Differences in the Effectiveness of Smoke Evacuator Types for Reducing Surgical Smoke: A Randomized Controlled Trial

Surgical smoke contains respirable particles and volatile organic compounds (VOCs) associated with carcinogenic and infectious risks to operating room personnel. Whether electrocautery-incorporated smoke evacuation improves particulate and VOC clearance compared with hose-type evacuation remains undefined.

In this randomized, double-blind clinical trial (UMIN000047033) conducted from February 2022 to May 2023 at The University of Tokyo Hospital, 64 patients undergoing laparotomy were assigned 1:1:1 to electrocautery-incorporated evacuation with an 8 mm tip distance (n = 22), 18 mm tip distance (n = 23), or hose-type evacuation (n = 21). The primary endpoint was the change in particle counts at 0.3, 0.5, 1.0, and 5.0 μm during a standardized 10-minute sampling period. Secondary endpoints were acetaldehyde and formaldehyde levels. Comparisons used the Wilcoxon rank-sum testing with Bonferroni correction.