Hepatitis B detected in surgical smoke emitted during laparoscopic surgery

Last Updated: 2016-08-18

By Will Boggs MD

NEW YORK (Reuters Health) - Hepatitis B virus (HBV) can be detected in surgical smoke emitted during laparoscopic surgery of HBV-infected patients, researchers from Korea report.

"I hope that with the awareness of the hazards of surgical smoke to medical personnel working in operating rooms, there should be continued interest and research aimed towards effectively addressing this issue," Dr. Seon-Hahn Kim from Korea University Anam Hospital in Seoul told Reuters Health by email.

Other viruses - HIV and human papillomavirus (HPV) among them - have been detected in laser smoke, but HBV has never been detected in an aerosol form, Dr. Kim and colleagues note in Occupational & Environmental Medicine, online August 2.

The team sampled and analyzed surgical smoke from laparoscopic surgeries on 11 patients with hepatitis B to determine whether HBV was present.

On preoperative evaluations, all patients were positive for HB surface antigen (HBsAg), two had detectable HB surface antibody (HBsAb), two were positive for hepatitis B e antigen, and three were taking anti-HBV medications. Viral loads in the blood ranged between undetectable and 170 million IU/mL.

The researchers detected HBV in 10 of the 11 samples of surgical smoke. In the other case, the forward PCR result was positive for HBV, but the backward response was negative.

"Since we did not evaluate whether the isolated HBV virus is even viable to potentially have the infectivity, we cannot say at this moment that HBV can be acquired by airborne transmission," Dr. Kim said.

"Our next research using an animal model will target the viability and infectivity of HBV virus detected in surgical smoke," he said.

"Electrosurgical procedures that are open to the operating room environment may be more harmful than robotic or laparoscopic procedures with regard to uncontrolled surgical smoke emissions," the researchers note. "Regardless, healthcare personnel must be trained to recognize and understand the risk when treating patients with HBV."

"To effectively control surgical smoke during laparoscopic procedures, a combination of proper operating room air exchanges and local exhaust ventilation (i.e., laparoscopic smoke filtration devices which remove surgical smoke from the peritoneal cavity) should be used to protect healthcare workers and patients from exposure," they advise.

SOURCE: http://bit.ly/2b6p4kB

Occup Environ Med 2016.