What is surgical smoke, and how is it produced?

Surgical smoke plume is a potentially dangerous by-product generated from the use of lasers, electro-surgical pencils, ultrasonic devices, and other surgical energy-based devices. As these instruments cauterize or burn vessels and destroy tissue, vaporized fluids, including blood, create a gaseous material called a surgical smoke plume.

The Composition of Surgical Smoke

The composition or chemical makeup of this smoke plume is what makes the smoke so dangerous. The plume comprises 95% water and 5% additional matter. The other 5% matter is potentially hazardous to the surgical staff and patients.


The chemical component of surgical smoke plumes contains over 80 different toxic chemicals and by-products. Some of these components have documented harmful health effects, such as the following:

Perchloroethylene It is most commonly used as a main component in dry cleaning fluid.
Hydrogen cyanide A neurotoxin used in the production of plastic and chemical weapons. 
Toluene A solvent that is similar to paint thinner and is a known carcinogen.
Formaldehyde It is a chemical used to preserve surgical specimens and can be found in embalming fluid.
Ethylbenzene It is most used in the manufacture of Styrofoam.
Benzene It is a chemical used to manufacture plastics and is a known Carcinogen.


Along with the chemical toxins, biological and physical components make up surgical smoke plumes that add to the overall risk factors for inhalation.

The biological matter of the plume can include blood with potential infectious viruses and bacteria. Since surgical smoke comprises approximately 95% water vapor, it creates a viable carrier for bacteria and viruses, which can transfer infectious diseases.

Evidence of an airborne virus transmitted within a surgical smoke plume is documented.

The different types of smoke produced in the Operating Room

  • Electrocautery smoke
  • Laser smoke
  • Ultrasonic scalpel smoke
  • Harmonic scalpel smoke
  • Suction irrigation smoke


Health risks for patients

There are associated hazards to patients when they are exposed to surgical smoke. The evidence demonstrates that the risks of surgical smoke exposure to the patient are:

  • Reduced visibility of the surgical site during the procedure
  • Potential delays during the procedure
  • Absorption and excretion of smoke by-products and port site metastasis

Health risks for surgical staff

The synergistic and antagonistic interactions of aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, and dioxins have not been studied and are difficult to predict. The researchers concluded that surgical smoke should be evacuated to protect the OR team from the toxic, possibly carcinogenic, mutagenic, and genotoxic effects.

Chemical Hazards


In a study to determine the chemical composition of surgical smoke, samples were collected of surgical smoke generated by electrocautery during colorectal surgery. The sampling tube was attached near the end of the electrocautery pencil or held in the plume above the pencil.

The electrocautery smoke contained significant benzene, ethyl benzene, styrene, carbon disulfide, and toluene. Benzene, a known carcinogen, was detected in significant quantities. The substances detected can cause eye irritation, dermatitis, central nervous system effects, and hepatic and renal toxicity.

Carcinogenicity of surgical smoke

Studies suggest that malignant cells can be aerosolized when the ultrasonic scalpel is used on tumor-bearing tissue and may be the reason for tumor recurrence at a port site remote from the original tumor.

The researchers concluded that smoke from an ultrasonic scalpel may contain viable tumor cells, and there is a theoretical risk of transfer of the viable tumor cells to anyone close to the surgical procedure.

Respiratory and skin irritation caused by surgical smoke


Due to the toxic chemical components found in surgical smoke, the respiratory system is negatively affected, but also with more severe conditions such as asthma or pneumonia. The size of the particles in the surgical smoke directly influences the type of adverse respiratory health effects experienced by the perioperative team.

Potential risks of infection transmission through surgical smoke

Viable bacteria exist within the laser smoke plume generated during laser resurfacing. Additional research is needed to define the exposure risk associated with patients who have hepatitis, HIV, and antibiotic-resistant bacteria.


Surgical smoke evacuation systems

One of the most effective methods of removing the hazards of surgical smoke plumes is using smoke evacuation system. These systems remove the plume at its surgical site source by using a tube attached to the accessory or device creating the plume. Connecting it to the surgical site (approximately within 2 inches of the plume source), about 99.9% of 0.12-micron sizes or larger can be removed from the environment before inhalation.

The system usually contains a series of filters allowing filtration down to the micron size to ensure even the smallest particulates can be captured.

Smoke evacuation unit:

Generates suction and houses filters.


They filter surgical smoke from the air as it passes through the Unit.


Transport surgical smoke from the surgical site to the Unit.

Electrocautery pencils with integrated smoke evacuation:

Collect and filter smoke right at the incision site. The electrocautery pencils work with other surgical smoke evacuation systems.


Transport surgical smoke from the surgical site to the Unit.

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