Smoke and particulate filters in endoscopic surgery reviewed during COVID-19 pandemic

Abstract

Aim: This study aimed to evaluate the efficacy of smoke filters for use in endoscopic surgery and their significance during the present COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: The literature was reviewed by analyzing articles on PubMed using the search terms “smoke”, “filter”, and “laparoscopy”. Results: A systematic literature search revealed six smoke filter clinical studies pertinent to endoscopic surgery. The studies focused on the different aspects and efficacy of these filters: (1) UGF1 filter (Pall Biomedical, St. Germaine en Laye, France) investigated captured mesothelial cells and other debris, (2) Valve-less trocar AirSeal™ (SurgiQuest, Orange, CT) fitted with an ultra-low particulate air (ULPA) filter investigated smoke evacuation and filtration to reduce exposure of staff to hazardous fumes, (3) automatic smoke evacuator (IES2, ERBE) equipped with ULPA identified 37 filtered carcinogenic substances, (4/5) the Tropian trocar (Tropian Tech., Gunpo, Korea), a charcoal filter, investigated in two studies focused on filtration of further hazardous compounds, and (6) charcoal/ULPA combination filter by Dyeing and Finishing Technology Institute investigated filtration rates of volatile organic compounds. Conclusions: Surgical plume can be cleared of hazardous chemical through smoke filters. There were six different filter studies identified with regards to endoscopic surgery which can aid in protecting the surgical staff from dangerous smoke by filtering cells, recirculating, and filtering gas, and removal of carbon-based substances. No clinical study has specifically investigated the removal of viruses by smoke filters including the SARS-CoV-2.