Particulate Matter Production by Various Electrosurgical Techniques

Riopelle AM, Potter CT, Jeong D, Schanbacher CF. Plume Generated by Different Electrosurgical Techniques: An In Vitro Experiment on Human Skin. Dermatol Surg. 2022 Sep 1;48(9):949-953. doi: 10.1097/DSS.0000000000003518. Epub 2022 Jun 28. PMID: 36054048.

Bipolar electrocoagulation produced the least amount of particles, with the following techniques producing more in increasing order: electrofulguration, electrodessication, electrocautery, and monopolar electrocoagulation.

Clinical Pearls

• Surgical smoke produced via electrosurgery can be harmful to both patients and providers

• This in-vitro study tested various five electrosurgical techniques to determine the size and concentration of particles produced via each technique

• Bipolar electrocoagulation produced the least amount of particles, with the following techniques producing more in increasing order: electrofulguration, electrodessication, electrocautery, and monopolar electrocoagulation

Discussion:

Electrosurgical techniques are used often by dermatologists and dermatologic surgeons. The most common electrosurgical techniques used include electrocoagulation, electrocautery, electrodessication, and electrofulguration. While these techniques are often necessary for patient care, they produce surgical smoke, also known as plume, which can be a health risk towards patients and providers. While this plume mostly consists of water as steam (95%), the other 5% is composed of particulate matter which can be carcinogenic and mutagenic. To better understand the production of particulate matter from electrosurgery, this study compared the concentration of particulate matter from different electrosurgical techniques.

Using donor human skin tissue from an abdominoplasty, an apparatus was created where the tissue was placed in a closed plexiglass chamber and one port was created to allow a portable particle counter to measure particle production. Following this, resident physicians were able to use five different electrosurgical devices (electrofulguration, electrodesiccation, electrocoagulation with monopolar tip, electrocoagulation with bipolar forceps, and electrocautery on the human tissue inside each apparatus.

The electrosurgical technique which produced the greatest amount of particulate matter of all sizes was monopolar electrocoagulation, followed by electrocautery, electrodessication, electrofulguration, and bipolar electrocoagulation. The two techniques which consistently produced the smallest concentration of particulate matter of any size were bipolar electrocoagulation and electrofulguration with the former producing 12 times fewer particles than the latter.

While the electrosurgical techniques used by each physician may vary in any given clinical scenario, this study sheds light on what techniques may provide the least harm to providers and patients. Limitations in this study include the in-vitro design where fresh, frozen skin samples were used, thus potentially altering the tissue properties. Additionally, in clinical scenarios providers may often be wearing high-efficiency particulate air respirators including N95 respirators, reducing the detrimental effects of the particulate matter created.