Engineering controls for surgical smoke in laser medical handpieces

The hazard of surgical smoke is often overlooked when considering the safety of medical laser procedures but can present a high level of occupational risk. Administrative procedures for operating external extraction devices and the reliance on personal protective equipment are not sufficient for reducing the risk. This paper aims to quantify the hazard of laser-generated surgical smoke and demonstrate how effective engineering control solutions can reduce the risk. A new design solution is presented with engineering controls for surgical smoke extraction and optical radiation integrated into the laser handpiece. A fibre delivered diode laser is used to simulate laser vaporisation procedures on porcine skin tissue. Conventional external extraction conditions are compared to the new design solution. Fine particulate mass concentrations (PM2.5) from the simulated procedures, under different extraction conditions, are measured using optical particle size measurements. Peak concentrations of 55.86 ± 2.79 µg/m³ were measured without extraction; showing the hazard of laser-generated surgical smoke is five times greater than the World Health Organisation guideline of 10 µg/m³. A typical medical extraction setup only achieved a 16% reduction in peak concentration values, 47.07 ± 2.35 µg/m³; demonstrating that conventional, external, methods of extraction are ineffective. The new solution was able to capture all particulate material, reducing particulate concentrations to background levels, 2.19 ± 0.68 µg/m³, safely below the current recommended guidelines. The design and results present evidence that it is not only more effective to use engineering control methods but that it is practicable to do so.