Surgical smoke – what are the risks?

Key Statistics

• 95% — Surgical smoke = water vapour
• ≤80 — Chemicals identified in plume
• 1 g = 6 cig. — Chemical load, tissue electrocautery

Don't-miss facts

1. Surgical smoke = 95% water + 5% chemicals/debris; up to 80 chemicals incl. benzene (a known carcinogen, recommended exposure nil)

2. 1 g tissue electrocautery ≈ chemical load of 6 cigarettes

3. Particles <2.5 µm (incl. bacteria/viruses) reach the alveoli; electrosurgery generates the smallest particles (0.07 µm), most dispersible

4. Theatre particle count: 60,000→1 million/ft³ within 5 min of device activation; up to 20 min to fall back to baseline

5. Standard face masks filter only >5 µm particles – poor smoke protection; fitted respirator removes down to 0.1 µm

6. Portable evacuation system is gold standard: 30–50 ft³/min, 99.9999% efficient to 0.12 µm; nozzle must stay within 1 cm of source (98% vs <50% efficiency at >2 cm)

7. General ventilation alone insufficient – needs ≥15 air exchanges/hour plus wall suction/portable evacuation

8. ‘Chimney effect’ (port-site metastasis) unproven; no legislation currently governs surgical smoke – only professional guidance (BOHS, AfPP, AORN, CSA, ACORN)

Particle size hierarchy (largest → smallest by device)

Ultrasonic scalpel 0.35–6.5 µm Laser ≤0.31 µm Electrosurgery 0.07 µm (smallest, most airborne)

Abbreviation Key

• HPV — human papillomavirus
• COSHH — Control of Substances Hazardous to Health Regulations
• HIV — human immunodeficiency virus
• µm — micrometre
• BOHS — British Occupational Hygiene Society
• RCOG — Royal College of Obstetricians and Gynaecologists
• AfPP — Association for Perioperative Practice
• HSE — Health and Safety Executive

Source: Addley S et al. Surgical smoke – what are the risks? The Obstetrician & Gynaecologist 2019;21:102–106. doi:10.1111/tog.12552

Clinically reviewed by NHS obstetricians and gynaecologists

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