Surgical smoke, routinely generated by lasers, electrosurgical devices, and ultrasonic tools, has been a longstanding part of operating room culture. Despite the near-constant presence of this smoke, its risks to perioperative care are under-recognized and inconsistently addressed. This lack of awareness and action has descended into a blind spot in healthcare, putting both healthcare professionals and patients at risk. This overlook can be attributed to the normalization that occurs over years of exposure. These insights were shed by Vangie Dennis, MSN, RN, CNOR, CMLSO, FAORN, FAAN, a respected member of the infection prevention community, and a former president of AORN, who is currently serving on ICT’s Editorial Advisory Board.
Contrary to a common misconception, the hazards from surgical smoke are not confined to surgeons alone. Instead, they cast a far wider net, affecting patients particularly in vulnerable circumstances, such as cesarean deliveries or procedures under supervised anesthesia. As a result, the surgical smoke conversation extends from just professional safety to include the entire perioperative team and patient population. Regardless of the source of the smoke – be it lasers, electrosurgery, or other heat-producing devices – the resulting plume is dangerous due to the presence of harmful components.
The prolonged and repeated exposure to surgical smoke has both immediate and long-term health repercussions. In the short term, headaches, eye irritation, nausea, and fatigue are common whilst chronic exposure may result in severe long-term respiratory diseases such as adult-onset asthma and chronic obstructive pulmonary disease. Surgical smoke also contains mutagenic and carcinogenic compounds, pushing the risks beyond speculation. Furthermore, surgical smoke poses infection risks, as viable viral particles – including pathogens such as the human papillomavirus- have been detected.
Addressing the prevalent ignorance around surgical smoke are engineering controls, regarded as the most effective intervention. Local exhaust ventilation and smoke evacuation systems are the front lines of defense, but their effectiveness relies heavily on proper usage. Despite compelling research and guidance, measurable outcomes, and legislative efforts, the pace of change remains slow, with some states still not implementing smoke evacuation practices. Moving forward, the need for coordinated efforts across education, policy, and practice is apparent. Surgical smoke isn’t a minor concern, but a significant, permeating, preventable risk that deserves rigorous attention, advocacy, and proactive measures.