5. Wu YC, Tang CS, Huang HY, Liu CH, Chen YL, Chen DR, et al. Chemical production in electrocautery smoke by a novel predictive model. Eur Surg Res 2011; 46: 102-7.
6. Ilce A, Yuzden GE, Yavuz van Giersbergen M. The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions. J Clin Nurs 2017; 26: 1555-61.
7. Englehardt RK, Nowak BM, Seger MV, Duperier FD. Contamination resulting from aerosolized fluid during laparoscopic surgery. JSLS 2014; 18: e2014.00361.
8. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Resources for smoke & gas evacuation during open, laparoscopic and endoscopic procedures. Updated March 29, 2020. Available from: https://www.sages.org/resources-smoke-gasevacuation-during-open-laparoscopic-endoscopic-procedures/ (Accessed: 24 December 2024).

9. Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg 2020; 272: e6.
10. Mintz Y, Arezzo A, Boni L, Chand M, Brodie R, Fingerhut A. A low-cost, safe, and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients. Ann Surg 2020;272:e7-e8.
11. Sanderson C. Surgical smoke. J Perioper Pract 2012;2 2: 122-8.
12. AORN Recommended Practices Committee. Recommended practices for surgical attire. AORN J 2005; 81: 413-20.
13. Sossai D, Dagnino G, Sanguineti F, Franchin F. Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty. J Orthop Traumatol 2011; 12: 207-11.
14. Kameyama H, Otani T, Yamazaki T, Iwaya A, Uehara H, Harada R. Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era. Surg Endosc 2021; 35: 1-8.
15. Yeganeh A, Hajializade M, Sabagh AP, Athari B, Jamshidi M, Moghtadaei M. Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries. World J Orthop 2020; 11: 177-183.
16. Tanaka Y, et al. Generation of surgical smoke in spinal surgery. Med J Niigata City Gen Hosp 2019; 40:1 8-23.
17. Kwak H, Kim S, Seo Y, Song K. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med 2016; 73: 857-63.
18. Davies CG, Khan MN, Ghauri ASK, Ranaboldo CJ. Blood and body fluid splashes during surgery: the need for eye protection and masks. Ann R Coll Surg Engl 2007; 89:7 70-2.
19. Mintz Y, Arezzo A, Boni L, Baldari L, Cassinotti E, Brodie R, et al. The risk of COVID-19 transmission by laparoscopic smoke may be lower than for laparotomy: a narrative review. Surg Endosc 2020; 34: 3298-305.
20. Royal Australasian College of Surgeons. RACS update on COVID-19. 2020 March 30. Available from: https://mailchi.mp/surgeons/racs-covid19-update-326517?e=81e1d44a55 (Accessed: 24 December 2021).
21. Brat GA, Hersey S, Chhabra K, Gupta A, Scott J. Protecting surgical teams during the COVID-19 outbreak: a narrative review and clinical considerations. Ann Surg 2020; 278: e957-e959.