Development of an effective simulation model for evaluating smoke leakage during laparoscopic surgery

Boland, Patrick A.1; McEntee, Philip D.1; Moynihan, Alice1; Nolan, Kevin2;Cahill, Ronan A.1,3,1,3,


1UCD Center for Precision Surgery, Dublin, Ireland

2School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland

3Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

Abstract

The leakage of surgical gas and smoke from the peritoneum during laparoscopy may release noxious aerosols, including potential carcinogens, viruses and other contaminants, into the operating theatre, especially into the breathing zone of the surgical team. Reliable and realistic models and methods that develop and detect surgical smoke in simulated settings are necessary to effectively test devices and strategies intended to reduce such leaks. Here, we report a novel high-fidelity laparoscopic smoke model with innovative imaging methods applicable to the theatre setting, followed by an assessment of the usefulness of commercial laparoscopic trocars and smoke evacuation methods in mitigating gas leaks. Various smoke production methods (including tissue cautery and industrial smoke machinery) and detection methods (including schlieren imaging, laser videography, intraperitoneal video recording, and an aerosol detector) were tested, with the smoke machine model proving the most reproducible. Schlieren imaging, laser videography and intraperitoneal video recording were all effective methods of surgical smoke quantification. Following model establishment, laparoscopic trocars (VersaOneTM, Medtronic, Ireland) and smoke evacuation systems (EVA15 smart insufflator and evacuator, Palliare, PlumePort Activ® Smoke Filtration Device, Conmed and ValleylabTM Smoke Evacuation System, Medtronic) were examined in a standardized way with performance assessment by three surgeons independently using a boutique scoring system. The EVA15 outperformed other smoke systems in clearing surgical smoke from the operative field and in reducing trocar leaks during instrumentation. This method of simulated surgical smoke production and assessment can benchmark other laparoscopic equipment regarding smoke management strategies in a similar fashion.

腹腔镜手术中，腹膜腔内的手术烟雾和气体泄漏可能向手术室（特别是手术团队呼吸区域）释放有害气溶胶，包括潜在致癌物、病毒等污染物。为有效测试减少此类泄漏的设备和策略，需要建立可靠且贴近真实场景的手术烟雾模拟检测方法。本研究报道了一种新型高仿真腹腔镜烟雾模型及适用于手术室环境的创新成像技术，并系统评估了商用腹腔镜套管针和烟雾抽吸装置的防泄漏效能。

研究方法：

  1. 烟雾生成与检测：测试多种烟雾生成方法（组织电灼、工业烟雾机等）及检测技术（纹影成像、激光摄像、腹膜内视频记录、气溶胶检测仪），发现工业烟雾机模型重现性最佳；

  2. 量化评估：纹影成像、激光摄像与腹膜内视频记录均可有效量化手术烟雾；

  3. 设备评测：建立标准化评估体系后，由三位外科医生采用定制评分系统对腹腔镜套管针（VersaOneTM）及三种烟雾抽吸系统（EVA15智能气腹机、PlumePort Activ®过滤装置、ValleylabTM抽吸系统）进行独立评测。

结果：
EVA15系统在清除术野烟雾和减少器械操作时的套管针泄漏方面表现最优。本研究所建立的模拟手术烟雾生成与评估方法，可为其他腹腔镜设备的烟雾管理策略提供标准化评测基准。