Differences in the Effectiveness of Smoke Evacuator Types for Reducing Surgical Smoke: A Randomized Controlled Trial
In brief
Integrated smoke evacuator cuts particle exposure by up to 97% versus hose
In a randomized trial of 64 laparotomy patients, an electrocautery-incorporated evacuator positioned 8 mm from the cautery tip lowered respirable particle counts by 96-97% across sizes from 0.3 to 5 µm compared with a standard hose system, and also reduced acetaldehyde and formaldehyde levels. The benefit was less pronounced at an 18 mm tip distance, suggesting that device type and proximity are key to minimizing operating-room smoke exposure.
- Journal
- Journal of the American College of Surgeons (Q1)
- Published
- 16 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yuhi Yoshizaki, Yoshikuni Kawaguchi, Toshiaki Kawakami, Tomoaki Hayakawa, Yoshihito Hayashi, Yui Sawa, et al.
- PMID
- 42747024
- DOI
- 10.1097/XCS.0000000000001943
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 20 September 2026): Smoke evacuator RCT, operating‑room safety, not patient outcomes
Abstract
BACKGROUND: Surgical smoke contains respirable particles and volatile organic compounds (VOCs) associated with carcinogenic and infectious risks to operating room personnel. Whether electrocautery-incorporated smoke evacuation improves particulate and VOC clearance compared with hose-type evacuation remains undefined. STUDY DESIGN: In this randomized, double-blind clinical trial (UMIN000047033) conducted from February 2022 to May 2023 at The University of Tokyo Hospital, 64 patients undergoing laparotomy were assigned 1:1:1 to electrocautery-incorporated evacuation with an 8 mm tip distance (n = 22), 18 mm tip distance (n = 23), or hose-type evacuation (n = 21). The primary endpoint was the change in particle counts at 0.3, 0.5, 1.0, and 5.0 μm during a standardized 10-minute sampling period. Secondary endpoints were acetaldehyde and formaldehyde levels. Comparisons used the Wilcoxon rank-sum testing with Bonferroni correction. RESULTS: The 8 mm electrocautery-incorporated system reduced particle counts by 96% to 97% across 0.3 to 5.0 μm compared with hose-type evacuation (all p < 0.05). The 18 mm system reduced 0.3 μm particles by 78% vs hose (p = 0.005), with 81% to 88% reductions for 0.5 to 5.0 μm particles (p > 0.05). Median (interquartile range) acetaldehyde levels were 1.90 (1.10 to 2.50), 2.70 (0.50 to 4.00), and 7.90 (3.10 to 15.20) μg/m3 in the 8 mm, 18 mm, and hose groups, respectively; both electrocautery groups were lower than hose (all p < 0.05). Formaldehyde levels were similarly reduced (all p < 0.05). CONCLUSIONS: Electrocautery-incorporated smoke evacuation significantly reduced respirable particle and VOC exposure compared with hose-type evacuation, with maximal particulate reduction at an 8 mm tip distance. Device selection and proximity to the cautery source materially influence operating room exposure to surgical smoke.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.