2026 Poster Presentations
P316: REDUCING SURGICAL SMOKE EXPOSURE IN RHINOLOGIC ELECTROSURGERY: A PILOT EVALUATION OF A NOVEL EVACUATION DEVICE
Corinne R Stonebraker, BA1; A. Michael Ierardi, MES, MS, CIH, CSP2; Megan Christy, BSE1; Rachel L Thompson, MS2; Turner Baker, PhD1; Lacy Brame, DO1; Katherine Liu, MD1; Raj Shrivastava, MD1; Alfred-Marc Iloreta, MD1; 1Icahn School of Medicine at Mount Sinai; 2CUNY Graduate School of Public Health and Health Policy
Background: Surgical smoke presents unique concerns in endoscopic surgery, where electrocautery is frequently used in confined anatomical spaces of the paranasal sinuses and skull base. Exposure to aerosolized particulate matter (PM) is associated with acute symptoms and long-term health risks in surgeons and operating room (OR) staff. Few studies have evaluated suction system performance in reducing PM exposure during endoscopic surgery, underscoring the need for practical engineering solutions.
Objective: We designed a novel smoke evacuator prototype (NSEP) that redirects airflow away from OR staff and captures harmful particles in the nasopharynx. This study evaluates the effectiveness of the NSEP in reducing airborne ultrafine PM (PM2.5) during simulated rhinologic electrosurgery.
Methods: 3D-printed endonasal models with surrogate tissue approximated a rhinologic surgical field. Electrocauterization was performed with a monopolar cautery device during three 3-second intervals separated by 15-second pauses. Real-time PM2.5 was measured at 1-second intervals with a SidePak™ AM520 in the operator’s approximate breathing zone. Ambient metrics were monitored with an AtmotubePRO. PM2.5 exposure during NSEP use was compared to three surgical smoke evacuation methods: monopolar suction electrocautery, handheld suction in the contralateral nostril, and no suction (control condition). All suction operated at 15 L/min. Exposure metrics included peak and mean PM2.5 concentrations, with percent reductions calculated relative to control. The non-parametric Kruskal-Wallis test was performed to compare average PM2.5 concentrations between the NSEP and the three comparison conditions, followed by post hoc Holm-adjusted Dunn tests to account for multiple comparisons.
Results: Peak PM2.5 concentrations were highest during the control (697 μg/m³) and lowest for the NSEP (4.0 μg/m³). Mean PM2.5 concentrations were highest in the control (8.8 μg/m³), followed by monopolar suction electrocautery (2.7 μg/m³), handheld suction (2.6 μg/m³), and the NSEP (1.6 μg/m³), corresponding to percent reductions of 69.2%, 70.8%, and 82.3%, respectively. Compared to the control, PM2.5 concentrations were significantly lower during NSEP use (p = 0.028). There were no statistically significant differences between NSEP and the other experimental conditions (monopolar suction p = 0.62, and handheld suction p = 0.62).
Discussion: This benchtop experiment provides preliminary evidence that this NSEP can substantially reduce PM2.5 exposures during endoscopic surgery. Although no statistically significant differences were found between the NSEP and conventional suction systems, the magnitude of reduction observed with the NSEP (>80%) compared to the control condition is clinically meaningful. The absence of significant pairwise differences in experimental conditions likely reflects limited statistical power due to few replicates and short durations. Nonetheless, the consistent finding of the lowest peak and mean concentrations during the NSEP condition suggests potential performance advantages compared to standard suction devices. Transient peak exposures remain concerning, given evidence of surgical smoke’s mutagenicity, infectious potential, and the absence of a “safe” exposure threshold.
Conclusions: This study suggests that the NSEP offers a promising engineering control for reducing surgical smoke exposure during rhinologic procedures. Further evaluation in live surgical settings is warranted to assess device performance under real-world conditions.
Figure 1: Time-trend graph
Figure 2: Experimental setup
